Hepatitis B

Hepatitis B
Electron micrograph of hepatitis B virus
SpecialtyInfectious disease, gastroenterology
SymptomsNone, yellowish skin, tiredness, dark urine, abdominal pain[1]
ComplicationsCirrhosis, liver cancer[2]
Usual onsetSymptoms may take up to 6 months to appear[1]
DurationShort or long term[3]
CausesHepatitis B virus spread by some body fluids[1]
Risk factorsIntravenous drug use, sexual intercourse, dialysis, living with an infected person[4][5]
Diagnostic methodBlood tests[1]
PreventionHepatitis B vaccine[1]
TreatmentAntiviral medication (tenofovir, interferon), liver transplantation[4]
Frequency296 million (2019)[1]
Deaths820,000 resulting from hepatitis B (2019)[1]

Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV) that affects the liver;[1][6] it is a type of viral hepatitis.[7] It can cause both acute and chronic infection.[1]

Many people have no symptoms during an initial infection. For others, symptoms may appear 30 to 180 days after becoming infected and can include a rapid onset of sickness with nausea, vomiting, yellowish skin, fatigue, dark urine, and abdominal pain.[1] Symptoms during acute infection typically last for a few weeks, though some people may feel sick for up to six months.[8] Deaths resulting from acute stage HBV infections are rare.[9] An HBV infection lasting longer than six months is usually considered chronic.[1] The likelihood of developing chronic hepatitis B is higher for those who are infected with HBV at a younger age. About 90% of those infected during or shortly after birth develop chronic hepatitis B,[8] while less than 10% of those infected after the age of five develop chronic cases.[5] Most of those with chronic disease have no symptoms; however, cirrhosis and liver cancer eventually develop[2] in about 25% of those with chronic HBV.[4]

The virus is transmitted by exposure to infectious blood or body fluids.[4] In areas where the disease is common, infection around the time of birth or from contact with other people's blood during childhood are the most frequent methods by which hepatitis B is acquired.[4] In areas where the disease is rare, intravenous drug use and sexual intercourse are the most frequent routes of infection.[4] Other risk factors include working in healthcare, blood transfusions, dialysis, living with an infected person, travel in countries with high infection rates, and living in an institution.[4][5] Tattooing and acupuncture led to a significant number of cases in the 1980s; however, this has become less common with improved sterilization.[10] The hepatitis B viruses cannot be spread by holding hands, sharing eating utensils, kissing, hugging, coughing, sneezing, or breastfeeding.[5] The infection can be diagnosed 30 to 60 days after exposure.[4] The diagnosis is usually confirmed by testing the blood for parts of the virus and for antibodies against the virus.[4] It is one of five main hepatitis viruses: A, B, C, D, and E.[11] During an initial infection, care is based on a person's symptoms.[4] In those who develop chronic disease, antiviral medication such as tenofovir or interferon may be useful; however, these drugs are expensive.[4] Liver transplantation is sometimes recommended for cases of cirrhosis or hepatocellular carcinoma.[4]

Hepatitis B infection has been preventable by vaccination since 1982.[4][12] As of 2022, the hepatitis B vaccine is between 98% and 100% effective in preventing infection.[1] The vaccine is administered in several doses; after an initial dose, two or three more vaccine doses are required at a later time for full effect.[1] The World Health Organization (WHO) recommends infants receive the vaccine within 24 hours after birth when possible.[1] National programs have made the hepatitis B vaccine available for infants in 190 countries as of the end of 2021.[13][14] To further prevent infection, the WHO recommends testing all donated blood for hepatitis B before using it for transfusion. Using antiviral prophylaxis to prevent mother-to-child transmission is also recommended, as is following safe sex practices, including the use of condoms.[1] In 2016, the WHO set a goal of eliminating viral hepatitis as a threat to global public health by 2030. Achieving this goal would require the development of therapeutic treatments to cure chronic hepatitis B, as well as preventing its transmission and using vaccines to prevent new infections.[15][16][17]

An estimated 296 million people, or 3.8% of the global population, had chronic hepatitis B infections as of 2019. Another 1.5 million developed acute infections that year, and 820,000 deaths occurred as a result of HBV.[1] Cirrhosis and liver cancer are responsible for most HBV-related deaths.[18] The disease is most prevalent in Africa (affecting 7.5% of the continent's population) and in the Western Pacific region (5.9%).[19] Infection rates are 1.5% in Europe and 0.5% in the Americas.[19] According to some estimates, about a third of the world's population has been infected with hepatitis B at one point in their lives.[18] Hepatitis B was originally known as "serum hepatitis".[20]

  1. ^ a b c d e f g h i j k l m n o p "Hepatitis B Fact Sheet". World Health Organization. 24 June 2022. Archived from the original on 9 August 2022. Retrieved 9 August 2022.
  2. ^ a b Chang MH (June 2007). "Hepatitis B virus infection". Semin Fetal Neonatal Med. 12 (3): 160–167. doi:10.1016/j.siny.2007.01.013. PMID 17336170.
  3. ^ Vos, Theo; et al. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  4. ^ a b c d e f g h i j k l m "Hepatitis B Fact sheet N°204". who.int. July 2014. Archived from the original on 9 November 2014. Retrieved 4 November 2014.
  5. ^ a b c d "Hepatitis B FAQs for the Public – Transmission". U.S. Centers for Disease Control and Prevention (CDC). Archived from the original on 11 December 2011. Retrieved 29 November 2011.
  6. ^ Logan CM, Rice MK (1987). Logan's Medical and Scientific Abbreviations. J. B. Lippincott and Company. pp. 232. ISBN 0-397-54589-4.
  7. ^ "Hepatitis MedlinePlus". U.S. National Library of Medicine. Retrieved 19 June 2020.
  8. ^ a b Centers for Disease Control and Prevention (30 March 2022). "Hepatitis B Questions and Answers for the Public - Symptoms". Archived from the original on 9 August 2022. Retrieved 9 August 2022.
  9. ^ Rubin R, Strayer DS (2008). Rubin's Pathology : clinicopathologic foundations of medicine (5th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. p. 638. ISBN 9780781795166.
  10. ^ Thomas HC (2013). Viral Hepatitis (4th ed.). Hoboken: Wiley. p. 83. ISBN 9781118637302.
  11. ^ Global hepatitis report 2017 (PDF). WHO. 2017. ISBN 978-92-4-156545-5.
  12. ^ Pungpapong S, Kim WR, Poterucha JJ (2007). "Natural History of Hepatitis B Virus Infection: an Update for Clinicians". Mayo Clinic Proceedings. 82 (8): 967–975. doi:10.4065/82.8.967. PMID 17673066.
  13. ^ "Immunization coverage- Global immunization coverage 2021". World Health Organization. 14 July 2022. Archived from the original on 10 August 2022. Retrieved 10 August 2022.
  14. ^ Williams R (2006). "Global challenges in liver disease". Hepatology. 44 (3): 521–526. doi:10.1002/hep.21347. PMID 16941687. S2CID 23924901.
  15. ^ Block, Timothy M.; Chang, Kyong-Mi; Guo, Ju-Tao (29 September 2021). "Prospects for the Global Elimination of Hepatitis B". Annual Review of Virology. 8 (1): 437–458. doi:10.1146/annurev-virology-091919-062728. ISSN 2327-056X. PMID 34586871.
  16. ^ Cox, Andrea L.; El-Sayed, Manal H.; Kao, Jia-Horng; Lazarus, Jeffrey V.; Lemoine, Maud; Lok, Anna S.; Zoulim, Fabien (September 2020). "Progress towards elimination goals for viral hepatitis". Nature Reviews Gastroenterology & Hepatology. 17 (9): 533–542. doi:10.1038/s41575-020-0332-6. ISSN 1759-5053. PMC 7376316. PMID 32704164.
  17. ^ COMBATING HEPATITIS B AND C TO REACH ELIMINATION BY 2030. Geneva, Switzerland: World Health Organization. May 2016. Retrieved 6 January 2022.
  18. ^ a b Nelson, Noele P.; Easterbrook, Philippa J.; McMahon, Brian J. (November 2017). "Epidemiology of Hepatitis B Virus Infection and Impact of Vaccination on Disease". Clinics in Liver Disease. 20 (4): 607–628. doi:10.1016/j.cld.2016.06.006. PMC 5582972. PMID 27742003.
  19. ^ a b World Health Organization (2021). "Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021" (PDF). World Health Organization. Web Annex 1: Key data at a glance. Retrieved 10 August 2022.{{cite web}}: CS1 maint: location (link)
  20. ^ Barker LF, Shulman NR, Murray R, Hirschman RJ, Ratner F, Diefenbach WC, Geller HM (1996). "Transmission of serum hepatitis. 1970". Journal of the American Medical Association. 276 (10): 841–844. doi:10.1001/jama.276.10.841. PMID 8769597.