Hepatitis B part 1

Hepatitis B Overview

Hepatitis B is an infectious hepatitis caused by the hepatitis B virus (HBV). This infection has two possible phases; 1) acute and 2) chronic.

1. Acute hepatitis B refers to newly acquired infections. Affected individuals notice symptoms approximately 1 to 4 months after exposure to the virus. In most people with acute hepatitis, symptoms resolve over weeks to months and they are cured of the infection. However, a small number of people develop a very severe, life-threatening form of acute hepatitis called fulminant hepatitis.
2. Chronic hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely.

Approximately 90% to 95% of infected adults are able to fight off the virus so their infection is cured. Only about 5% to 10% of adults infected with HBV go on to develop chronic infection. Children are at much higher risk for chronic infection. Up to 90% of infected young children will fail to clear the virus from their bodies and go on to develop chronic infection.

About two-thirds of people with chronic HBV infection are chronic carriers. These people do not develop symptoms, even though they harbor the virus and can transmit it to other people. The remaining one third develop "active" hepatitis, a disease of the liver that can be very serious.

       The liver is an important organ that filters toxins out of the blood, stores energy for later use, helps with digestion, and makes substances that fight infections and control bleeding.

       The liver has an incredible ability to heal itself, but long-term inflammation caused by HBV can result in permanent damage.

       Scarring of the liver is called cirrhosis, a condition traditionally associated with alcoholism but one that is also caused by chronic active hepatitis B infection. When this occurs, the liver can no longer carry out its normal functions and may fail completely. The only treatment for liver failure is liver transplant.

       Chronic hepatitis B also can lead to a type of liver cancer known as hepatocellular carcinoma.

       Any of these conditions can be fatal. About 15% to 25% percent of people with chronic hepatitis B die of liver disease.

Hepatitis B is the most common serious liver infection in the world. Worldwide, about 350 million people are chronic carriers of HBV, of whom, more than 620,000 die from liver-related disease each year.

In the United States, hepatitis B is largely a disease of young adults aged 20-50 years. About 800,000 to 1.4 million Americans are chronic hepatitis B virus carriers, and the disease causes about 3, 000 deaths each year.

The good news is that infection with HBV is usually preventable because there is an effective vaccine. Use of the vaccine has resulted in an 82% decrease in the number of new infections reported in the United States each year.

Hepatitis B Transmission and Causes

The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood or fluids contaminated with blood. Another important route of transmission is from an infected mother to a newborn child, which occurs during or shortly after birth.

       Direct contract with blood may occur through the use of dirty needles during illicit drug use, inadvertent needle sticks experienced by healthcare workers, or contact with blood through other means. Semen, which contain small amounts of blood, and saliva that is contaminated with blood also carry the virus.

       The virus may be transmitted when these fluids come in contact with broken skin or a mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.

People who are at an increased risk of being infected with the hepatitis B virus include the following:

       Men or women who have multiple sex partners, especially if they don't use a condom

       Men who have sex with men

       Men or women who have sex with a person infected with hepatitis B virus

       People with other sexually transmitted diseases

       People who inject drugs with shared needles

       People who receive transfusions of blood or blood products

       People who undergo dialysis for kidney disease

       Institutionalized mentally handicapped people and their attendants, caregivers, and family members

       Health care workers who are stuck with needles or other sharp instruments contaminated with infected blood

       Infants born to infected mothers

In some cases, the source of transmission is never known.

You cannot get hepatitis B from the following activities:

       Having someone sneeze or cough on you

       Hugging someone

       Handshaking a persons hand

       Breastfeeding your child

       Eating food or drinking water

       Casual contact (such as an office or social setting)

Hepatitis B Symptoms

Half of all people infected with the hepatitis B virus have no symptoms and may never realize that they have been infected. Adults are more likely to develop symptoms than children. For those who do get sick, symptoms usually develop within 1 to 4 months after exposure to the virus. The initial symptoms are often similar to the flu.

Common symptoms of hepatitis B include:

       Appetite loss

       Feeling tired (fatigue)

       Nausea and vomiting

       Itching all over the body

       Pain over the location of the liver (on the right side of the abdomen, under the lower rib cage)

       Jaundice (a condition in which the skin and the whites of the eyes turn yellow in color)

       Dark urine (the color of cola or tea)

       Pale-colored stools (grayish or clay colored)

Many types of acute viral hepatitis such as hepatitis A and hepatitis C have symptoms that are indistinguishable from hepatitis B.

Fulminate hepatitis is a severe form of acute hepatitis that can be life-threatening if not treated right away. Fortunately, fulminate hepatitis is rare. The symptoms of fulminate hepatitis develop very suddenly and may include:

       Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic encephalopathy)

       Sudden collapse with fatigue

       Jaundice

       Swelling of the abdomen

Prolonged nausea and vomiting can cause dehydration. Individuals with dehydration may notice these symptoms:

       Extreme weakness

       Confusion or trouble concentrating

       Headache

       Lack of urination

       Irritability

Symptoms of liver damage may include the following:

       Fluid retention causing swelling of the belly (ascites) and sometimes the legs

       Weight gain due to ascites

       Persistent jaundice

       Loss of appetite, weight loss, wasting

       Vomiting with blood in the vomit

       Bleeding from the nose, mouth, or rectum; or blood in the stool

       Hepatic encephalopathy (excessive sleepiness, mental confusion, and in advanced stages, development of coma)

When to Seek Medical Care

Call your health care professional if you have any of the following:

       Nausea and vomiting that does not go away in 1-2 days

       The inability to keep down liquids

       A high fever or fever that persists more than 2 days

       Yellow skin or eyes

       Dark-colored urine (like tea or cola)

       Pain in the abdomen.

For severe symptoms including confusion or delirium go to a hospital emergency department.

You should also contact your health care practitioner if you think you may have been exposed to the hepatitis B virus.

If you have chronic hepatitis B infection and think you might be pregnant; or if  you are pregnant and think you have been exposed to hepatitis B inform health care practitioner right away.

Hepatitis B Treatment

Acute hepatitis B usually resolves on its own and does not require medical treatment. If very severe, symptoms such as vomiting or diarrhea are present, the affected person may require treatment to restore fluids and electrolytes. There are no medications that can prevent acute hepatitis B from becoming chronic.
If a person has chronic hepatitis B, they should see their health care provider regularly