Hepatitis B - Symptoms, Treatment, Prevention, and More

Table of Content

• What is Hepatitis B?

• Facts about the hepatitis B virus

• Types of Hepatitis B

• Transmission of Hepatitis B

• Hepatitis B Symptoms

• Hepatitis B Diagnosis

• Hepatitis B Treatment

• Hepatitis B Prevention

• How hepatitis B is different from other hepatitis viruses?

• Complications of Hepatitis B infection

• Best diet tips for Hepatitis B

• Take-Home Points

• FAQ on Hepatitis B

Introduction

Hepatitis B is a major public health concern. The Hepatitis virus causes hepatitis. There are five types of Hepatitis, namely, Hepatitis A, B, C, D, and E. The hepatitis B virus causes hepatitis B. It damages the liver and may lead to cirrhosis and hepatocellular carcinoma.

What is Hepatitis B?

Hepatitis B is also called HBV infection. One in four people who suffer from chronic Hepatitis B infection is at risk of death due to cirrhosis and liver cancer.

Hepatitis B vaccination is important to prevent Hepatitis B.  according to World Health Organisation (WHO), offering 98% to 100% protection.

About 1% of patients with HBV infection also get infected with HIV. Tenofovir included in the treatment combinations as first-line therapy for HIV is also active against HBV.

Facts about the hepatitis B virus

Let us know these important facts about the Hepatitis B virus.

• The Hepatitis B virus survives outside the body for seven days. At this time, the virus can cause infection if it enters the body of an unvaccinated person.

• The incubation period is 30 to 180 days. 

• The virus is detectable within 30 to 60 days after infection.

Types of Hepatitis B:

There are two types of hepatitis B. They are:

• Acute hepatitis

• Chronic hepatitis

Acute hepatitis B

Acute hepatitis B is a short-term infection with symptoms lasting several weeks.  It may last up to 6 months.  When the body cannot fight the virus, it progresses to chronic infection.

Chronic hepatitis B

Chronic hepatitis B is a long-lasting infection. When one gets infected early like in children (95 %), the chances of developing chronic hepatitis B infection is more. 5 % of adults develop chronic hepatitis B infection.

Transmission of Hepatitis B

Let us understand “How does hepatitis B spread?”

Hepatitis B spreads by:

• Needle stick injuries like in healthcare settings, dentists, and nurses.

• Tattoo and piercing

• Body fluids like saliva and semen.

• Reuse of contaminated needles

• Drug abusers

• Unvaccinated individuals

• Multiple sexual partners.

• Childbirth.

• Contact with an open wound.

• Needle sharing

• Sharing a toothbrush or razor.

Hepatitis B Symptoms

Hepatitis B symptoms are:

• Nausea 

• Vomiting 

• Loss of appetite

• Pain in abdomen

• Jaundice

• Dark urine

• Tiredness 

• Weakness 

• Joint pain

Hepatitis B Symptoms in Men

The hbv symptoms include fever, abdominal pain, nausea, vomiting, weakness, tiredness, pain in joints, jaundice, dark-coloured urine, light-coloured stools and swelling in arms/legs/belly. The symptoms of hepatitis B in adults are also the same. 

HBV symptoms can range from mild to moderate.

Hepatitis B Diagnosis

Hepatitis B diagnosis has the following important considerations:

• Blood investigations

• Radiographic imaging 

Hepatitis B Treatment

The important points in consideration for Hepatitis B treatment are given below:

Acute treatment

• IV fluids.

• IV nutrition.

• Pain relief.

Treatment for chronic infection

• A regular check-up every six months.

• Regular tests like Blood tests, Imaging tests, and elastography.

• Medication

• Immune modulator drugs include interferons,  peginterferon alfa-2a, and interferon alfa-2b, given by injection for six to 12 months. 

• Oral antiviral medications. . First-line antivirals include tenofovir disoproxil or tenofovir alafenamide and entecavir. 

• Lifestyle changes: Avoid alcohol and eat healthy food.

• Surgery

• Liver transplantation

Hepatitis B Prevention

It is possible to prevent Hepatitis B by:

• Infants vaccination: The vaccine protects for 20 years or lifelong.

•  Antiviral prophylaxis for preventing transmission from mother to child. 

• Practice safe sex

• Disease awareness

• Not sharing personal items like toothbrushes and razors.

• Dispose of the needle after use

• Planning while traveling and childbirth

• Cover open wound

• Be cautious while piercing and tattooing.

• Clean blood with one part household bleach and 10 parts water if you have a Hepatitis B patient at home.

How hepatitis B is different from other hepatitis viruses?

The following are important differences between Hepatitis B and other viruses:

• Vaccine is available

• Preventable 

• Spread through body fluids like saliva.

• Chronic infection can be treated but is not curable. 

• Antiviral medications control the infection.

Complications of hepatitis B infection

The complications of Hepatitis B infection are as follows:

• Hepatitis D or delta virus only affects people with Hepatitis B.

• Cirrhosis. The liver is replaced by scar tissue which affects the functioning of the liver.

• Chronic liver failure.  The liver loses its ability to function. A liver transplant is the only cure.

• Liver cancer. Chronic hepatitis B is the leading cause of liver cancer and cause of death among those who are suffering from Hepatitis B.

Hepatitis B prophylaxis

• Vaccination.  Immediate hepatitis B vaccine is recommended, preferably within 24 hours of exposure. To get fully vaccinated against the virus, you will need two more doses over the next six months.

• Hepatitis B immune globulin (HBIG). It is made from human blood containing naturally-produced antibodies to the hepatitis B virus. This is given to those who have been recently been exposed to the virus as a preventive measure.

Hepatitis B Vaccination

Who should be vaccinated against hepatitis B?

• All infants 

• Unvaccinated children aged <19 years

• Adults

• Those aged 60 years and older.

Those who are at risk of hepatitis B:

• Multiple sexual partners

• Men who have sex with men

• Household contacts (family member positive for hepatitis B)

• People on maintenance dialysis

• Those who travel to countries where hepatitis B virus or HBV infection is pandemic.

• Those who suffer from hepatitis C virus or HCV infection

• Patients with liver diseases, cirrhosis, fatty liver disease, etc.

• HIV patients

• Healthcare settings

Hepatitis B vaccination in India

Given below includes important information related to Hepatitis B vaccination in India.

• If the mother is positive for hepatitis B, the vaccine is given within 12 hours after birth, along with hepatitis B immune globulin (HBIG) — to provide protection against the virus immediately. 

• If the mother is negative for the Hepatitis B virus, HepB vaccine is given to the newborn within 24 hours after birth.

The HepB injection provides long-term immunity and reduces the risk of cirrhosis and liver cancer. 

When a mother is negative for the Hepatitis B virus, immunization is delayed for babies weighing less than 4 pounds, 7 ounces (2,000 grams) at the time of birth. In this case, the first dose is given at one month of age or at the time of hospital discharge.

Routine vaccination:

• Minimum age: Birth

• Administer monovalent HepB vaccine to all newborns within 48 hours of birth. Monovalent HepB vaccine should be used for doses administered before age six weeks.

• A total of 4 doses of HepB vaccine is permissible when a combination vaccine containing HepB is administered after the birth dose.

• Infants who did not receive a dose at birth should receive three doses of a HepB-containing vaccine starting as soon as feasible.

• The ideal minimum interval between dose one and dose 2 is four weeks, and between doses 2 and 3 is eight weeks. Ideally, the final (3rd or 4th) dose in the HepB vaccine series should be administered no earlier than age 24 weeks and at least 16 weeks after the first dose, whichever is later.

• Hep B vaccine may also be given in any of the following schedules: Birth, 1, & 6 mo, Birth, 6 and 14 weeks; 6, 10 and 14 weeks; Birth, 6 ,10 and 14 weeks, etc. All schedules are protective.

Best diet tips for Hepatitis B

Foods have an antiviral effect against the Hepatitis B virus. Some of the important diet tips include:

• Grapes

• Plums

• Peanuts

• Apple

• Blueberries

• Sunflower seeds

• Almonds

• Spinach 

• Broccoli

• Mango 

• Rice 

• Curcuma longa 

These foods contain resveratrol, vitamin E, selenium, and curcumin, which have an anti-viral effect against many viruses, including Hepatitis B.

Choose your favourite food from the list below if you are suffering from hepatitis B:

• Whole grain pasta

• Brown rice

• Porridge 

• Veg Oats 

• Veg idli

• Veg poha

• Veg upma

• Oatmeal 

• Coconut water

• Soup 

• Cooked food in olive oil and coconut oil

• Pomegranate juice

Take-Home Points

• Hepatitis B is a serious liver disease and is preventable. So it is important to get a regular check-up done every six months. Vaccination should be the topmost priority during childhood itself.

• Discuss with your doctor before taking medicine and herbal supplements, as these are harmful to the liver.

• It is advisable to adopt healthy habits like eating a balanced diet, maintaining a good weight, and avoiding alcohol to keep the liver healthy.

References

• https://www.elsevier.es/en-revista-annals-hepatology-16-avance-resumen-anti-hepatitis-b-virus-activity-food-S1665268122001089

• https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00124-8/fulltext

• https://www.who.int/news-room/fact-sheets/detail/hepatitis-b#:~:text=Hepatitis%20B%20is%20a%20potentially,from%20cirrhosis%20and%20liver%20cancer.

• https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#vaccFAQ

• https://my.clevelandclinic.org/health/diseases/4246-hepatitis-b

• https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-b

• https://immunizeindia.org/content/hepatitis-b-hepb-vaccine/#:~:text=Hep%20B%20vaccine%20may%20also,to%20those%20not%20previously%20vaccinated