The term "hepatitis" refers to syndromes or diseases causing liver inflammation, including inflammation due to viruses and chronic alcohol abuse.
Viruses causing hepatitis include Hepatitis A, B, C, E and the delta factor. Each virus causes a distinct syndrome, though they share some symptoms and consequences.
Most people who become infected with Hepatitis B get rid of the virus within 6 months. A short infection is known as an "acute" case of Hepatitis B.
Approximately 10% of people infected with the Hepatitis B virus develop a chronic, life-long infection. People with chronic infection may have symptoms, but many of these patients never develop symptoms.
These patients are sometimes referred to as "carriers" and can spread the disease to others. Having chronic Hepatitis B increases your chance of permanent liver damage, including cirrhosis (scarring of the liver) and liver cancer.
Hepatitis B is also known as serum hepatitis and is spread through blood and sexual contact. It is seen with increased frequency among intravenous drug users who share needles and among the homosexual population. This photograph is an electronmicroscopic image of hepatitis B virus particles. (Courtesy of the Centers for Disease Control.)
Hepatitis B is transmitted via blood and other body fluids. Infection can occur through:
In acute hepatitis, it takes about 1 to 6 months from the time of infection until the disease manifests itself. Early symptoms may include nausea and vomiting, loss of appetite, fatigue, and muscle and joint aches. Jaundice, together with dark urine and light stools, follows. About 1 percent of patients infected with hepatitis B die due to liver damage in this early stage.
The risk of becoming chronically infected depends on the age at the time of infection: more than 90 percent of newborns, about 50 percent of children, and less than 5 percent of adults infected with hepatitis B develop chronic hepatitis.
Most damage from hepatitis B virus is caused by the body's response to the infection. The body's immune response against the infected liver cells (hepatocytes) damages the cells, causing liver inflammation (hepatitis). As a result, liver enzymes (transaminases) leak out of the liver into the blood, causing transaminase blood levels to be elevated. The virus impairs the liver's ability to produce the clotting factor prothrombin, increasing the time required for blood clot formation (prothrombin time).
Liver damage also impairs the body's ability to rid itself of bilirubin (a breakdown product of old red blood cells), causing jaundice (yellow discoloration of the eyes and body) and dark urine.
Acute hepatitis needs no treatment other than careful monitoring of liver function, by measuring serum transaminases and prothrombin time.
In rare cases of liver failure, the patient should be monitored in an intensive care unit. Because damage to the liver decreases its ability to degrade proteins, protein intake should be restricted and oral lactulose or neomycin should be administered (to limit protein production by bacteria in the gut).
Patients should be supported and monitored until they recover or until prognostic factors indicate a liver transplant is necessary. Liver transplantation is the only definitive cure in cases of liver failure.
Treatment of chronic hepatitis is geared towards reducing inflammation, symptoms, and infectivity. Recombinant alpha interferon, currently the only approved antiviral agent for hepatitis, converts 37 percent of patients from the replicative phase to non-replicative phase. However, it is ineffective in most patients, very expensive, and causes some adverse effects. These include a flu-like syndrome, fever, chills, malaise, muscle aches, and rigors ('shakes'). Currently, trials are underway in Europe for natural interferon, which has fewer side effects and is more effective. Liver transplantation is used to treat end-stage chronic hepatitis B liver disease.
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The acute illness usually subsides after 2 to 3 weeks, and the liver returns to normal within 16 weeks. 10% of people infected may develop chronic hepatitis. There is a higher incidence of hepatocellular carcinoma in those who have had hepatitis B virus infection than in the general population. Hepatitis B is fatal in approximately 1% of cases of acute hepatitis B.
Screening of all donated blood has reduced the likelihood of contracting hepatitis B from a blood transfusion.
As an initial screen, blood donors are now required to fill out a questionnaire about their sexual and drug use activities. The blood of those who are in high-risk groups is not used. Also, serologic tests are used to screen collected blood for the hepatitis B virus.
Mandatory reporting of the disease allows state health care workers to track people who have been exposed and to immunize contacts that have not yet developed the disease. Formerly, hepatitis B vaccine was made from human blood products, so it was not received well by the public.
The new hepatitis B vaccine is entirely artificial, with no human products, and therefore cannot transmit either hepatitis B or the AIDS virus. The new vaccine is both safe and effective. Those receiving the vaccine require three vaccinations administered within a six month period to achieve full immunity. Vaccination of babies has become routine in pediatric care in the US.
Sexual contact with a person who has acute or chronic hepatitis B should be avoided. Condoms, if used consistently and properly, may also reduce transmission through sexual contact. However, immunization provides the only definitive protection against the virus. Vaccination of those at high risk has been of only limited success. Therefore, the United States Public Health Service has recommended universal vaccination of all neonates and pre-pubertal teenagers.
Infants born of mothers who either currently have acute hepatitis B or who have had the infection receive a special immunization series to prevent viral transmission. This includes administering hepatitis B immune globulin and a hepatitis B immunization within 12 hours of birth.