Hepatitis B is the most common chronic liver infection worldwide.

According to the World Health Organisation's findings, an estimated 296 million people live with hepatitis B in 2019, with 1.5 million new infections per year, and a mortality rate of approximately 820,000 people.

In fact, viral hepatitis is ranked the seventh most common cause of mortality. In Singapore, it is estimated that one  in 25 persons (~ four per cent) of the population has chronic hepatitis B infection.

What exactly is hepatitis B?

Hepatitis B is caused by the hepatitis B virus, abbreviated as HBV. HBV spreads through blood, semen, open sores or wounds or other bodily fluids.

However, it cannot be spread to others by sneezing or coughing. Hepatitis B causes liver inflammation that can — if it persists — cause lasting liver damage.

For many people, hepatitis B is a short-term illness that goes away on its own after some time. For others, however, it can become a chronic condition.

Younger people, especially infants and children below the age of five, who are infected by HBV have a much higher risk of developing chronic hepatitis B.

People from certain regions in the world also carry a higher risk of developing chronic hepatitis B, including persons from Sub-Saharan Africa, the Pacific islands, the Middle East, as well as parts of Northeast and Southeast Asia.

Acute and chronic hepatitis B

Acute hepatitis B is a short-term illness that happens in the first six months after being infected by HBV. It is estimated that 90 per cent of persons infected with hepatitis B will be able to overcome the infection within six months.

In such cases, these persons also develop permanent immunity to hepatitis B. Generally, most healthy adults and children above five years of age are more likely to recover from acute hepatitis B.

If it persists for more than six months, then the acute condition has become chronic. Chronic hepatitis B lasts longer, maybe even throughout your lifetime, as the virus multiplies in the liver.

Chronic hepatitis B can cause severe inflammation and scarring of the liver, significantly impairing liver functions. There is also a risk of developing liver cancer or other health complications.

To make things more complicated, symptoms may not develop immediately up until you or your loved one develops liver-related complications.

There are also rare instances where hepatitis B recurs in people who have had it before, which also causes further liver-related complications.

Causes of hepatitis B

HBV spreads from exposure to blood, semen or other body fluids. This means direct exposure, so factors like sneezing and coughing do not spread the virus to other people.

Some causes include:

• Unprotected sexual contact with someone who is infected.
• Sharing non-sterile needles/syringes with someone who is infected.
• Using items that were used by/on an infected person, but not properly sterilised (i.e., getting a tattoo or using someone's razor to shave).
• Direct contact/exposure to infected fluids (blood, semen, etc.) and/or open sores/wounds.
• Being conceived by a mother with hepatitis B.

You might notice that some of these causes are very much similar to the causes of HIV, as they both spread by similar means.

Risk factors of hepatitis B

The risk of developing hepatitis B will increase if you or your loved one:

• Have unprotected sex.
• Share or use unsterilised items.
• Live or care for someone with chronic hepatitis B.
• Receive treatment from someone who does not use properly sterilised equipment.
• Provide treatment to someone, where there is a high likelihood of direct exposure to (infected) body fluids.
• Work or live in institutional facilities, such as prisons or hospitals.
• Travel to areas with a high risk of HBV infection.

Note that having any of these risk factors does not mean that you will develop hepatitis B.

Symptoms of hepatitis B

Hepatitis B usually does not cause any symptoms. If there are symptoms, they can range from mild to serious. However, in chronic cases, symptoms may not develop until many years later.

In the case of acute hepatitis B, symptoms may include:

• Low-grade fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal or joint pain

For chronic hepatitis B, symptoms that may develop include the above-mentioned symptoms, as well as:

• Jaundice (yellow colouration of the skin or eyes).
• Severe cases of nausea and/or vomiting.
• Bloated/swollen stomach.
• Liver complications, such as liver failure or liver cancer.

Because of similar transmission methods, HBV/HIV co-infection is another complication that may arise.

WHO estimates show that about one per cent of persons with HBV infection are also infected with HIV.

The reduction of the immune system's capabilities caused by HIV seems to exacerbate the effects of hepatitis B, especially in chronic cases, but further studies are needed to determine if this is the case.

Diagnosing hepatitis B

If you or your loved one suspect a hepatitis B infection, the first thing to do is to seek immediate medical attention.

The sooner you can have it examined, the higher the chances of mitigating its effects on you or your loved one. A physical exam is usually performed to look for potential signs of liver damage, such as jaundice.

They may also review your family history to look for potential risk factors, such as if your family may have had hepatitis B or liver cancer at any time.

There are three diagnostic tests that may be conducted by the doctor, or a combination of the three if needed.

• Hepatitis B core antibody test: This test helps determine if you or your loved one has acute or chronic hepatitis B.
• Blood tests: One or more tests may be performed to determine if you or your loved one has acute or chronic hepatitis B. Certain blood tests also can tell if you or your loved one might have signs of liver damage or if treatment is needed. Follow-up tests may be needed for cases of chronic hepatitis B as the condition can change over time.
• Liver ultrasound: A transient elastography will be performed. This is a special ultrasound test of the liver that helps doctors check your liver condition and determine the extent of any liver damage.
• Liver biopsy: The doctor will extract a small tissue sample from the liver using a non-invasive procedure. Tests will then be conducted on the sample to determine if there is any liver damage and how severe it may be.

Treatment of hepatitis B

We must reiterate that if you believe either you or your loved one may be exposed to HBV, you should seek medical attention immediately.

The first thing the doctor will order is a shot of hepatitis B immune globulin (HBIG). When it is given within 12 hours of exposure, the shot can give you or your loved one short-term protection from hepatitis B infection.

If you have yet to receive a hepatitis B vaccination shot, the doctor will arrange for you or your loved one to be given the vaccine.

The vaccine will give you or your loved one immunity from hepatitis B; it is the main source of safeguarding a community from hepatitis B.

Treating acute hepatitis B

In acute cases, symptoms do not usually present themselves and the infection will go away on its own. You or your loved one will be monitored to see if there are any changes to your condition.

However, if there are symptoms, doctors will advise getting sufficient rest and fluid intake, as well as having a well-balanced diet.

You or your loved one might need to be hospitalised and given some treatment if the symptoms do worsen.

The doctor might prescribe an over-the-counter pain reliever for any abdominal pains, or antiviral medications for treating acute liver complications.

Treating chronic hepatitis B

For chronic cases, a number of prescriptions will be given to help alleviate your or your loved one's condition. Be sure to discuss the potential side effects of treatment with the doctor beforehand.

Among the medications you may be given include:

• Antiviral medications: WHO recommends the use of oral medications, specifically tenofovir or entecavir, to combat HBV infection and reduce the chance of liver damage or other complications.
• Interferon: Interferon alfa-2b is a synthetic version of a protein that the body naturally produces. Injections of interferon alfa-2b are given to suppress the growth of the HBV virus in the body. It can also help to reduce the intensity of liver damage.
• Liver transplant: If liver damage has advanced significantly, you or your loved one may need to undergo a liver transplant. This surgical procedure removes the damaged liver and replaces it with a healthy one from either a living or deceased donor. As the liver can regenerate slowly, it is possible to use a part of a healthy liver for the transplant. An unfortunate side effect of a transplant is that the receiver will need to take anti-rejection drugs for as long as they live.

Once treatment concludes and the infection goes away, you or your loved one will be considered an "inactive carrier".

The virus is no longer in your body, but any antibody tests in the future will show that you had hepatitis B. Unfortunately, follow-up treatment will be important for the rest of your or your loved one's lives.

Follow-up checks will be important to see how you or your loved one's condition is changing. Certain laboratory tests may be ordered at specific intervals in order to monitor the situation from time to time.

Preventing hepatitis B

Hepatitis B vaccine

There is still no known cure for hepatitis B, but proper care can help those with the virus to live a normal life. The best form of prevention is through vaccination.

The hepatitis B vaccine is typically administered as three or four injections over a six-month period (or whatever time frame the doctor decides is best).

It is recommended that newborns, children and teenagers be administered the vaccine as soon as possible. The protection you and your loved ones get lasts for at least 20 years and carries on for the rest of your lives.

There is also no need to receive booster doses once you complete the full vaccination cycle.

If you need to travel to a region with a high risk of contracting hepatitis B, getting at least one vaccination shot (or completing as many shots as possible before travelling) should be sufficient to afford you some protection from HBV infection.

Changes to your or your loved one's lifestyle habits may also be helpful in preventing reactivated/recurrent hepatitis B.

• Practise safe sex.
• Get tested for hepatitis B as a health precaution.
• Do not use illegal drugs.
• Do not share personal items, such as razors, needles, etc.
• Make sure sterile equipment is used at all times.
• If travelling, be sure to check if the region you are going to is at risk of hepatitis B infection.
• Abide by a healthy, well-balanced diet.
• Have a routine exercise schedule to keep fit.
• Quit smoking or alcohol consumption.

For pregnant women with hepatitis B, there is a chance that hepatitis B can be passed to their unborn child. Make sure to have yourself tested if you suspect you might be infected by HBV.

Safeguarding your child means ensuring the baby is given the hepatitis B vaccine hours after their birth, together with an HBIG dose.

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Depending on which vaccine is administered, two more shots will need to be given at specific schedules — one when they are one month old, and another at six months.

If a third shot is needed, it will be administered when the child reaches the age of one.

This article was first published in Homage.