The Ins and Outs of Hepatitis B

Hepatitis B virus (HBV), a vaccine-preventable disease, is a leading worldwide cause of liver disease and a global public health concern. HBV has worldwide consequences, causing acute (a short-term but serious illness) or chronic (a long-term but serious illness) hepatitis (liver inflammation).

Better handling of blood products, general hygiene practices, and childhood immunization campaigns could all contribute to the global eradication of the HBV burden.

Hepatitis B virus: the ins and outs

Unlike hepatitis A, which is contracted through eating or drinking, the hepatitis B virus (HBV) is spread through contact with blood and other body fluids. HBV, a DNA virus belonging to the Hepadnaviridae family, does not have an animal reservoir. Therefore, with continued global collaboration and public health initiatives, this disease could be completely eradicated.

Even with a highly effective vaccine, this illness is still widespread. The most recent global data derived pre-COVID (2019) suggests that 1.5 million people become infected annually, and over 290 million people chronically live with disease resulting from HBV.

According to recent estimates from the World Health Organization, 84% of the 190 member states worldwide have access to the approved 3-series vaccination for HBV. This increases our chances of reducing the potential effects of the disease, in addition to the fact that 113 Member States administer the HBV vaccine to newborns on their first day of life, at least once.

Hepatitis B transmission

Since many nations started immunizing newborns against HBV, there has been a notable decrease in the virus's ability to spread. Vaccinating infants with a three-dose protocol makes disease prevention greatly effective and has reduced clinical disease globally.

Even so, it still results in more than 900,000 fatalities per year. Death occurs as a result of the damage caused by HBV, which typically causes primary liver cancer (hepatocellular carcinoma) or end-stage liver disease (cirrhosis).

Vertical & horizontal transmission

HBV is a virus that spreads through blood. This means transmission occurs via contact with blood and bodily fluids. Transmission occurs vertically (from mother to child at birth or to the fetus in pregnancy) or via exposure to infected blood or fluids (horizontal transmission).

As a result, transmission occurs through exposure to any avenue that permits contact with bodily fluids, such as blood, semen, vaginal fluid, and menstrual blood. Some potential exposure paths are:

• Direct contact with wounds or open sores of infected individuals.
• Needle sharing and other drug paraphernalia usage.
• Tattooing or body piercing using equipment that isn’t properly sterilized.
• Sexual interactions (men who have sex with men are at further increased risk.)
• During pregnancy (intrauterine transmission.)
• During delivery (perinatal transmission.)

Incubation period

From the time one is exposed until a person shows symptoms of HBV, this is referred to as the incubation period. This ranges from 30 to 180 days. Even if people aren’t showing signs of infection, testing can identify viral exposure 1–2 months after infection.

Virus survival

HBV can live for seven days in the environment when it is not inside the body. That is a decent duration of time when unvaccinated individuals could become infected.

Hepatitis B risk factors

Those at highest risk for developing infection from HBV include:

• Any individual not vaccinated for HBV and exposed to bodily fluids.
• Those with underlying illnesses, such as those infected with HIV, underlying cancers or other immunosuppressive diseases.
• Newborns of infected mothers.
• Those who have lived or traveled to areas where HBV is more common, including Africa, Asia, Eastern Europe, South America, and some areas of the Middle East, are more likely to be exposed and become infected.

Those infected by 5–6 years of age are at the highest risk for chronic disease, while those older than that usually have the acute form that resolves without intervention.

Hepatitis B symptoms

Some people will show no symptoms when infected, while others may demonstrate:

Chronic liver disease

Sadly, HBV is well known for its capacity to cause chronic illness. Younger individuals at the time of disease have a higher chance of developing chronic infections and the eventual risk of liver failure (cirrhosis).

The CDC notes that 9 out of 10 infected infants will become chronically affected. The likelihood of developing a chronic illness decreases with age.

Apart from the cause of generalized liver failure, HBV is the leading cause of liver cancer worldwide. A person with chronic HBV illness risks developing cancer and liver damage, which can lead to cirrhosis, liver failure, and even death.

HBV reactivation

Even though it is uncommon, people who have had HBV infection and appear to have recovered without any liver damage may experience a relapse of the illness at a later age.

Patients with a suppressed immune system, such as those receiving chemotherapy for cancer treatment, those with inflammatory bowel disease, psoriasis, or rheumatoid arthritis, or those taking immunosuppressive medications (like cyclosporine or steroids) after receiving an organ transplant, may experience reactivation.

In addition, patients with HIV infection or hepatitis C (an additional bloodborne viral illness that affects the liver) should undergo routine screenings for the possibility of reactivation of previously treated HBV disease.

Hepatitis B treatment

Since there is no cure for HBV, prevention is the ultimate goal. The best way to do this is through vaccination. Hepatitis B cannot be cured. Patients with the acute form of the illness are treated with medicine, sometimes in conjunction with liver-protecting therapies, to treat their symptoms. For many, treatment is either symptomatic or nonexistent.

The majority of adults will recover on their own and will not require antiviral medication. But for those who have a chronic illness, the goal is to manage symptoms, maintain comfort and a high standard of living, and delay the progression of cancer or end-stage liver disease.

The use of hepatitis B immunoglobulin can be protective and aid in the resolution of infection without negative effects in acutely infected individuals exhibiting clinical signs as well as in infants born to infected mothers.

The treatment of chronic HBV consists of medications to decrease one’s risk of developing cancer, end-stage liver disease, and other related complications. This includes taking antiviral medication for the rest of your life, like tenofovir, among others. These antiviral drugs do not cure HBV, however, they help to reduce its risk of spreading, so treatment, once started, is frequently lifelong.

Screening and testing recommendations

Screening for HBV is essential to detecting the illness early and averting long-term liver damage because many people do not exhibit symptoms, and those that do can take one to two months to appear.

The Centers for Disease Control and Prevention (CDC) derived newly updated testing recommendations for 2023. These include:

• All adults over the age of 18 should undergo a triple-panel test at least once in their lifetime.
• Each time a woman becomes pregnant, she should be tested.
• Healthcare workers and others at high risk of exposure should be routinely screened.
• Anyway, whoever would like to be tested should be.

Additionally, screening is valuable for people born in or those unvaccinated with a recent travel history to areas where HBV is more common. People who are immunosuppressed for various reasons, at risk for infection, or reactivating previous infections should also be routinely screened.

Preventing hepatitis B

As they say, "an ounce of prevention is worth a pound of cure." Therefore, protecting oneself from HBV infection is the best course of action. One can reduce their risk by taking the following actions:

• Newborn vaccination control. Reduce mother-to-child transmission.
• Use of antivirals during pregnancy for infected mothers.
• Use of hepatitis B immunoglobulin within 24 hours of delivery for at-risk newborns or in anyone with a known exposure.
• Ensuring safe and effective blood products and handling safety protocols.
• Use appropriate infection control practices to limit the spread of those infected.
• Engage in safe sex practices, including using condoms and limiting the number of sexual partners.
• Use proper hygiene practices (e.g., don’t share your toothbrush or razors).
• Adequate screening of donated blood and blood products before use for HBV.
• Routine testing of pregnant women.
• Testing for at-risk people. E.g., migrant workers from endemic areas, healthcare workers, those in close contact with infected individuals, sex workers, those with HIV, and those who are incarcerated.

Stay tuned for new advances

Testing on new vaccine formulations is still ongoing in an effort to increase vaccine efficacy and better serve the needs of elderly and immunocompromised people.

The international medical community is focused on this illness because infectious diseases without wildlife reservoirs (species that maintain the virus outside the human population) can be completely eradicated, like smallpox. Eradication is possible but will require international cooperation, improved immunization campaigns, and funding.

Hepatitis B – global eradication is feasible

Consider getting vaccinated against HBV if you have not already. The vaccination is safe and effective, and HBV can be easily avoided. In the United States, vaccination against HBV is standard practice for infants and has become a part of the common childhood immunization programs.

If you’re pregnant, undergo screening to make sure your unborn child is not at risk. If you aren’t vaccinated but plan to travel to areas with high disease infection rates, consider vaccination.

Despite being easily avoidable, HBV can result in fatal infections, cancer, and other serious illnesses. By improving vaccination rates, overall vaccine access, and increasing awareness, this disease could be eradicated in the future. Any disease we can eliminate is worth preventing. As there is currently no cure, prevention is the key. If you are at risk, get screened frequently and steer clear of high-risk activities.