Hepatitis B is primarily a sexually transmitted infection

Affecting nearly 250 million people in the world in its chronic form, with close to 800 000 deaths per year, hepatitis B is not taken lightly by the WHO, which sees it as a deadly virus and a major concern, just like the AIDS virus. To be a carrier of the hepatitis B virus (HBV) (of the Hepadnavirus family), you should have directly been in contact with an infected person, as transmission occurs in many ways. We will mention them as we go. Transmission occurs through contact with the blood of an infected person, but saliva and semen are also vectors of contamination; the virus then passing in the blood or through the mucous membranes of the healthy person. Attacking the liver, a vital organ of the human body due to its regenerative, filtering and eliminative capabilities, hepatitis B has the disadvantage of remaining extremely contagious and persisting outside the body of the infected person through objects contaminated with a body fluid for example, all of this lasting for a period of up to 7 days. Caution is called for; we will talk about it when we discuss prevention. The modes of transmission are:

• Sex without condoms, whether oral sex (cunnilingus, fellatio, anilingus) or during anal or vaginal penetration
• A transmission from mother to child in childbirth
• Contamination by contact with objects that have been in contact with the body fluid of an infected person, (shaver, toothbrush …), the virus is very resistant to fresh air
• Kissing with tongue (thus exchange of saliva), although the risk remains low
• Sharing of needles during drug use
• A shot administered by the hospital staff, nurses … by a contaminated needle

Prevention tips

Prevention remains critical in slowing the spread of the virus worldwide, since the transmission through blood and mucous membranes requires special hygiene measures. It is therefore necessary:

• Not to use the personal belongings of an infected person (towels, toothbrush …) especially any material that may have been in contact with the blood or the body secretions of that person
• For medical staff, to pay special attention when in contact with infected people and with all that has been in contact with them. Precautions are therefore required.
• To use protection, regardless of the type of sexual intercourse with a person, known or not, if the two partners have not undergone comprehensive testing for sexually transmitted infections
• To vaccinate the child from his/her birth (we will talk about this)

Symptoms not always present

The HBV incubation period, i.e. the time between infection and the onset of the first symptoms varies from 1 month to 6 months depending on the individual. The difficulty of diagnosis resides in the fact that the symptoms are very often absent. Usual symptoms are:

• Loss of appetite
• Nausea
• Unexplained fatigue
• Jaundice (yellowing of the skin, conjunctivitis …), symptom of liver damage
• Pain in the abdomen
• Unexplained fever

Hepatitis may remain an acute hepatitis (which vanishes away in 90% of cases) or it may turn into chronic hepatitis (for life in 10% of cases), we will talk about it when we discuss treatments.

Serological examination, a safe and non-invasive screening method

The hepatitis B virus is detected by a blood test in a laboratory. It is the only way to know if we are contaminated by this virus or not and the detection has the best results between 30 to 60 days after infection. The laboratory will look for a specific type of antibody, anti-HBc but also for a specific type of antigen, the hepatitis B surface antigen HBs in the blood test, antibodies and antigens characteristic of infection. Therefore a clear sign of the initiation of the immune system defending itself against HBV. Serology should also be considered to perform an assay of transaminases in the blood but also to determine the bilirubin level. In fact, liver malfunction causes an accumulation of bilirubin. Therefore, the high level of transaminases or bilirubin clearly and irrefutably indicates that there are lesions in the liver. A blood test is the only way to confirm the diagnosis. Chronic hepatitis B will be particularly confirmed by biopsy.

The treatment of hepatitis B

As I have already mentioned, hepatitis B is either an acute HBV or it becomes chronic, in which case the patient will have it for life. Acute Hepatitis B will simply vanish away (90% of cases), the doctor is not prescribing specific drugs to the patient but a lot of rest, a balanced diet regimen, the patient having to drink plenty of water and of course to give up alcohol consumption in order to preserve the liver’s health as much as possible. Chronic hepatitis B is treated but it will never be cured (10% of acute HBV progress to chronic HBV). We will stop the spread of the virus by medication, including antivirals, to control a much more severe disease course; it may turn into liver cancer or cirrhosis. Please note that interferons may also be prescribed. The vaccine remains the major weapon for protection against the virus. Vaccination is recommended:

• for newborns
• for medical staff that is more exposed than the rest of the population
• for all individuals travelling to endemic areas
• for drug users
• for persons with multiple sexual partners or who have sex with a person with chronic HBV

A booster vaccination is to be performed every 10 years.