Hepatitis B: symptoms,Prevention,and Treatment.

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

ORIGIN OF HEPATITIS B VIRUS
 Its an ancient disease first
described in 5th 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.

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.

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.

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

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.

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.
o Abdominal pain
o Dark urine
o Loss of appetite
o Nausea and vomiting
o Weakness and fatigue

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

MODES OF TRANSMISSION
o Sexual- sex workers and
homosexuals and particular
at risk.
o Parenteral – IVDA, health
workers are at increased risk.
o 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.

LIFE CYCLE OF HEPATITIS B
First stage
o 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.
o Active viral replication is known to continue despite little or
no elevation in the amino tranferase levels and no
symptoms of illness.

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

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

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

PREVALENCE
o More than 2,000 thousand people alive today have been
infected with HBV at some time in their lives .
o About 350 million infected chronically and become carriers
of virtues .
o Three quarters of the world’s population live where there
are high level of infection .
o 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.
o The world can be devided into 3 areas where the prevalence
of chronic hepatitis infection is high (>8%),intermediate (2-
8%),and low(<2%).

PREVALENCE
o High endemicity areas include South –east Asia and pacific
basin, Sub- saharan Africa, parts of middle east, some
countries in eastern Europe.
o 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.
o Low endemicity areas include North America, Western and
Northern Europe, Australia.
o The carrier rate here 2% and less than 20% of the
population infected with HBV.

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

PREVENTION
Primary prevention
o 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.
o 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.
o Implementation of blood safety strategies, including blood
supplies based on voluntary

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

SECONDARY PREVENTION
o Certain drugs that are known to be
Early diagnosis provides the best
opportunity for effective medical
support and prevention of further
spread.
o It also allows the infected persons to
take steps to prevent transmission of
the disease to others.
o 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.

o Treatment of acute HBV infection is primarily supportive,
Good nutrition and bed rest should be reinforced.
o Abstinence from alcohol and the use of hepatotoxic
drugs is also necessary.
o Conversely, chronic HBV infection may be progressive and,
therefore, requires management. The goals of therapy include
minimization of hepatocellular damage and viral clearance.
o 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.

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

TERTIARY PREVENTION
o There is no surgical treatment
for hepatitis B.
o In case of advanced liver
damage because of hepatitis
and condition becomes life-
threatening, there is need a liver
transplant.
o 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.

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

PLASMA DERIVED VACCINE
o 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.
o The first plasma derived vaccines
were manufactured in USA and
France in 1982- 1981 .

COMBINATION VACCINES
o 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.
o 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.
o 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.

COMBINATION VACCINES
o 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.
o Hepatitis B immunoglobulin –
HBIG may be used to protect
persons who are exposed to
hepatitis B .

CONCLUSION
o 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.

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

Hepatitis B: symptoms,Prevention,and Treatment.

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