Hepatitis B
Tuesday, August 11, 2009 at 12:30PM
Hepatitis means inflammation of the liver. Viruses are the commonest cause but drugs and alcohol can also disturb the bodies immune system.
The hepatitis B virus is very common, and the World Health Organisation estimate that there are 350 million people chronically infected world wide and of these 2 million people die each year, but the prevalence of infection in the UK is amongst the lowest in the world, and most of the infections are acquired through adult risk behaviours. In England and Wales, injecting drug use and homosexual contact are the most frequently reported routes of transmission.
Hepatitis B virus (HBV) infection causes acute symptoms disease in less than 10% of infected children and 30% of adults, and HBV infection can resolve. Other high risk groups are infants born to infectious mothers and ethnic minorities. Acute infections in UK residents cause less than 10% of all new chronic infections with the majority being attributable to immigrant carriers. The remaining infections are then split between 85% of infections in newborns and 4% in adults become chronic and potentially can lead to cirrhosis or cancer of the liver.
"Section of liver damaged by HBV. Note the enlarged cells and blistering of the capsular surface."
Normal liver. It has a fine lobular texture and smooth capsular surface
Transmission
Sharing or using contaminated equipment during injecting drug use.
Vertical transmission, from an infectious mother to her unborn child, either before or during birth, or through breast feeding.
Sexual transmission.
Receipt of infected blood or blood products.
Needlestick or other sharps injury, (inparticular those sustained by healthcare workers).
Tattooing and body piercing.
Incubation
40 to 160 days
Infectivity
Highly infectious during the development of antibody and antigen development when the patients blood and body fluids contain potentially replicating virus components. If a person fails to develop antibodies then their blood remains significantly infectious.
Symptoms
Jaundice in a man with hepatic failure.
A short, flu like illness, including sore throat, tiredness, joint pain and loss of appetite.
Fatigue.
Nausea and vomiting.
Diarrhoea.
Loss of weight.
Jaundice.
Itchy skin.
Complications
Failure to clear the infection in 6 months leads to chronic carrier state. Many people who become chronic carriers have no symptoms and are unaware that they are infected. These people will remain infectious and will be at risk of developing cirrhosis and primary liver cancer.
Diagnosis
Blood test
Treatment
Alpha interferon an antiviral drug, or lamivudine a drug which has antiviral properties.
Prevention
Vaccination.
Precautions
Follow Standard Principles, use personal protective equipment, gloves and aprons.
Take care when handling infective materials, all body fluids and when handling soiled bed linen and clothing.
Wash hands thoroughly.
If working in a high risk environment, hospital, care home, prison, probation hostel or with homeless ensure that you are vaccinated.
References
Health Protection Agency, 2008, General Information on Hepatitis B.
Health Protection Agency, 2007, Infections among injecting drug users in the UK.
Infectious Diseases, 1996, Banister, Begg and Gillepsie. Blackwell Science Ltd.
World Health Organization Hepatitis B.
July 2009