Hepatitis B: symptoms,Prevention,and Treatment.

Hepatitis B is a viral infection affecting the liver. The disease goes through different phases, which can be diagnosed by serology. Diagnostic testing comprises the three most important parameters: HBs antigen, anti-HBs antibody, and anti-HBc antibody. These three parameters can be used to identify active infection, previous infection, and status after vaccination. In addition, anti-HBc IgM antibody can be used to confirm acute infection. Hepatitis B virus (HBV) is a small DNA virus which is capable of integrating into the host genome and causes various liver diseases most notably liver cirrhosis and liver cancer.
-Introduction to Hepatitis
– Viral Hepatitis Transmission
– Symptoms & acute vs. chronic
5:35 - Laboratory Tests and Councilman Bodies
– Hep B Serology (HBsAg & Anti-HBs)
– Treatment of Viral Hepatitis
- Vaccines
The rate of deaths due to liver cancer is increasing faster than any other type of cancer. Hepatitis B and C are major contributing factors to liver cancer. At this seminar, learn the critical importance of hepatitis prevention and treatment.

1. HEPATITIS B

2. CONTENTS Origin of hepatitis b virus Introduction Hepatitis B virus Types of hepatitis viruses Viral hepatitis Symptoms Modes of transmission life cycle of hepatitis B First stage Second stage Third stage Fourth stage Prevalence Prevention Cure Conclusion REFERENCE

3. ORIGIN OF HEPATITIS B VIRUS Its an ancient disease first described in 5 th century B.C. Earliest recognized blood – borne out break of hepatitis was in Germany in 1883 after receiving smallpox vaccine. In 1947 Mac Calum and Bauer introduce the term hepatitis A for infectious and Hepatitis B for serum hepatitis. This terminology was adopted by WHO in 1973.

4. INTRODUCTION The terms hepatitis describes inflammation of the liver. Hepatitis may be caused by alcohols , drugs autoimmune diseases, metabolic diseases, and viruses. Viral infections accounts for more than half the cases of acute hepatitis. Viral hepatitis is a systematic infection affecting the liver predominantly with primary inflammation of the liver by any one of the heterogeneous group of hepatotropic viruses.

5. HEPATITIS B VIRUS DEFINATION Hepatitis B is a serious and common infectious diseases of the liver, affecting millions of people throughout the world. The severe pathological consequences of persistent HBV infectious include the development of chronic hepatic insufficiency , cirrhosis and hepato cellular carcinoma (HCC) In addition , HBV carries can transmit the disease for many years.

6. TYPES OF HEPATITIS VIRUSES The types of hepatitis viruses are. Hepatitis A (HAV) (1973) Hepatitis B (HBV) (1970) Hepatitis C (HCV) (1998) Hepatitis D (HDV) (1977) Hepatitis E (HEV) (1983) Hepatitis F - Not separate entity – Mutant of B virus. Hepatitis G (HGV) (1995) All of these are RNA viruses except HBV which is a DNA virus.

7. VIRAL HEPATITIS Viral hepatitis is classified as, Acute hepatitis Chronic hepatitis Acute hepatitis self –limited liver injury of less than 6 months. Chronic hepatitis Hepatic inflammation more than 6 months.

8. SYMPTOMS Signs and symptoms of hepatitis B range from mild to severe. They usually appear about one to four months after u have been infected although you could see them as early as two weeks post-infection. Some people, usually young children , may not have any symptoms. Hepatitis B signs and symptoms may include. Abdominal pain Dark urine Loss of appetite Nausea and vomiting Weakness and fatigue

9. SYMPTOMS Joint pain Yellowing of your skin and the whites of your eyes (jaundice) Belly pain hepatomegaly

10. MODES OF TRANSMISSION Sexual- sex workers and homosexuals and particular at risk. Parenteral – IVDA, health workers are at increased risk. Perinatal - mothers who are HBeAg positive are much more likely transmit to their offspring than those who are not. Perinatal transmission is the main means of transmission in high prevalence populations.

11. LIFE CYCLE OF HEPATITIS B First stage The duration of this stage for healthy adults is approximately 2-4 weeks and coincide with incubation period .For newborns ,the duration of this period often is decades. Active viral replication is known to continue despite little or no elevation in the amino tranferase levels and no symptoms of illness.

12. SECOND STAGE In the second stage, an inflammatory reaction with a cytopathic effect occurs. HBeAg can be identified in the sera and a decline of the levels of HBV and DNA is seen. The duration of this stage for patients with acute infection is approximately 3-4 weeks ( symptomatic period ) For patients with chronic infection , 10 years or more may elapse before cirrhosis develops.

13. THIRD STAGE In the third stage , the host can target the infected hepatocytes and the HBV viral replication no longer occurs. HBeAb can be detected. The HBV DNA levels are lower or undetectable, and aminotransferase levels are within the reference range. In this stage, an integration of the viral genome into the host’s hepatocyte genome take place. HBsAg still is present.

14. FOURTH STAGE In the fourth stage, the virus cannot be detected and antibodies to various viral antigens have been produced. Different factors have been postulated to influences the evolution of these stages, including age, sex, immunosuppression, and co-infection with other viruses.

15. PREVALENCE More than 2,000 thousand people alive today have been infected with HBV at some time in their lives . About 350 million infected chronically and become carriers of virtues . Three quarters of the world’s population live where there are high level of infection . Every year there are over 4million acute causes of HBV and about 25% of carriers, 1 million people a year, die from chronic active hepatitis, cirrhosis or primary liver cancer. The world can be devided into 3 areas where the prevalence of chronic hepatitis infection is high (>8%), intermediate (2-8%),and low(<2%).

16. PREVALENCE High endemicity areas include South –east Asia and pacific basin, Sub- saharan Africa, parts of middle east, some countries in eastern Europe. In these areas about 70-90% of population becomes HBV infected before the age of 40,and 8 to 20% of people are HBV carries. Low endemicity areas include North America, Western and Northern Europe, Australia. The carrier rate here 2% and less than 20% of the population infected with HBV.

17. PREVALENCE The rest of the world falls into intermediate range of HBV prevalence, with 2to8% of a given population being HBV carriers.

18. PREVENTION Primary prevention Non- remunerated blood donations, effective public education on blood donation, donor selection , and quality-assured screening of all donated blood and blood components used for transfusion can prevent transmission of HBV and HCV. Advocacy and raising awareness of all types of viral hepatitis infection help to reduce transmission in the community. Safe and effective vaccines are widely available for the prevention of HAV and HBV infections and an HEV vaccine has recently been licensed in China. Implementation of blood safety strategies, including blood supplies based on voluntary

19. PRIMARY PREVENTION Infection control precautions in health care and community settings can prevent transmission of viral hepatitis as well as many other diseases. Safe injection practices can protect against HBV and HCV transmission. Harm reduction practices for injecting drug users prevent HAV,HBV and HCV transmission. Occupational safty measures prevent transmission of viral hepatitis to health care workers. Safe food and water provide protection against HAV and HEV infection

20. SECONDARY PREVENTION Certain drugs that are known to be Early diagnosis provides the best opportunity for effective medical support and prevention of further spread. It also allows the infected persons to take steps to prevent transmission of the disease to others. Early diagnosis of those with chronic infection also allows people to take precautions to protect the liver from additional harm, specifically by abstaining from alcohol and tobacco consumption and avoiding toxic to the liver.

21. SECONDARY PREVENTION Treatment of acute HBV infection is primarily supportive, Good nutrition and bed rest should be reinforced. Abstinence from alcohol and the use of hepatotoxic drugs is also necessary. Conversely, chronic HBV infection may be progressive and, therefore, requires management. The goals of therapy include minimization of hepatocellular damage and viral clearance. Possible adverse effects to interferon include fever and chills, headache, depression, malaise, tachycardia, bone marrow suppression, alopecia, and, on rare occasion, cardiac or renal failure.

22. SECONDARY PREVENTION In acute hepatitis B the treatment is basically symtomatic Rest Ant emetics to control vomiting plenty of fluids and carbohydrates Hepatotropic agent

23. TERTIARY PREVENTION There is no surgical treatment for hepatitis B. In case of advanced liver damage because of hepatitis and condition becomes life- threatening, there is need a liver transplant. In rare cases, acute hepatitis B progresses rapidly to liver failure, a deadly condition called fulminant hepatitis. For people who developed this condition, a liver transplant is the only treatment choice.

24. CURE OF HEPATITIS B Hepatitis B vaccination 1965 Discovery of Australian antigen 1973 Successful HBV infection of chimpanzees 1981 licensure of plasma- derived vaccine 1986 licensure of recombinant vaccine 1991 universal infant vaccination 1996 universal adolescent vaccination

25. PLASMA DERIVED VACCINE These vaccines derived from the plasma of HBsAg – positive donors, consist of highly purified, formalin - inactivated or heat – inactivated, alum – absorbed, hepatitis B sub virion particles (22nm) of HBsAg that are free to detectable nucleic acid and therefore, noninfectious. The first plasma derived vaccines were manufactured in USA and France in 1982- 1981 .

26. COMBINATION VACCINES The HBsAg vaccines can be combined with other vaccines such as Calmetta – Guerin Bacillus (BCG), measles, mumps and rubella, Haemophilus influenzae b, diptheria, tetanus and petussis combined with polio. Neonates born to mother who are HBsAg positive should be given a combination of passive and active immunization to provide immediate protection in the first 6 hours after delivery, followed by long term immunity with the vaccine. The vaccine is administered by intramuscular injection in the antrolateral aspect of the thigh of the new born and infants or deltoid (arm) muscles of children and adults in order to achieve optimal protection.

27. COMBINATION VACCINES It is particular effective within 48 hours of the incident. It may also be given to neonates who are at increased risk of contracting hepatitis B i.e. who mothers are HBsAg and HBsAg positive. Hepatitis B immunoglobulin – HBIG may be used to protect persons who are exposed to hepatitis B .

28. CONCLUSION Hepatitis B is the most common serious liver infection in the world .It is caused by the hepatitis B virus (HBV) that attacks liver cells and can lead to liver failure, cirrhosis scarring or cancer of the liver. The virus is transmitted through contact with blood and bodily fluids that contain blood.

29. REFERENCE Hepatitis B Epidemiology and prevention of Vaccine-preventable diseases The Pink Book: Course Textbook – 12 th edition second printing (May 2012) Center of Diseases Control.