Hepatitis B: symptoms

It is a disease of viral origin that can occur in acute or chronic form. Here’s how it manifests itself.

Hepatitis B is a viral disease that affects the liver. It is triggered by the hepatitis B virus (HBV) which, after an acute infection, can also lead to the development of a chronic form of the disease.

Belonging to the Hepadnaviridae family, the hepatitis B germ is a virus formed by DNA of which six different types (genotypes A-F) are currently known distributed in different areas of the world.

According to data from the European Centre for Disease Prevention and Control (ECDC), in 2014 in the states belonging to the European Economic Area (EEA, to which more than 22,000 infections by this virus belong, for an incidence of 4.2 cases per 100,000 inhabitants. Among these, 11.9% corresponded to acute infections and 64% to chronic infections, while the remaining 24.1% were not classified.

In most cases (33.8%) the virus affected individuals aged between 25 and 34 years; Men were more at risk of contracting the infection than women, with a male/female ratio of 1.5:1.

The possibility that hepatitis B becomes chronic varies depending on the age at which the infection is contracted: in adults it is around 5-10% of cases, while at a young age the risk is greater, so much so that in newborns exposed to the virus shortly after birth it reaches about 90%.

The incidence of the disease appears to have been steadily decreasing since 2006, probably due to the effectiveness of national vaccination programs. However, cases of chronic hepatitis have increased over the years; According to experts, this could be due to better reporting of the pathology and an increase in diagnostic procedures.

In this scenario, it is still essential both to monitor the incidence of infection in the population and to carry out initiatives to prevent and control the disease.

Symptoms of hepatitis B

Acute forms of hepatitis B do not always trigger clear symptoms in all infected individuals; To show them is about 70% of adults who contract the infection, while in many cases younger children may have to deal with asymptomatic, but still contagious forms.

In general, symptoms are more frequent from 5 years of age. They may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal, muscle and joint pain, dark urine, clay-colored stools, and jaundice (i.e., yellowing of the skin and whites of the eyes).

The latter is not the most common symptom; in fact, according to data released by the Higher Institute of Health, only 30-50% of adults and 10% of children affected by acute infections manifest it.

The disease is fatal in only 1% of cases, although this percentage increases over 40 years of age.

On average, about 90 days pass from infection to the onset of symptoms, but they can occur in a period of time varying between 6 weeks and 6 months after transmission of the virus. When they appear very quickly we speak of fulminant hepatitis.

Usually the disorders persist for a few weeks, but some people may suffer from it for up to 6 months.

Chronic forms of hepatitis B may be associated with symptoms similar to those of acute infections. However, most chronic patients do not deal with disorders associated with the virus for even 20 or 30 years.

However, the situation should not be underestimated. In fact, in a variable percentage between 15 and 25% of cases, chronic hepatitis B evolves into serious liver diseases, such as cirrhosis (a condition in which liver tissues undergo fibrosis) or liver cancer (with a higher risk of cancer in cases of cirrhosis).

What’s more, symptoms may be lacking even when the health of the organ begins to be compromised. However, appropriate blood tests can help to keep the situation under control.

Contagion

Hepatitis B can be contracted through contact with the blood or body fluids of individuals infected with the virus (seminal fluid, vaginal fluids or saliva).

Transmission of the virus can for example occur through needles contaminated with infected blood, or through deep woundssexual intercourse or contact of infected fluids with the skin, eyes or mouth (for example, by exchanging toothbrush or razor with an infected individual). In addition, transmission of the virus from mother to fetus before or during childbirth is also possible.

Thanks to the controls carried out on donated blood in industrialized countries, the risk of contagion through transfusions has been practically eliminated.

However, some individuals are exposed to a particularly high risk of contracting the virus:

  • Drug addicts
  • those who have unprotected sex
  • who has been on dialysis for a long time
  • Healthcare professionals
  • family members of infected individuals
  • those who undergo practices that require the use of needles and syringes that should be properly sterilized before use (such as performing tattoos or piercings, but also manicures and pedicures).

Diagnosis

If symptoms or other clues suggest the possibility of hepatitis B, your doctor may order some blood tests to ascertain the diagnosis.

Both acute and chronic infections can be recognized by the presence of a protein normally located on the surface of the virus (hepatitis B surface antigen, HBsAg) and specific antibodies.

In particular, anti-HBs is an antibody produced by the body in response to the presence of the surface antigen HBsAg; its presence may indicate that the individual has already defeated an acute infection, becoming immune to subsequent infections by HBV, or that he has been vaccinated against the virus.

Anti-HBc are antibodies that recognize another portion of the virus (the so-called core antigen); Their presence may indicate a past or ongoing infection. In particular, the presence of anti-HBc antibodies of the IgM class is used to detect an acute infection contracted no later than 6 months before the analysis.

Finally, the presence of the HbeAg protein (hepatitis B “e” antigen) indicates high levels of virus in the patient’s blood (which can then transmit it to other people) and can help monitor the effectiveness of therapy against chronic hepatitis B.

The detection in the blood of antibodies directed against this antigen (anti-HBe) is instead indicative of chronic hepatitis B at low risk of liver complications, while that of HBV DNA reveals that the virus is actively multiplying, that the infection is contagious and, in the case of chronic forms, that an increased risk of liver damage is possible.

Hepatitis B: how is it treated?

Unless it is severe, acute hepatitis B does not require any type of specific treatment; In most cases, acute problems resolve in 2-3 weeks and the liver returns to normal conditions in a period of time varying between 4 and 6 months.

The cure consists of rest, plenty of fluid intake and healthy eating, but in some cases hospitalization may be necessary.

Chronic forms may require taking antiviral drugs that help fight the presence of the virus in the blood. Alcohol consumption should be avoided altogether and it is important to be careful with any medications and supplements taken, because they could damage the liver.

Antiviral medications are typically given when liver function is deteriorating, when symptoms of long-term liver damage appear, and when blood levels of HBV are elevated.

Finally, liver transplantation may be necessary in case of liver failure.

Prevention

Hepatitis B can be effectively prevented not only through an adequate lifestyle, but also thanks to a safe and effective vaccine.

According to the World Health Organization (WHO) it is precisely this vaccination that allows, today, to maintain the incidence of chronic HBV infections in children under the age of 5 at such low levels.

Administered in multiple boosters, the hepatitis B vaccine stimulates the immune system to protect the body from HBV by producing specific antibodies against this virus, conferring long-lasting immunity.

The vaccination calendar included in the Pnpv (National Vaccine Prevention Plan) 2017-2019 provides for the administration of 3 doses of the viral hepatitis B vaccine in the first year of life, with vaccination obligation for those born from 2001.

First dose Second dose Third dose
3rd month 5rd month 11rd month

However, in the case of children of HBsAg positive mothers, the first administration should take place within the first 12-24 hours of life and should be associated with that of specific antibodies, the second at 4 weeks after the first and the third from the 61st day of life.

In addition, according to the Higher Institute of Health, thehepatitis B vaccine is strongly recommended for the categories of people most at risk, such as drug addicts, health workers and those living with chronic carriers of the virus.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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