Hepatitis B (Hbv) is a highly contagious infectious liver disease caused by a DNA virus that is transmitted through infected blood, semen and vaginal secretions, or from mother to child

Hepatitis B causes an acute infection of the liver, which, depending on the immune condition of the patient, can become chronic and progress to cirrhosis of the liver (usually within a time window of five years) or liver cancer (hepatocarcinoma).

Hbv infection in high-endemic countries is responsible for up to 90% of liver cancers, which in developing countries is almost always fatal; in high-income countries, however, surgery and chemotherapy can increase life expectancy.

The likelihood of Hepatitis B going from acute to chronic depends mainly on the age at which the disease is contracted

In adults, the disease may become chronic in about 5-10% of cases, while 9 times out of 10 Hepatitis B becomes chronic in infants infected shortly after birth.

Hepatitis B is most prevalent in sub-Saharan Africa and East Asia. High rates of chronic infections are also found in the Amazon, Eastern Europe and Central Europe.

It is also estimated that in the Middle East and the Indian subcontinent, 2-5% of the general population is chronically infected, compared to less than 1% of the population in Western Europe and North America.

Signs and symptoms of Hepatitis B

Hepatitis B has an incubation period of 45 to 180 days during which the first symptoms may appear, although in most cases, and especially in children, Hepatitis B is completely asymptomatic.

When symptoms are present, however, general malaise, fever, fatigue, nausea and vomiting, and musculoskeletal pain are observed.

Jaundice, dark-coloured urine and light-coloured stools may sometimes appear.

Rarely, liver failure, kidney problems, pancreatitis and neuropathy.

Causes and transmission of Hepatitis B

The source of Hepatitis B infection is individuals with acute disease or chronic carriers, who present the virus in their blood, but also in other biological fluids: saliva, bile, nasal secretion, breast milk, semen, vaginal mucus, etc.

Transmission occurs

• via the blood by apparent parenteral route (blood transfusion or blood products in undeveloped countries, cuts and punctures with infected needles and instruments) or inapparent parenteral route (injuries to the skin or mucous membranes by contaminated toothbrushes, scissors, combs and brushes, or surgical instruments that have not been properly sterilised)
• sexually (semen, cervical mucus)
• through biological fluids (bile, nasal discharge)
• from mother to child at birth and through breast milk.

The Hepatitis B virus is very resistant and can survive in external environments such as dry blood for up to 7 days.

Therefore, contagion is possible both through contact with the sick person and through contact with contaminated objects.

The person sick with Hepatitis B is contagious in the acute phase.

The chronically ill person (chronic HBV carrier) remains infectious for life.

Who is at risk of contracting the Hepatitis B virus

Although anyone can become ill, certain categories of people are at greater risk of coming into contact with the Hbv virus.

These include

• those who engage in unprotected sex with multiple partners
• drug addicts
• family members and persons in contact with infected persons
• children born to infected mothers
• laboratory staff and workers who are exposed to blood and/or may handle needles and syringes if not perfectly sterilised
• those who practice and perform piercings, manicures, pedicures
• patients undergoing haemodialysis
• those who travel to countries where the virus is particularly widespread.

Since the introduction of vaccination in Italy in 1991, new cases of Hepatitis B have been reduced by 80%.

Screening of blood donors has also reduced the probability of contracting the infection through transfusions.

Diagnosis

The diagnosis of Hepatitis B is made by detecting markers (Ag) and antibodies (Ab) in the patient’s blood:

• HBsAg, the surface antigen that indicates the state of infection. All persons who test positive for HBsAg are considered potentially infectious.
• HBsAb, is the antibody against the surface antigen. Its presence indicates immunisation and is found after recovery from an infection or after vaccination.
• HBcAb-IgM, the antibody found in the replication phases of the virus. It is positive in both acute and chronic relapsed forms.
• HBcAb-IgG, the antibody that indicates contact with the virus. It remains positive throughout life regardless of the outcome of the infection.
• HBeAg, is found in the early phase of acute hepatitis and in some forms of chronic hepatitis.
• HBeAb, the antibody directed against HBeAg. Its presence does not prevent evolution to the chronic form.
• Hbv-DNA, the virus genome that always indicates infection activity. By definition, the healthy carrier will always be Hbv-DNA negative.
• HBcAg: is the antigen of the central part of the virus, the only marker that is only found in liver cells and never in the blood.

Hepatitis B therapies

For acute hepatitis B, there is no specific therapy.

Treatment is largely aimed at improving the patient’s quality of life and long-term survival by supporting adequate nutritional balance, preventing progression of the disease into cirrhosis and reducing the incidence of hepatocellular carcinoma.

To aid the healing process, the Hepatitis B patient is recommended to take bed rest and follow a light diet (low in fat but rich in liquids, sugars and proteins) and avoid alcohol consumption.

If you suspect that you have come into contact with the Hbv virus, it is important to seek medical advice immediately.

A treatment with specific immunoglobulins administered within 24 hours of infection, combined with a vaccination with subsequent booster shots, can protect the patient from developing the infection.

How to prevent Hepatitis B

The hepatitis B vaccine is the cornerstone of prevention.

The World Health Organisation recommends that all children receive the hepatitis B vaccine as soon as possible after birth.

It is strongly recommended for population groups at greater risk of coming into contact with the virus.

It is administered by intramuscular injection, on the arm for adolescents and adults, and on the thigh for infants.

Side effects are rarely reported and when they do occur they tend to be mainly local at the injection site (itching, slight swelling, pain).

A general feeling of malaise and the appearance of fever, headache and bone/joint pain may occur.

The vaccine protects against the virus for 10-15 years.

To check the actual coverage, it is sufficient to check the presence and titre of Anti-HBs with a simple blood test.

It is contraindicated for individuals with a known allergy to the components of the vaccine itself.

It is also important, in the case of Hepatitis B, to inform one’s partner of the infection and recommend that the test be performed.

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