Hepatologist "SM-Clinic" answered questions about viral hepatitis B

Viral hepatitis B in adults is a serious infectious disease that can cause severe liver damage. Is it possible to cure this pathology? What does each of us need to know about hepatitis B?

A few numbers. In 90% of cases, hepatitis B is cured. But 10% of people remain carriers of the virus after treatment - their blood can be infected for months, years, and sometimes for life. Why the virus remains with them is not known for certain.

70% of carriers develop chronic persistent hepatitis B. They look healthy, the liver does not bother them, or it makes itself felt, but extremely rarely. The remaining 30% of carriers constantly suffer from liver disease. They may eventually develop cirrhosis and then, 30 to 40 years later, liver cancer.

There is currently no treatment for carriers. The risk of becoming a chronic carrier is inversely proportional to the age of the infected person. For example, infants become carriers in 90 - 95% of cases, while adults will become carriers in only 3 - 10%.

What is viral hepatitis B

Viral hepatitis is an infectious disease that primarily affects the liver.
The provocateur of this infection is the hepatitis B virus (HBV), which enters the body through blood, saliva or semen, and then travels through the bloodstream to the liver. The body has several defense mechanisms to fight disease. White blood cells, which protect the body from infections, attack and destroy infected liver cells. In addition, our immune system produces antibodies that circulate in the blood to destroy the virus and protect against subsequent infection.

The incubation period (the time between initial exposure to the virus and the onset of illness) for hepatitis B ranges from 60 to 150 days. Symptoms appear on average 90 days after infection.

Routes of transmission of viral hepatitis B in adults

Blood is the main source of hepatitis B virus. It can also be found in other tissues and body fluids, but in lower concentrations.
The hepatitis B virus can be transmitted in several ways.

Through blood.

This may happen in the following cases:

• punctures of the skin with infected needles, lancets, scalpels or other sharp objects;
• direct contact with open sores of an infected person;
• splashes of infected blood on the skin with minor scratches, abrasions, burns or even minor rashes;
• splashes of blood on the mucous membranes of the mouth, nose or eyes;
• using other people's toothbrushes or razors.

Contact with surfaces contaminated with blood can also cause illness, but to a lesser extent.
By the way, the virus can remain stable in dried blood for up to 7 days at 25 °C.

Hand contact with blood-contaminated surfaces such as laboratory benches, test tubes, or laboratory instruments can transmit the virus to the skin or mucous membranes.

Through saliva.

The saliva of people with hepatitis B may contain the virus, but in very low concentrations compared to blood. Nevertheless, infection is possible, for example, through bites.

But it is impossible to become infected through dishes or mouthpieces (smoking or musical instruments) - such cases have not been registered.

Through semen or vaginal secretions.

Hepatitis B is found in semen and vaginal secretions. The virus can be transmitted during unprotected sex and from mother to child during childbirth.

Feces, nasal discharge, sputum, sweat, tears, urine, and vomit do not spread hepatitis B. Unless they are contaminated with blood, the risk of contracting hepatitis B from these fluids is very low.

Synovial fluid (lubricant for joints), amniotic fluid, cerebrospinal fluid, and peritoneal fluid (found in the abdomen) may contain hepatitis B virus, but the risk of transmission is unknown.

Hepatitis B is not spread by sneezing, coughing, shaking hands, hugging, kissing, breastfeeding, or sharing cutlery, water, or food.

Vaccination against viral hepatitis B

Viral hepatitis is one of the most unpredictable infectious diseases. The disease first affects the liver, and then the skin, blood vessels, other digestive organs and the nervous system are involved in the painful process. Because of the high likelihood of encountering the virus, babies are vaccinated in the first days of their lives. Several years after revaccination, immunity against the hepatitis B virus weakens, so everyone can encounter it again.

What kind of disease is hepatitis B?

About 5% of the world's population suffers from viral hepatitis B. But in some countries this figure needs to be multiplied by 4. The main source of hepatitis B infection are sick people and virus carriers. For infection, it is enough for only 5 to 10 ml of infected blood to come into contact with the wound. The main routes of infection with hepatitis B:

• sexual - with unprotected sexual intercourse;
• infection occurs through vascular damage: cuts, abrasions, cracks on the lips, if there is bleeding gums;
• parenteral route, that is, through medical manipulations or injections: with blood transfusions, injections with one non-sterile syringe, like drug addicts;
• The vertical route of transmission of hepatitis B is from mother to child at birth.

How does hepatitis B manifest?

1. A person is worried about severe intoxication: lack of sleep, fatigue, loss of appetite, nausea and vomiting.
2. There is a feeling of pain in the liver and heaviness in the epigastric region.
3. Yellow discoloration of the skin and sclera.
4. Severe itching of the skin.
5. Damage to the nervous system: irritability or euphoria, headaches, drowsiness.
6. Later, blood pressure begins to decrease, and the pulse becomes rare.

This condition may last for several months. If you're lucky, everything ends in recovery. Otherwise, dangerous complications arise:

• bleeding;
• acute liver failure;
• damage to the bile ducts, addition of additional infections.

Should adults be vaccinated against hepatitis B? - yes, since hepatitis B is a chronic disease, once infected, a person will never get rid of it. At the same time, the susceptibility of people around to the virus is high, and the symptoms of hepatitis go away slowly. Vaccination against hepatitis B for adults is necessary to avoid contracting this dangerous disease. This is the only way to prevent the disease.

Indications for vaccination

First of all, children are vaccinated immediately after birth, except for those who have contraindications. After revaccination (at 6 or 12 months), immunity is unstable and persists for five, maximum six years. Adults are vaccinated depending on the indications.

Who is being vaccinated? - all adults at risk.

1. People whose family has a virus carrier or a sick person.
2. Medical students and all healthcare workers.
3. People with severe chronic diseases who regularly receive blood transfusions.
4. Previously unvaccinated people who have not had viral hepatitis B.
5. Adults who have had contact with virus-contaminated material.
6. People whose work involves the production of blood products.
7. Preoperative patients if they have not been vaccinated before.
8. Vaccination of oncohematological patients.

Contraindications to hepatitis B vaccination for adults are:

1. Pregnancy and lactation period.
2. Reaction to previous vaccine administration.
3. Intolerance to one of the components of the drug.
4. Acute infectious diseases.
5. Exacerbation of chronic diseases. Vaccination is recommended during the period of normalization of the condition.

Adults tolerate hepatitis B vaccination well, but due to the individual characteristics of the body, the following reactions may occur:

• soreness and inflammation at the site of vaccine administration;
• tissue compaction, scar formation;
• the general reaction may manifest itself as fever, weakness, and malaise.

What complications can occur in adults after receiving the hepatitis B vaccine?

1. Pain in the joints, stomach or muscle area.
2. Nausea, vomiting, loose stool, tests may show an increase in liver parameters.
3. General and local allergic reactions: itching of the skin, the appearance of a rash in the form of urticaria. In severe situations, it is possible to develop angioedema or anaphylactic shock.
4. Isolated cases of nervous system reactions have been reported: convulsions, neuritis (inflammation of peripheral nerves), meningitis, motor muscle paralysis.
5. Sometimes there is an increase in lymph nodes, and in a general blood test the number of platelets decreases.
6. Fainting and a temporary feeling of shortness of breath are possible.

If the symptoms are not pronounced, bother you for several hours and go away on their own, don’t worry. In case of long-term persistent complaints, it is necessary to consult a doctor and notify the health workers who administered the hepatitis B vaccination about the occurrence of a reaction to the vaccine. How to avoid such situations? It is important to learn how to behave correctly before and after vaccination.

1. Vaccinations must be planned in advance. The need for vaccination is announced several days in advance. To ensure minimal side effects from the hepatitis B vaccine in an adult, it is better to get it before the upcoming weekend. It is advisable to stay at home during this difficult period for the body, when the immune system is under severe strain.
2. After vaccination, do not plan an active holiday with friends or family, try not to visit places with a lot of people, and stock up on food for the weekend in advance.
3. Be sure to undergo the required examination by a doctor before immunization, and 30 minutes after vaccination, remain under the supervision of the health care worker who administered the vaccine.
4. Do not wet the injection site for at least 24 hours.
5. Together with your doctor, you need to choose the optimal schedule for vaccination against hepatitis B for adults and discuss the possibility of using symptomatic medications in case of complications.

Do adults need a hepatitis B vaccine? Yes, if he is at risk and may encounter patients with hepatitis B. A mild course of the disease will not save a person from possible complications. It is much easier to deal with a reaction to a vaccine than to spend months treating viral hepatitis in case of infection.

Where to get vaccinated?

In the immunoprophylaxis office at the Pruzhany Central Regional Hospital, you can get vaccinated against hepatitis B. For information, call 2-31-57.

Be healthy!

Symptoms of viral hepatitis B in adults

The main symptoms of hepatitis B include:

• dark urine;
• clay-colored stool (gray-white);
• jaundice;
• heat;
• joint pain;
• abdominal pain;
• fatigue;
• lack of appetite;
• nausea, vomiting.

Symptoms may vary depending on the person's age.
Many people may not show symptoms (asymptomatic disease). A very small proportion of patients develop a critical form of the disease called fulminant hepatitis B. This condition occurs as a result of a sudden loss of liver function.

What is an allergy to a vaccine?

Traditionally, allergic reactions to vaccines can be divided into local and general.

• Locally, redness at the injection site and the formation of a small compaction are possible. If the diameter of the red spot does not exceed 2.5 cm, then the allergic reaction is considered mild and does not require contact with an allergist. If the diameter of the spot is more than 2.5 cm, but less than 5, then this reaction is considered average. When a red lump more than 5 cm in diameter forms, the allergic reaction is considered severe and requires immediate consultation with a specialist.
• Among the common reactions that occur after vaccination against hepatitis B, it is worth noting a slight rise in temperature, fatigue, headache and aches in muscles and joints, dizziness and nausea. The severity of these reactions is traditionally determined depending on the temperature indicator. Up to 37.50C – weak reaction, up to 38.50C – medium and further – high.

It is worth noting that the previously described cases of autism or multiple sclerosis after the administration of a hepatitis vaccine do not refer to allergic reactions. In addition, these cases were never properly confirmed in medical practice, since they were not accompanied by the appropriate evidence base.

Modern methods of treatment

Currently, there is no specific treatment for patients with acute hepatitis B. The acute infection is usually short-lived and often goes away on its own, due to the immune system.
Your doctor may recommend rest and proper nutrition and fluids to help your body fight the infection. Hospitalization may be required for patients who experience severe vomiting and are unable to maintain adequate nutritional levels. This may also be necessary to prevent the development of complications.

Although a chronic infection cannot be cured, there are two standard treatments that will help control the virus and prevent further liver damage:

• liver transplantation – this may be recommended in cases where the liver is seriously damaged;
• antiviral drugs, for example, Interferon - this is prescribed for a short period of time to suppress the virus.

“Antiviral therapy for chronic hepatitis B is carried out if there are certain indications,” says infectious disease specialist, hepatologist Tatyana Kovaleva.
– The specialist assesses the level of viral load, changes in liver enzymes, the degree of liver damage based on the results of ultrasound examination (ultrasound) of the abdominal organs and liver elastography (fibroscan) and then makes a decision. If antiviral therapy is prescribed, it is carried out over a long period of time, and in some cases permanently. Modern antiviral drugs lead to remission of the disease, prevent the progression of liver damage and the development of deaths. “Despite the successes of modern therapy, it is currently impossible to completely eliminate the hepatitis B virus from liver cells, since the DNA of the virus can integrate into the genetic apparatus of liver cells,” continues Dr. Tatyana Kovaleva. “Therefore, even with complete clinical recovery and the absence of the hepatitis B virus in the blood, it remains in the liver cells for life. With a pronounced decrease in immunity (use of immunosuppressive therapy, hormones, cytostatics, etc.), the hepatitis B virus can become active, which will require the re-prescription of antiviral therapy.

Prevention of viral hepatitis B in adults at home

The most reliable prevention is vaccination.
Since 2000, it has been administered to all children, starting at birth. And more recently, for adults too. Vaccines provide safe and reliable protection—tests show that 90 to 95% of vaccinations in healthy people result in resistance to hepatitis B. Hepatitis B vaccination is safe. Side effects are usually minor, most often soreness at the injection site.

A contraindication to vaccination is an allergy to any ingredients of the vaccine.

Popular questions and answers

Infectious disease specialist and hepatologist Tatyana Kovaleva answered our questions related to hepatitis B.

What complications can there be with viral hepatitis B?

Acute hepatitis B in some people occurs with the development of jaundice and may be accompanied by severe liver damage with the development of liver necrosis.
In most adults, acute hepatitis B is asymptomatic without any clinical manifestations and ends with self-recovery. Only in 5 - 10% of adult patients the disease becomes chronic and continues for many years. This condition is called “chronic carriage of the virus” or “chronic hepatitis B”.

Because infection with the hepatitis B virus is often not accompanied by the development of jaundice, many patients are unaware that they have this disease. Chronic hepatitis B is often diagnosed during routine examination, including during pregnancy. If chronic hepatitis B is detected in a pregnant woman, she can pass the infection to her child. Currently, it is recommended to monitor the level of viral load during pregnancy; if high levels are detected, the pregnant woman is prescribed preventive antiviral therapy. If the child has not been vaccinated after birth, the risk of contracting the hepatitis B virus from the mother can reach 90% or more. In childhood, the risk of the disease becoming chronic is 30 - 98%.

If chronic hepatitis B is detected, constant monitoring by a specialist is necessary.

Many people with chronic hepatitis B may not have any symptoms for a long period of time. However, after a few years without antiviral therapy, severe manifestations of hepatitis may develop - liver cirrhosis or liver cancer (hepatocellular carcinoma). Weight loss, increased fatigue, and yellowing of the skin and sclera may indicate progression of the disease.

When to call a doctor at home for viral hepatitis B?

If jaundice develops, sleep disturbances, deterioration in health, swelling in the legs or development of ascites (increase in the size of the abdomen), darkening of the urine, you must call a doctor at home. The doctor will assess the severity of the patient’s condition and the need for his hospitalization in an infectious diseases hospital.

HEPATITIS B

(serum hepatitis) is a liver disease caused by the hepatitis B virus. It is transmitted through the blood, and extremely rarely through other body fluids. It is considered an “occupational disease” of drug addicts who share needles for intravenous drug use. The disease is characterized by icteric discoloration of the skin and sclera, darkening of urine, and discoloration of feces. Almost 100% of those infected with hepatitis B recover without any consequences, acquiring lifelong immunity. Hepatitis B is dangerous for infants (it leads to chronic hepatitis resulting in cirrhosis or liver cancer), but cases of it in this age group are, rather, incidental. The hepatitis B vaccine can safely be considered as one of the most dangerous in terms of the number of severe post-vaccination complications it causes, a huge number of which, including autoimmune ones, are well documented in the scientific literature, and ineffective (after just a few years the number of “protective” antibodies sharply decreases or the antibodies disappear at all).

ARTICLES ABOUT HEPATITIS B VACCINATION

Hepatitis B: Testimony of Michael Belkin Hepatitis B: Testimony of Prof. Bonnie Dunbar Hepatitis B: Testimony from Betty Flak Hepatitis B: Testimony from Patty White Be vigilant! (article by P. Pedzhdu) Case of Caryn Hawkins (transcript of the hearing) Should children be vaccinated against hepatitis B? (article by Dr. M. Girard) Letter from a pathologist regarding mandatory hepatitis B vaccination (letter from a doctor) Why are mandatory hepatitis B vaccinations continued? (article by E. Maniotis et al.) Hepatitis B vaccine: what's wrong? (article by Dr. E. Yazbak) The first cancer vaccine: facts and ineffectiveness (article by Dr. E. Yazbak) Multiple sclerosis and hepatitis B vaccination (article by J. Komange and Dr. M. Girard) Analysis of infant deaths, following primary hepatitis B vaccination, based on the Vaccine Adverse Event Reporting System (VAERS), 1992–2002 (article by V. Soldatenkova and Dr. E. Yazbak) Autoimmune risk of hepatitis B vaccine (article by Dr. M. Girard ) New study: hepatitis B vaccine triples the risk of autism in boys (article by D. Kirby) Another vaccine, another lie, another day in government (article by K. England) Hepatitis B: information mayhem, Hepatitis B - Alaska, Reactions to the hepatitis B vaccine - a saga of lies? (chapters from Peter and Hilary Butler's Just a Jab) Hepatitis B Vaccine and Autoimmune Diseases (from Dr. Richard Moskowitz's article "Unseen at First Look: The Role of Vaccination in Chronic Disease")