Hepatitis B

What is Hepatitis?

Hepatitis means the inflammation or swelling of the liver. It is commonly caused by the hepatitis viruses (Hepatitis A, B, and C), heavy alcohol intake, some toxins and drugs, other systemic diseases and infections. 

Hepatitis A, Hepatitis B and Hepatitis C are three types of viral Hepatitis that may have similar symptoms and manifestations but are caused by three different viruses.

What is Hepatitis B?

Hepatitis B is an infectious disease of the liver caused by the Hepatitis B Virus.  In the acute (newly-acquired) phase, the symptoms may be similar to having the flu and some, but not all, can have jaundice (yellowing of the eyes and skin). In most patients, Hepatitis B can become “chronic”, meaning it can be a long-term or life-long infection. Persons with chronic Hepatitis B infection are at risk for liver cirrhosis and liver cancer.

Hepatitis B affects approximately 350 million people worldwide and contributes to an estimated 780,000 deaths each year.

Hepatitis B is a major public health problem in the Philippines. An estimated 7.3 million adult Filipinos (16.7% of the adult population) are chronically infected making our country hyperendemic for Hepatitis B. This rate is extremely high compared to other countries and is more than double the 8% average prevalence of HBV infection in the Western Pacific region. A 2003 survey showed the prevalence of Hepatitis B to be the highest in the 20-49 year age group, which comprises the workforce and the reproductive age group.

There is a safe and effective vaccine to protect yourself from Hepatitis B. The vaccine is given as a series of three shots over a period of six months. It stimulates the body’s immune system to produce antibodies that protect against the virus. In the Philippines, the Hepatitis B immunization is included in the Maternal, Newborn, Child Health and Nutrition (MNCHN) Package of the Department of Health (DOH). Republic Act 10152 (An Act Providing for Mandatory Basic Immunization Services for Infants and Children) provides free hepatitis B vaccination and is mandatory for all infants. To increase its effectiveness in preventing the transmission of the virus, the first dose should be given to newborns within the first 24 hours of life.

For babies born to mothers infected with Hepatitis B, an additional shot called HBIG (pre-formed antibodies against the virus) should also be given shortly after birth.  To prevent mother-to-child transmission of the Hepatitis B virus, all mothers should be screened during an early pre-natal visit to test for the Hepatitis B surface antigen or HBsAg. Mothers who test positive should be referred to a specialist for consideration of anti-viral treatment. 

How is Hepatitis B Transmitted?

Hepatitis B is spread through blood, semen, or other body fluids. A person may acquire the infection through the following activities:

• Birth (spread from a hepatitis B positive mother to her baby)
• Sex with an infected partner
• Sharing needles, syringes, or other drug-injection equipment with an infected person
• Sharing razors, nail clippers/manicure or pedicure paraphernalia or toothbrushes with an infected person
• Direct contact with the blood or open wounds of an infected person
• Exposure to blood from needles or other sharp instruments 

If you believe that you might have been exposed to the virus, see your doctor. It can be prevented by getting the hepatitis B vaccine with an additional shot called HBIG (Hepatitis B Immuneglobulin) within 24 hours of exposure.

Hepatitis B is not spread through:

• Touching, hugging or kissing
• Casual contact (sneezing, doorknobs, toilet seats, etc.)
• Drinking alcohol
• Food, water or air
• Sharing cups and utensils
• Ordinary workplace and school activities

How does one know if he or she has Hepatitis B?

Not everyone develops the symptoms. Although the majority of adults (70%) develop symptoms, many young children do not. Adults and children over the age of five are more likely to have symptoms.

Symptoms can appear three months after exposure to the virus, but can appear any time between six weeks and six months after exposure.

Symptoms include:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pains
• Jaundice (yellow color in the skin or the eyes)

People usually have symptoms for a few weeks, but some people can feel ill for as long as six months.

Most people have no symptoms and feel healthy for many years. About 15 to 25% develop complications in the liver, such as cirrhosis or liver cancer.  In the early stages of liver cirrhosis and liver cancer, patients may still have no symptoms. However, tests for liver function and a liver ultrasound may begin to show some abnormalities.

Hepatitis B is a silent killer.  Most infected individuals appear healthy and have no symptoms until complications of cirrhosis and cancer develop.  A simple blood test can tell you whether you are infected or protected from the virus.

Who are at risk for Hepatitis B?

Since the Philippines is considered a hyperendemic area for hepatitis B, all Filipinos should be offered testing for hepatitis B and vaccination given to those who are negative for the HBsAg and anti-HBs.

The following people are at greater risk:

• Infants born to infected mothers
• People who have sex with an infected partner
• People who have multiple sex partners
• People who have a sexually transmitted disease
• Men who have sexual contact with other men
• People who inject drugs or share needles, syringes, or other drug equipment
• People who live in the same household with an infected individual
• Those who work in occupations where they are exposed to infected blood and body fluids
• Hemodialysis patients

Because of the high rates of hepatitis B infection in the Philippines, universal vaccination is mandated.

Hepatitis B vaccination is especially recommended for:

• All infants, starting with the first dose of the vaccine within 24 hours of birth
• All children and adolescents younger than 19 years of age who have not been vaccinated
• People whose sexual partners have Hepatitis B
• Sexually active persons who have multiple partners
• Persons undergoing treatment for sexually transmitted diseases
• Men who have sexual contact with other men
• People who share needles, syringes, or other drug equipment
• People who have close household contact with someone infected
• Health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job
• People with end-stage renal disease, including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
• Residents and staff of facilities for developmentally disabled persons
• People with chronic liver disease  (aside from Hepatitis B)
• People with HIV infection
• Anyone who wishes to be protected from hepatitis B virus infection

What happens when you have Hepatitis B?

Hepatitis B is one of the most common liver infection in the world.  Up to one in four people who are chronically infected with the virus can develop liver cirrhosis and liver cancer if left undiagnosed and untreated.  Chronic hepatitis B can slowly cause liver damage without you knowing it.  Even if you do not feel sick, the virus can be harming your liver and you can infect others.  That is why hepatitis B is called a silent killer. 

How is Hepatitis B diagnosed?

There are several blood tests your doctor can request to diagnose hepatitis B. Listed below are some common tests and what they mean. It is important that you ask your doctor for the proper interpretation of your test results.

What are the available treatment options?

Treatment for Acute Hepatitis B is mostly supportive in the form of rest, adequate nutrition and hydration. When your immune system is healthy, most people recover from acute hepatitis B.  In some cases, hospitalization is needed particularly for those who are unable to eat due to vomiting and lack of appetite. Some develop signs of liver failure such as disorientation, confusion or even coma needing urgent hospitalization. These patients may be given antiviral drugs and may need to be evaluated for a liver transplant. 

There are several drugs available for the treatment of Chronic Hepatitis B. The choice depends on several factors. Ask your doctor what is the most appropriate drug for you. However, not all patients need to be treated. Patients should be evaluated by doctors experienced in the management of hepatitis B such as internists, pediatricians, gastroenterologists, hepatologists, and infectious disease specialists.  You can visit this link to gain access to the Hepatology Society of the Philippines (HSP) website. People with chronic hepatitis B, even those without symptoms, need long term monitoring for the early detection of complications in the liver such as cirrhosis and liver cancer.

What are the possible complications of Hepatitis B?

Chronic Hepatitis B may cause liver damage without your knowledge. The following are complications which may result from Chronic Hepatitis B:

• Fibrosis – scarring of the liver
• Cirrhosis – severe scarring which may affect liver function
• Liver Cancer – Chronic Hepatitis B is a major cause of Liver Cancer

What are the related services available at The Medical City?

At The Medical City, we have a complete roster of competent doctors who can assess and treat patients with hepatitis B. The following services are also offered for patients with Hepatitis B at the Center for Liver Disease Management and Transplantation:

1. Vaccination against hepatitis B for those who are not immune or protected from the virus
2. Fibroscan or transient elastography which allows for early detection of liver damage or fibrosis from the hepatitis B virus
3. Evaluation of liver disease severity and need for antiviral therapy
4. Diagnosis and treatment of hepatitis B related complications such as liver cancer and liver cirrhosis
5. Evaluation for liver transplantation

For inquiries, please contact:

CENTER FOR LIVER DISEASE MANAGEMENT AND TRANSPLANTATION

2/F Nursing Tower, The Medical City

Ortigas Avenue, Pasig City

Tel. No.: (+632) 988-1000 / (+632) 988-7000 Ext. 6506

References:

Hepatology Society of the Philippines website. 2014 Consensus Guidelines for the management of chronic hepatitis B

hepBsmart

Center for Disease Control and Prevention

World Health Organization