Introduction
Hepatitis B, caused by the hepatitis B virus (HBV), is a serious liver infection with potential acute and chronic complications. Globally, it remains a critical public health issue, often leading to liver inflammation, cirrhosis, and hepatocellular carcinoma. Approximately 50% of infected individuals are unaware of their status, underscoring the need for awareness and prevention.
Types of Hepatitis B
- Acute Hepatitis B
- Occurs within 6 months of exposure.
- Symptoms range from mild (fatigue, nausea) to severe (jaundice, dark urine).
- Most adults recover fully, developing lifelong immunity.
- In 2022, acute cases were predominant in adults aged 40–59.
- Chronic Hepatitis B
- Diagnosed when HBV persists >6 months.
- Increases risk of cirrhosis, liver failure, and liver cancer.
- Asymptomatic early stages often delay diagnosis.
Symptoms
- Acute Phase: Jaundice, fever, abdominal pain, dark urine, joint pain, loss of appetite.
- Chronic Phase: Often asymptomatic initially; advanced stages manifest as cirrhosis (ascites, bruising) or liver cancer.
Transmission
HBV spreads via contact with infectious fluids (blood, semen, vaginal secretions):
- Sexual: Unprotected intercourse.
- Parenteral: Shared needles (drug use, unsterile tattoos/piercings).
- Perinatal: Mother-to-child during childbirth.
Risk Factors
- Behavioral: Unprotected sex, multiple partners, IV drug use.
- Occupational: Healthcare workers exposed to blood.
- Medical: Immunocompromised states, chronic liver disease.
Diagnosis
Blood Tests:
- HBsAg: Detects active infection (positive 1–9 weeks post-exposure).
- Anti-HBs: Indicates immunity (post-vaccination/recovery).
- Anti-HBc: Distinguishes past (IgG) vs. recent (IgM) infection.
- HBeAg/HBV DNA: Measures infectivity and viral load.
Interpretation:
- Active Infection: HBsAg+/HBeAg+.
- Immunity: Anti-HBs+.
- Past Exposure: Anti-HBc+ (total).
Management
- Prophylaxis
- Post-Exposure: Hepatitis B vaccine + HBIG within 24 hours.
- Preventive Vaccination: A 3-dose series is recommended for all infants and high-risk adults.
- Acute Infection
- Supportive care (hydration, rest); monitor liver function.
- Chronic Infection
- Antivirals: Tenofovir (TDF/TAF), and entecavir to suppress viral replication.
- Interferon: Pegylated interferon for select patients (limited duration).
- Monitoring: Regular liver imaging (ultrasound/Fibroscan) and HBV DNA testing.
Prevention Strategies
- Vaccination: Key to global eradication efforts.
- Safe Practices: Condom use, sterile needles, avoiding shared personal items (razors).
- Prenatal Screening: HBV+ mothers require antiviral therapy and infant HBIG/vaccination post-birth.
Complications
- Cirrhosis/Liver Failure: Managed via lifestyle changes, antivirals, or transplant.
- Liver Cancer: Surveillance with biannual ultrasound in high-risk patients.
- Reactivation: Immunosuppression (e.g., chemotherapy) necessitates antiviral prophylaxis.
Conclusion
Early detection through testing and vaccination are pivotal in controlling HBV. Public health initiatives must prioritize education, accessible vaccination, and harm reduction programs. Individuals at risk should seek prompt medical consultation for testing and tailored care.
Key Takeaway: Hepatitis B is preventable and manageable with timely intervention, reducing long-term morbidity and mortality.