Hepatitis B

Once the disease has been overcome, the affected person is immune. In individual cases, however, the inflammation can flare up again. In the case of a chronic course, considerable consequential damage is possible. Infants and young children are now vaccinated against hepatitis B as standard.

Overview: What is hepatitis B?

The hepatitis B virus has been with mankind for many thousands of years. Fortunately, a healthy body can usually successfully fight and heal an infection on its own. If a hepatitis B disease develops chronically, there is a risk of massive damage to the liver with many burdens for those affected.

The liver fulfills a variety of tasks in the human body. As well as breaking down toxins, it has an influence on blood sugar, water balance and digestion. The regeneration and performance of the largest internal organ is restricted by inflammation. Various symptoms occur and burden the body in addition to the existing inflammation. For example, a liver that is no longer fully functional can only detoxify the body inadequately. Even if there are no or mild symptoms, this is a major challenge for the body. In addition to dealing responsibly with the risk of infection, you can take various measures to strengthen your liver and immune system in the event of hepatitis B infection. This means that a favorable course of the disease with subsequent immunity is likely.

Hepatitis B – frequency and obligation to report

Since in many cases a hepatitis B infection heals itself and is usually unremarkable, the actual number of cases is probably much higher than the statistics indicate. Hepatitis B is one of the most common infectious diseases worldwide, with around 260 million chronic cases. The disease is most prevalent in large parts of Africa, the Middle East, Turkey, China and South East Asia. Comprehensive vaccination has reduced the number of infections in Canada, Mexico, the USA, southern regions of South America and northern and western Europe to less than one percent.

The risk of infection is high as it is transmitted via bodily fluids. This makes mandatory reporting sensible. In Switzerland, doctors, hospitals and laboratories are obliged to report a case of hepatitis B in accordance with the Epidemics Act.

Hepatitis B: causes and risk factors

The hepatitis B virus is transmitted via blood and other bodily fluids (semen, saliva, tear fluid). The virus enters the body via small skin lesions or the mucous membranes. During childbirth, the mother can transmit the pathogen to her newborn baby. The concentration of viruses in the blood is very high, which is why even the smallest drops can be infectious. Possible transmission routes:

• Unprotected sexual intercourse
• Contact with infected blood (risk for rescue workers, medical and nursing staff)
• Contaminated objects (drug cutlery, ear piercers, tattoo or acupuncture needles, shared toothbrushes, razors)
• Blood bank (very rare due to modern medical standards)
• Dialysis

In industrialized countries, more than half of all cases of infection occur during unprotected sexual intercourse. Many of those affected are young adults. In small children, the hepatitis B virus can also be passed on through biting and scratching. In almost 90 percent of cases, transmission from infected mother to newborn leads to chronic hepatitis B. In areas of the world with a high prevalence, most infections occur at birth.

Hepatitis D as a possible combination

Rarely, a hepatitis B infection can also lead to hepatitis D disease. The hepatitis D virus uses the envelope of the hepatitis B virus as a transport route. The outbreak of hepatitis D can occur at the same time (also called co-infection or simultaneous infection) or after (superinfection) hepatitis B. The course of hepatitis D is often highly problematic. Vaccination protects against hepatitis B and D in equal measure.

Symptoms: Hepatitis B

The incubation period, i.e. the time between infection with the hepatitis B virus and the outbreak of liver inflammation, is between one and six months. In the vast majority of cases, hepatitis B is acute and heals completely. If the virus is detectable in the blood for longer than six months, it is referred to as chronic hepatitis B. The symptoms are non-specific and often so mild that they go unnoticed by those affected. Around 65 percent of all acutely ill patients suffer from no symptoms or general symptoms that also occur in the context of many other diseases. One third of those affected also develop varying degrees of jaundice after initial unspecific symptoms. The following symptoms may occur after an outbreak of hepatitis B:

• Fatigue
• Fatigue
• Loss of appetite
• Weight loss
• Headache
• Muscle pain
• Joint problems
• Elevated temperature or fever
• Feeling of pressure in the area of the liver (right upper abdomen)

The more obvious signs of inflammation of the liver are:

• Diarrhea
• Nausea
• Vomiting
• Itching
• Icterus (jaundice): Discoloration and discoloration of urine and stool, yellowing of eye whites and skin

In rare cases, the body cannot cure hepatitis B on its own. Blood clotting and various metabolic processes are then disturbed, for example. This can lead to shrinkage of the liver and have life-threatening consequences. Treatment involves medication and possibly intensive medical care. A transplant may also be necessary. If you initially experience general symptoms, it is still advisable to consult a doctor to monitor the course of the disease. This enables you to deal promptly with the unlikely but possible case of so-called fulminant hepatitis B with the most serious consequences.

Hepatitis B: Diagnosis with us

An infection with the hepatitis B virus can often trigger an inflammation of the liver completely unnoticed due to the complete absence or minimal symptoms, which the body copes with on its own. Only accompanying jaundice (icterus) is a clear indication of liver disease. This is why the infection is often discovered by chance during a general blood test, for example if the liver values are elevated. We will then arrange for a more detailed examination of the blood to clarify the cause. The following values are determined to determine a hepatitis B infection:

• Virus antigens: The virus itself or its proteins indicate that a disease is currently underway in the body.
• Antibodies: These antibodies produced by the body indicate that a cure or vaccination is currently taking place. In the case of a chronic course, they indicate an improvement in the condition.
• Virus DNA: The presence of the genetic material of the virus basically confirms the suspicion of an infection. The quantity allows conclusions to be drawn about the stage of chronic hepatitis B and makes it possible to assess the infectiousness of the person affected. In addition, we will order further tests in the event of high levels of viral DNA in order to determine the exact severity of the liver damage and initiate measures if necessary.

Even if there are no or only minor symptoms, it makes sense to be accompanied by a doctor throughout the healing process so that they can intervene quickly in the event of an unfavorable course. Regular monitoring of blood values makes this possible.

Hepatitis B: Further diagnostic procedures

An analysis of the blood values is sufficient in most cases. Nevertheless, there is the possibility of further examinations, which are mainly used in the later course of chronic hepatitis B. These include liver biopsies and various ultrasound procedures. As soon as a confirmed diagnosis has been made, the doctor is obliged to report it.

Hepatitis B: prevention, early detection, prognosis

The treatment of persistent hepatitis B is problematic and the hepatitis B virus is highly infectious. For this reason, vaccination is recommended in Switzerland for all infants, preferably at the ages of two, four and twelve months. If vaccination has not yet been carried out, older children and adolescents (aged between eleven and 15 years) should also be vaccinated in order to achieve the most comprehensive immunization possible. Even if a large number of hepatitis B infections take a favorable course, this prevention is recommended.

In addition, a healthy lifestyle supports the liver and the immune system. A healthy diet, sufficient exercise and abstaining from alcohol and smoking are not the only things you can do to help hepatitis B heal. In this way, they also ensure a healthy general condition and thus a high quality of life. Responsible handling of syringes and needles and the use of condoms during sexual intercourse are further preventive measures.

Early detection of a hepatitis B infection is only possible if the liver values of an infected person are recorded. If you belong to a risk group or are aware of potentially dangerous behavior, you should consult a doctor even if the symptoms are only very mild.

Course and prognosis of hepatitis B

Around 90 percent of hepatitis B infections heal completely after an acute course and cause no or mild symptoms. Jaundice can be a temporary side effect. Acute hepatitis B is usually over after two to six weeks and may not be detected at all or may be detected by chance afterwards. In very rare cases, however, an acute course leads to considerable damage to the liver, including organ failure and coma. Once the disease has been overcome, the person concerned is immune to the hepatitis B virus. However, as the virus remains inactive in the liver, it can be reactivated in special cases, often only after decades. The causes may be:

• Chemotherapy,
• Kidney or bone marrow transplantation,
• HIV/AIDS.

Due to the weakening of the immune system, often as part of treatment, the inactive hepatitis B virus can multiply rapidly. Complete destruction of the liver is possible and the course of the disease is very serious, but fortunately very rare.

A chronic hepatitis B infection is present if the virus or antibodies are detectable in the blood for longer than six months. Here too, the affected person may not experience any symptoms, but the virus damages the liver gradually over a long period of time and can lead to considerable problems. The probability of a chronic course decreases with increasing age. For example, liver inflammation becomes chronic in 90 percent of newborns, but only in 50 percent of four-year-olds. Although some of those affected are chronically infected, i.e. are unable to cope with the virus completely, they lead a normal life even without treatment due to stable liver function. Infectivity is relatively low. In other cases, the hepatitis B virus multiplies at a high rate over a long period of time. This makes the sick person highly contagious.

A stressed and inflamed liver does not have to be reflected immediately in worrying liver values. However, the liver tissue progressively scars (liver fibrosis), which leads to cirrhosis in 20 percent of cases. This can lead to severe liver dysfunction with additional side effects such as bleeding from the oesophagus and varicose veins. In addition, around half of all cases of malignant liver cancer can be attributed to chronic hepatitis B. The possible serious consequences of a hepatitis B infection can be completely ruled out by vaccination. If you are not sure whether you have been vaccinated or know that you have no protection against the hepatitis B virus, you can have the vaccination done by a doctor.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.

Hepatitis B: Treatment

In the first few months of a hepatitis B infection, drug therapy is not necessary as the body copes with the infection itself. In chronic cases, we will prescribe medication. However, it is important that you yourself support the healing process through a healthy lifestyle. A complete cure for chronic hepatitis B is rarely possible. However, the further damage to the liver caused by the ongoing inflammation can be slowed down. In this way, further massive measures can be prevented in the event of serious consequential damage.