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Hepatitis B is caused by the Hepatitis B virus (HBV). This is a small DNA virus that belongs to a group of hepadnaviruses. The virus is made up of a nucleocapsid and an outer envelope composed mainly of three hepatitis B surface antigens (HBsAgs) that play a central role in the diagnosis of HBV infection (Baumert, et. al 2007). It is thought that this virus causes inflammation of the liver by inducing apoptosis (programmed cell death) which then causes HBV-induced liver injury. (Baumert, et. al 2007).
CDC, 2009 This summary adapted from the Centers for Disease Control is very helpful in understanding the progression of disease. HBsAgs: If there are high levels of these HBsAgs, a person may have an acute or chronic infection. If a person has HBsAg in their blood it means that person is infectious. Hepatitis B surface antibody (anti-HBs): The presence of anti-HBs generally indicates recovery and immunity from HBV infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B. Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with HBV in an undefined time frame. IgM antibody to hepatitis B core antigen (IgM anti-HBc):Positivity indicates recent infection with HBV (≤6 months). Its presence indicates acute infection. Hepatitis B e antigen (HBeAg): A product of the nucleocapsid gene of HBV that is found in serum during acute and chronic hepatitis B. Its presence indicates that the virus is replicating and the infected person has high levels of HBV. Hepatitis B e antibody (HBeAb or anti-HBe): Produced by the immune system temporarily during acute HBV infection or consistently during or after a burst in viral replication. Spontaneous conversion from e antigen to e antibody (a change known as seroconversion) is a predictor of long-term
clearance of HBV in patients undergoing antiviral therapy and indicates lower levels of HBV. 2008) . which can result in cirrhosis. hepatocellular cancer. (CDC. means continuous damage to the liver. liver failure. the person is said to be chronically infected. If a person is unable to clear the hepatitis B virus from their system after a period of time. Patients infected during childhood are at greatest risk for developing chronic hepatitis B infection. and even death. Chronic infection.
Hepatitis B vaccine is 95% effective in preventing HBV infection and its chronic consequences. extreme fatigue. Symptoms Hepatitis B virus can cause an acute illness with symptoms that last several weeks.not through casual contact. and is the first vaccine against a major human cancer. an estimated two billion people have been infected with the hepatitis B virus (HBV). HBV can also cause a chronic liver infection that can later develop into cirrhosis of the liver or liver cancer. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer. Most people in the region become infected with HBV during childhood. About 25% of adults who become chronically infected during childhood die from HBV-related liver cancer or cirrhosis.Hepatitis B Fact sheet N°204 Revised August 2008 Key facts Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. Where is hepatitis B most common? Hepatitis B is endemic in China and other parts of Asia. The hepatitis B virus is 50 to 100 times more infectious than HIV. and a major cause of cancer in women. dark urine. 8% to 10% of the adult population are chronically infected. Hepatitis B virus is an important occupational hazard for health workers. Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. In these regions. . with young children who become infected with HBV being the most likely to develop chronic infections. an estimated 2% to 5% of the general population is chronically infected. Worldwide. About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. About 90% of infants infected during the first year of life develop chronic infections. vomiting and abdominal pain. About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection. Hepatitis B is preventable with a safe and effective vaccine. In the Middle East and Indian sub-continent. Who is most at risk for chronic disease? The likelihood that an HBV infection will become chronic depends upon the age at which a person becomes infected. including yellowing of the skin and eyes (jaundice). 30% to 50% of children infected between one to four years of age develop chronic infections. Liver cancer caused by HBV is among the first three causes of death from cancer in men. The virus is transmitted through contact with the blood or other body fluids of an infected person . nausea. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B. It is a major global health problem and the most serious type of viral hepatitis. About 90% of healthy adults who are infected with HBV will recover and be completely rid of the virus within six months. People can take several months to a year to recover from the symptoms. and more than 350 million have chronic (long-term) liver infections. Less than 1% of the population in western Europe and North American is chronically infected. High rates of chronic infections are also found in the Amazon and the southern parts of eastern and central Europe. A vaccine against hepatitis B has been available since 1982.
The virus incubation period is 90 days on average. Liver cancer is almost always fatal. During that time. protection following the primary vaccination series drops below 90%. the first dose of vaccine should be given as soon as possible after birth (i. Treatment can cost thousands of dollars per year and is not available to most patients in developing countries. All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. Today. HBV is not spread by contaminated food or water. HBV may be detected 30 to 60 days after infection and persist for widely variable periods of time. including replacement of fluids that are lost from vomiting and diarrhoea. In areas where mother-to-infant spread of HBV is common. with varying success. protective antibody levels are achieved in only 65 to 75% of those vaccinated. but can vary from about 30 to 180 days. People in high risk groups should also be vaccinated. including interferon and anti-viral agents. and cannot be spread casually in the workplace. including: persons with high-risk sexual behaviour.Transmission Hepatitis B virus is transmitted between people by contact with the blood or other body fluids (i. At 60 years old. patterns of transmission are different than those mentioned above. partners and household contacts of HBV infected persons. HBV can survive outside the body for at least 7 days. In higher income countries. Chronic hepatitis B can be treated with drugs. those in western Europe and North America). . the virus can still cause infection if it enters the body of a person who is not infected. HBV is a major infectious occupational hazard of health workers. most people with liver cancer die within months of diagnosis. as part of existing routine immunization schedules. Protection lasts at least 20 years and should be lifelong. including health care workers. persons who frequently require blood or blood products. the majority of infections in these countries are transmitted during young adulthood by sexual activity and injecting drug use. recipients of solid organ transplantation. Common modes of transmission in developing countries are: perinatal (from mother to baby at birth) early childhood infections (inapparent infection through close interpersonal contact with infected household contacts) unsafe injections practices blood transfusions sexual contact In many developed countries (e. within 24 hours). semen and vaginal fluid) of an infected person. Care is aimed at maintaining comfort and adequate nutritional balance. The vaccine can be given as either three or four separate doses. injecting drug users. In developing countries.g. After age 40.e. surgery and chemotherapy can prolong life for up to a few years in some patients. Patients with cirrhosis are sometimes given liver transplants. Modes of transmission are the same for the human immunodeficiency virus (HIV). and often develops in people at an age when they are most productive and have family responsibilities. but HBV is 50 to 100 times more infectious Unlike HIV. Prevention All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis B prevention.e. which can help some patients. children and young adults. Treatment There is no specific treatment for acute hepatitis B. and international travellers to countries with high rates of HBV. those at occupational risk of HBV infection. The complete vaccine series induces protective antibody levels in more than 95% of infants.
and narrowly focused HBV-specific T-cell responses. seems to be primarily involved in disease pathogenesis. Pathophysiology The virus does not directly kill hepatocytes. vaccination has reduced the rate of chronic infection to less than 1% among immunized children. over one billion doses of hepatitis B vaccine have been used worldwide.The vaccine has an outstanding record of safety and effectiveness. the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B. In many countries where 8% to 15% of children used to become chronically infected with HBV. most HBV DNA is cleared from hepatocytes through non-cytocidal effects of inflammatory byproducts of CD8+ T lymphocytes. and trigger direct lysis of infected hepatocytes by HBV-specific CD8+ cytotoxic T cells.  . In acute HBV infection. stimulated by CD4+ T lymphocytes.  The cellular immune response. infrequent.a major increase compared with 31 countries in 1992. rather than the humoral immune response. These cause down-regulation of viral replication. notably interferon-gamma and tumour necrosis factor-alfa. These antigen-specific T cells mature and expand and then migrate to the liver. Since 1982. people with chronic HBV infection display weak.  The host's immune response to viral antigens is thought to be the cause of the liver injury in HBV infection. and the majority of mononuclear cells in livers of chronic HBV-infected people are non-antigenspecific. 164 countries vaccinate infants against hepatitis B during national immunization programmes .  In contrast. As of December 2006. Induction of antigen-specific T-lymphocyte response is thought to occur when host T lymphocytes are presented with viral epitopes by antigen-presenting cells in lymphoid organs.
Hepatitis B virus infection . the integration of HBV DNA to the hepatocyte nucleus during replication process could explain increased risk for hepatocellular carcinoma. Prince AM. Covalently closed circular DNA serves as a template for transcription of pregenomic messenger RNA. used with permission Due to the presence of HBV in extrahepatic sites.Life cycle of HBVFrom Ganem D. 2004. In addition. as well as the presence of covalently closed circular DNA (cccDNA) within hepatocytes.natural history and clinical consequences. eradication of the virus is an unrealistic goal based on the currently available drugs. a vital initial step in HBV replication. . N Engl J Med. Unfortunately.        Persistence of even low levels of cccDNA in the hepatocyte nucleus has been shown to correlate with viral rebound after discontinuation of therapy.    The continued presence of cccDNA within hepatocytes is considered as a marker of viral persistence. current therapies have not been effective in eradicating cccDNA and are only able to decrease levels. 350:1118-1129.
1. 2.About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. host genetic factors. Hepatitis B can be directly transmitted by person to person contact via infected body fluids.The natural history of HBV infection has been classified into 4 phases. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B. and level of immunosuppression. About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection. or HIV co-infection. with clearance of virus from the blood and liver.  which are influenced by age of infection. 95% of those infected become asymptomatic chronic HBV carriers. Hepatitis B is preventable with a safe and effective vaccine. Period of Communicability: The patient is capable of transmitting the virus during the latter part of the incubation period and during the acute phase. It can also be transmitted through sexual contact. hepatitis D. 3. HBV infects the liver and possibly the pancreas. . and lasting immunity to re-infection. 3. Mode of Transmission: 1. Transmission can occur through infected blood or body fluids introduced at birth. 2.  Hepatitis B is the inflammation of the liver caused by hepatitis B virus. Hepatitis B virus is an important occupational hazard for health workers. HbsAg appears in the blood 30 to 60 days after exposure and persists for variable periods of time. It can be transmitted though contaminated needles and syringes.  Patients who develop chronic HBV have a 10% to 30% risk of developing cirrhosis. Etiologic Agent: The disease is caused by Hepatitis B virus 1. particularly older patients with high levels of HBV DNA. presence of other viruses. 4. However. HBV mutations. by fecal-oral route by food-borne or water-borne transmission by arthropod (mosquito) transmission. Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.  Most (70%) of primary infections with HBV in adults are asymptomatic and self-limiting. This is considered to be more serious than hepatitis Adue to the possibility of severe complications such as massive damage and hepatocarcinoma of the liver. HBV transmission does not occur. This virus has very limited tissue tropism 2. 3. The hepatitis B virus is 50 to 100 times more infectious than HIV. compared with 30% of children infected over the age of 6 years. The virus may persist in the blood for many years. Incubation Period: The incubation period is 50 to 189 days or two to five months with a mean equal to 90 days. In neonates with immature immune systems. or patients with hepatitis C. about 30% of adults with acute HBV may have symptomatic icteric hepatitis.
7. malaise. Nausea. The virus replicates and large amount of HbsAg is released into the blood. 5. but symptoms may not be observed for 45 days or much longer. 5. Hands and other skin areas must be washed immediately and thoroughly after contact with body fluids. and anorexia. 6. Fever. Initiation of virus replication may be as short as three days from acquisition. 6. 2. fever and chills. 4. especially in hepatocytes. and other instruments that may be contaminated with blood. Production of virus and high level of HbsAg is continuous and the particles are found in the blood until the infections is resolved. Have adequate rest. 4. Avoid sharing of toothbrush. 4. and pale stools. and exercise and eat nutritious food. sleep. Jaundice. 3. by prick or by inoculation. Caution must be observed in giving care to patients with known HBV. Compliment fixation test Radio-immunoassay-hemaglutinin test Liver function test Bile examination in blood and urine Blood count Serum transaminase – SGOT. Diagnostics Procedures: 1. vomiting. the liver parenchyma shows degenerative changes consisting of cellular swelling and necrosis. SGPT. Hepatitis Immune Globulin (HBIg) should be administered within 72 hours to those exposed directly to hepatitis B virus either by ingestion. dark urine. Observe “safe sex”. 2. HBV can cause acute or chronic hepatitis. Recovery is indicated by a decline of fever and improved appetite. 6. 2. abdominal discomfort. Use disposable needles and syringes only once and discard properly. The virus must be delivered into the liver to establish infection. More About Hepatitis . 9. 3.Pathogenesis: 1. Prevention: 10. 5. ALT HbsAg Blood donors must be screened to exclude carriers. Fulminant hepatitis may be fatal and manifested by severe symptoms like ascitis and bleeding. Prodormal period Clinical Manifestations: 1. 7. Replication of the virus is not cytopathic and proceeds to relatively long periods without causing liver damage. 7. razor. 3. 8. Avoid injury with sharp objects or instruments. 2. 1. During the acute phase of infection. Hepatitis B vaccine is recommended for pre-exposure.
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