Hsv incubation period. The Incubation Period and Transmission of Herpes Simplex Virus: A Comprehensive Guide

27.12.202124.07.2023 by alexxlab

How long is the incubation period for herpes simplex virus? Can you spread herpes even when no symptoms are present? Get answers to your most pressing HSV questions.

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Understanding the Herpes Simplex Virus Incubation Period

Herpes simplex virus (HSV) is a highly contagious viral infection that can cause various symptoms, including cold sores, fever blisters, and genital lesions. The incubation period for both HSV-1 (oral herpes) and HSV-2 (genital herpes) is typically 2 to 12 days, with most people developing symptoms within 3 to 6 days after exposure to the virus.

It’s important to note that many people with HSV have such mild or unnoticeable symptoms that the infection may go undetected for years. This makes it challenging to pinpoint the exact moment of transmission, as the virus can be spread even during dormant periods when no visible sores or other symptoms are present.

Transmission of Herpes Simplex Virus

Herpes simplex virus is primarily transmitted through direct contact with infected areas, such as cold sores or genital lesions. However, the virus can also be spread through contact with saliva, sharing personal items like lip balm or utensils, or during sexual activity, even when the infected individual is not experiencing an outbreak.

The chances of transmitting HSV are lower during the first few days after initial exposure, as the virus may not have had time to replicate and shed. However, once the virus has established itself in the body, it can be transmitted to others at any time, including during periods of dormancy when no visible symptoms are present.

Managing Herpes Simplex Virus Outbreaks

While there is no cure for herpes simplex virus, there are several ways to manage the condition and reduce the risk of transmission:

Antiviral medications can help suppress viral activity and reduce the frequency and severity of outbreaks.
Practicing good hygiene, such as avoiding contact with infected areas and not sharing personal items, can lower the risk of transmission.
Using barrier methods, like condoms and dental dams, during sexual activity can help prevent the spread of the virus.

Seeking Medical Care for Herpes Simplex Virus

If you suspect you may have been exposed to herpes simplex virus or are experiencing symptoms, it’s important to seek medical attention. A healthcare provider can confirm the diagnosis, provide appropriate treatment, and offer guidance on managing the condition and reducing the risk of transmission.

Debunking Common Herpes Simplex Virus Myths

Herpes simplex virus is a common infection, but it is often surrounded by misinformation and stigma. It’s important to separate fact from fiction and understand the realities of this condition:

Myth: Herpes is always easily identifiable. The reality is that many people with HSV have such mild or unnoticeable symptoms that the infection goes undetected for years.
Myth: You can only spread herpes during an outbreak. The virus can be transmitted even when no visible symptoms are present, as it can still be shed from the skin and mucous membranes.
Myth: Herpes is a lifelong, incurable condition. While there is no cure for herpes, antiviral medications can help manage the condition and reduce the frequency and severity of outbreaks.

Reducing the Stigma Surrounding Herpes Simplex Virus

Herpes simplex virus is a common and manageable condition, yet it often carries a significant social stigma. It’s important to educate ourselves and others about the realities of HSV, and to be compassionate and understanding towards those affected by the virus.

By understanding the incubation period, transmission dynamics, and management strategies for herpes simplex virus, we can help reduce the stigma and empower those living with this condition to seek the care and support they need.

Key Takeaways

The incubation period for both HSV-1 and HSV-2 is typically 2 to 12 days, with most people developing symptoms within 3 to 6 days.
Herpes simplex virus can be transmitted even during dormant periods when no visible symptoms are present.
Antiviral medications, good hygiene, and barrier methods can help manage herpes simplex virus and reduce the risk of transmission.
Educating ourselves and others about the realities of HSV can help reduce the social stigma surrounding this common and manageable condition.

Herpes Incubation Period: Your HSV Questions Answered

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Medically reviewed by Jill Seladi-Schulman, Ph. D. — By Scott Frothingham — Updated on October 13, 2018

Overview

Herpes is a disease caused by two types of the herpes simplex virus (HSV):

HSV-1 is generally responsible for cold sores and fever blisters around the mouth and on the face. Often referred to as oral herpes, it’s usually contracted by kissing, sharing lip balm, and sharing eating utensils. It can also cause genital herpes.
HSV-2, or genital herpes, causes blistering sores on the genitals. It’s usually contracted through sexual contact and can also infect the mouth.

Both HSV-1 and HSV-2 have an incubation period between transmission of the disease and appearance of symptoms.

Once you’ve contracted HSV, there will be an incubation period — the time it takes from contracting the virus until the first symptom appears.

The incubation period for HSV-1 and HSV-2 is the same: 2 to 12 days. For most people, the symptoms begin to show up in about 3 to 6 days.

However, according to the Centers for Disease Control and Prevention, the majority of people who contract HSV have such mild symptoms that they either go unnoticed or are mistakenly identified as a different skin condition. Bearing that in mind, herpes could go undetected for years.

HSV typically alternates between a latent stage — or a dormancy period in which there are few symptoms — and an outbreak stage. In the latter, the primary symptoms are easily identified. The average is two to four outbreaks a year, but some people can go years without an outbreak.

Once a person has contracted HSV, they can transmit the virus even during dormant periods when there are no visible sores or other symptoms. The risk of transmitting the virus when it’s dormant is less. But it’s still a risk, even for people who are receiving treatment for HSV.

The chances are low that a person can transmit HSV to someone else within the first few days following their initial contact with the virus. But because of HSV dormancy, among other reasons, not many people can pinpoint the moment they contracted the virus.

Transmission is common from contact with a partner who might not know they have HSV and isn’t showing symptoms of infection.

There is no cure for herpes. Once you’ve contracted HSV, it stays in your system and you can transmit it to others, even during periods of dormancy.

You can talk to your doctor about medications that can lower your chances of transmitting the virus, but physical protection, although not perfect, is the most reliable option. This includes avoiding contact if you’re experiencing an outbreak and using condoms and dental dams during oral, anal, and vaginal sex.

Last medically reviewed on June 12, 2018

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Centers for Disease Control and Prevention. (2017). Genital herpes – CDC fact sheet (detailed) [Fact sheet].
cdc.gov/std/herpes/stdfact-herpes-detailed.htm
Genital herpes. (2018).
hhs.gov/opa/reproductive-health/fact-sheets/sexually-transmitted-diseases/herpes/index.html
Herpes simplex. (n.d.).
medlineplus.gov/herpessimplex.html

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Medically reviewed by Jill Seladi-Schulman, Ph.D. — By Scott Frothingham — Updated on October 13, 2018

Detailed STD Facts – Genital Herpes

What is genital herpes?

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).

How common is genital herpes?

Genital herpes infection is common in the United States. CDC estimated that there were 572,000 new genital herpes infections in the United States in a single year.¹ Nationwide, 11.9 % of persons aged 14 to 49 years have HSV-2 infection (12.1% when adjusted for age).² However, the prevalence of genital herpes infection is higher than that because an increasing number of genital herpes infections are caused by HSV-1. ³ Oral HSV-1 infection is typically acquired in childhood; because the prevalence of oral HSV-1 infection has declined in recent decades, people may have become more susceptible to contracting a genital herpes infection from HSV-1. ⁴

HSV-2 infection is more common among women than among men; the percentages of those infected during 2015-2016 were 15.9% versus 8.2% respectively, among 14 to 49 year olds. ² This is possibly because genital infection is more easily transmitted from men to women than from women to men during penile-vaginal sex. ⁵ HSV-2 infection is more common among non-Hispanic blacks (34.6%) than among non-Hispanic whites (8.1%). ² A previous analysis found that these disparities, exist even among persons with similar numbers of lifetime sexual partners. Most infected persons may be unaware of their infection; in the United States, an estimated 87.4% of 14 to 49 year olds infected with HSV-2 have never received a clinical diagnosis. ⁶

The age-adjusted percentage of persons in the United States infected with HSV-2 decreased from 18.0% in 1999–2000 to 12.1% in 2015-2016. ²

How do people get genital herpes?

Infections are transmitted through contact with HSV in herpes lesions, mucosal surfaces, genital secretions, or oral secretions. ⁵ HSV-1 and HSV-2 can be shed from normal-appearing oral or genital mucosa or skin. ⁷^,8 Generally, a person can only get HSV-2 infection during genital contact with someone who has a genital HSV-2 infection. However, receiving oral sex from a person with an oral HSV-1 infection can result in getting a genital HSV-1 infection. ⁴ Transmission commonly occurs from contact with an infected partner who does not have visible lesions and who may not know that he or she is infected. ⁷ In persons with asymptomatic HSV-2 infections, genital HSV shedding occurs on 10.2% of days, compared to 20.1% of days among those with symptomatic infections. ⁸

What are the symptoms of genital herpes?

Most individuals infected with HSV are asymptomatic or have very mild symptoms that go unnoticed or are mistaken for another skin condition. ⁹ When symptoms do occur, herpes lesions typically appear as one or more vesicles, or small blisters, on or around the genitals, rectum or mouth. The average incubation period for an initial herpes infection is 4 days (range, 2 to 12) after exposure. ¹⁰ The vesicles break and leave painful ulcers that may take two to four weeks to heal after the initial herpes infection. ^5,10 Experiencing these symptoms is referred to as having a first herpes “outbreak” or episode.

Clinical manifestations of genital herpes differ between the first and recurrent (i.e., subsequent) outbreaks. The first outbreak of herpes is often associated with a longer duration of herpetic lesions, increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, or headache. ⁵^,10 Recurrent outbreaks of genital herpes are common, and many patients who recognize recurrences have prodromal symptoms, either localized genital pain, or tingling or shooting pains in the legs, hips or buttocks, which occur hours to days before the eruption of herpetic lesions. ⁵ Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes. ⁵ Long-term studies have indicated that the number of symptomatic recurrent outbreaks may decrease over time. ⁵ Recurrences and subclinical shedding are much less frequent for genital HSV-1 infection than for genital HSV-2 infection.⁵

What are the complications of genital herpes?

Genital herpes may cause painful genital ulcers that can be severe and persistent in persons with suppressed immune systems, such as HIV-infected persons. ⁵ Both HSV-1 and HSV-2 can also cause rare but serious complications such as aseptic meningitis (inflammation of the linings of the brain). ⁵ Development of extragenital lesions (e.g. buttocks, groin, thigh, finger, or eye) may occur during the course of infection. ⁵

Some persons who contract genital herpes have concerns about how it will impact their overall health, sex life, and relationships. ^5,¹¹ There can also be considerable embarrassment, shame, and stigma associated with a herpes diagnosis that can substantially interfere with a patient’s relationships. ¹⁰ Clinicians can address these concerns by encouraging patients to recognize that while herpes is not curable, it is a manageable condition. ⁵ Three important steps that providers can take for their newly-diagnosed patients are: giving information, providing support resources, and helping define treatment and prevention options. ¹² Patients can be counseled that risk of genital herpes transmission can be reduced, but not eliminated, by disclosure of infection to sexual partners, ⁵ avoiding sex during a recurrent outbreak, ⁵ use of suppressive antiviral therapy, ^5,¹⁰ and consistent condom use. ⁷Since a diagnosis of genital herpes may affect perceptions about existing or future sexual relationships, it is important for patients to understand how to talk to sexual partners about STDs. One resource can be found here: www.gytnow.org/talking-to-your-partner

There are also potential complications for a pregnant woman and her newborn child. See “How does herpes infection affect a pregnant woman and her baby?” below for information about this.

What is the link between genital herpes and HIV?

Genital ulcerative disease caused by herpes makes it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 4-fold increased risk of acquiring HIV, if individuals with genital herpes infection are genitally exposed to HIV. ^13-15 Ulcers or breaks in the skin or mucous membranes (lining of the mouth, vagina, and rectum) from a herpes infection may compromise the protection normally provided by the skin and mucous membranes against infections, including HIV. ¹⁴ In addition, having genital herpes increases the number of CD4 cells (the target cell for HIV entry) in the genital mucosa. In persons with both HIV and genital herpes, local activation of HIV replication at the site of genital herpes infection can increase the risk that HIV will be transmitted during contact with the mouth, vagina, or rectum of an HIV-uninfected sex partner. ¹⁴

How does genital herpes affect a pregnant woman and her baby?

Neonatal herpes is one of the most serious complications of genital herpes.^5,¹⁶ Healthcare providers should ask all pregnant women if they have a history of genital herpes.¹¹ Herpes infection can be passed from mother to child during pregnancy or childbirth, or babies may be infected shortly after birth, resulting in a potentially fatal neonatal herpes infection. ¹⁷ Infants born to women who acquire genital herpes close to the time of delivery and are shedding virus at delivery are at a much higher risk for developing neonatal herpes, compared with women who have recurrent genital herpes . ^16,^18-20 Thus, it is important that women avoid contracting herpes during pregnancy. Women should be counseled to abstain from intercourse during the third trimester with partners known to have or suspected of having genital herpes. ^5,¹¹

While women with genital herpes may be offered antiviral medication late in pregnancy through delivery to reduce the risk of a recurrent herpes outbreak, third trimester antiviral prophylaxis has not been shown to decrease the risk of herpes transmission to the neonate. ^11,^21,²² Routine serologic HSV screening of pregnant women is not recommended. ¹¹ However, at onset of labor, all women should undergo careful examination and questioning to evaluate for presence of prodromal symptoms or herpetic lesions. ¹¹ If herpes symptoms are present a cesarean delivery is recommended to prevent HSV transmission to the infant.^5,^11,²³ There are detailed guidelines for how to manage asymptomatic infants born to women with active genital herpes lesions.²⁴

How is genital herpes diagnosed?

HSV nucleic acid amplification tests (NAAT) are the most sensitive and highly specific tests available for diagnosing herpes. However, in some settings viral culture is the only test available. The sensitivity of viral culture can be low, especially among people who have recurrent or healing lesions. Because viral shedding is intermittent, it is possible for someone to have a genital herpes infection even though it was not detected by NAAT or culture. ¹¹

Type-specific virologic tests can be used for diagnosing genital herpes when a person has recurrent symptoms or lesion without a confirmatory NAAT, culture result, or has a partner with genital herpes. Both virologic tests and type-specific serologic tests should be available in clinical settings serving patients with, or at risk for, sexually transmitted infections. ¹¹

Given performance limitations with commercially available type-specific serologic tests (especially with low index value results [<3]), a confirmatory test (Biokit or Western Blot) with a second method should be performed before test interpretation. If confirmatory tests are unavailable, patients should be counseled about the limitations of available testing before serologic testing. Healthcare providers should also be aware that false-positive results occur. In instances of suspected recent acquisition, serologic testing within 12 weeks after acquisition may be associated with false negative test results. ¹¹

HSV-1 serologic testing does not distinguish between oral and genital infection, and typically should not be performed for diagnosing genital HSV-1 infection. Diagnosis of genital HSV-1 infection is confirmed by virologic tests from lesions. ¹¹

CDC does not recommend screening for HSV-1 or HSV-2 in the general population due to limitations of the type specific serologic testing. ¹¹ Several scenarios where type-specific serologic HSV tests may be useful include:

Patients with recurrent genital symptoms or atypical symptoms and negative HSV NAAT or culture;
Patients with a clinical diagnosis of genital herpes but no laboratory confirmation; and
Patients who report having a partner with genital herpes. ¹¹

Patients who are at higher risk of infection (e.g., presenting for an STI evaluation, especially those with multiple sex partners), and people with HIV might need to be assessed for a history of genital herpes symptoms, followed by serology testing in those with genital symptoms. ¹¹

Providers are strongly encouraged to look at CDC’s STI Treatment Guidelines for further diagnostic considerations.

Is there a cure or treatment for herpes?

There is no cure for herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication.¹¹ In addition, daily suppressive therapy (i.e., daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners.¹¹

There is currently no commercially available vaccine that is protective against genital herpes infection. Candidate vaccines are in clinical trials.

How can herpes be prevented?

Correct and consistent use of latex condoms can reduce, but not eliminate, the risk of transmitting or acquiring genital herpes because herpes virus shedding can occur in areas that are not covered by a condom.^25,²⁶

The surest way to avoid transmission of STDs, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested for STDs and is known to be uninfected.

Persons with herpes should abstain from sexual activity with partners when herpes lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms, he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV.

Daily treatment with valacyclovir decreases the rate of HSV-2 transmission in discordant, heterosexual couples in which the source partner has a history of genital HSV-2 infection. ²⁷ Such couples should be encouraged to consider suppressive antiviral therapy as part of a strategy to prevent transmission, in addition to consistent condom use and avoidance of sexual activity during recurrences.

Counseling those with genital herpes, as well as their sex partners, is critical. It can help patients cope with the infection and prevent further spread into the community. The STI Treatment Guidelines includes messaging broken down by herpes type. ¹¹

Sources:

1. Kreisel KM, Spicknall IH, Gargano JW, Lewis FM, Lewis RM, Markowitz LE, Roberts H, Satcher Johnson A, Song R, St. Cyr SB, Weston EJ, Torrone EA, Weinstock HS. Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2018. Sex Transm Dis 2021; in press.

2. McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R. Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016. NCHS Data Brief, no 304. Hyattsville, MD: National Center for Health Statistics. 2018

3. Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA, 2006. 296(8): 964–73.

4. Bradley H, Markowitz L, Gibson T, et al. Seroprevalence of herpes simplex virus types 1 and 2—United States, 1999–2010. J Infect Dis, 2014. 209(3):325-33.

5. Corey L, Wald A. Genital Herpes. In: Holmes KK, Sparling PF, Stamm WE, et al. (editors). Sexually Transmitted Diseases. 4th ed. New York: McGraw-Hill; 2008: 399–437.

6. Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L. Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks and non-Hispanic whites aged 14 to 49 years–United States, 1988 to 2010. Sex Transm Dis, 2013. 40(11):860-4.

7. Mertz GJ. Asymptomatic shedding of herpes simplex virus 1 and 2: implications for prevention of transmission. J Infect Dis, 2008. 198(8): 1098–1100.

8. Tronstein E, Johnston C, Huang M, et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA, 2011. 305(14): 1441–9.

9. Wald A, Zeh J, Selke S, et al. Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons. New Engl J Med, 2000. 342(12): 844–50.

10. Kimberlin DW, Rouse DJ. Genital Herpes. N Engl J Med, 2004. 350(19): 1970–7.

11. Workowski, KA, Bachmann, LH, Chang, PA, et. al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70(No. 4): 1-187.

12. Alexander L, Naisbett B. Patient and physician partnerships in managing genital herpes. J Infect Dis, 2002. 186(Suppl 1): S57–S65.

13. Freeman EE, Weiss HA, Glynn JR, Cross PL, Whitworth JA, Hayes RJ. Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies. AIDS, 2006. 20(1): 73–83.

14. Barnabas RV, Celum C. Infectious co-factors in HIV-1 transmission. Herpes simplex virus type-2 and HIV-1: new insights and interventions. Curr HIV Res, 2012. 10(3): 228–37

15. Corey L, Wald A, Celum CL, Quinn TC. The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics. JAIDS, 2004. 35(5): 435–45.

16. Brown ZA, Selke S, Zeh J, et al. The acquisition of herpes simplex virus during pregnancy. N Engl J Med, 1997. 337(8): 509–15.

17. Kimberlin DW. Herpes simplex virus infections in the newborn. Semin Perinatol, 2007. 31(2): 19–25.

18. Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA, 2003. 289(2):203–9

19. Brown ZA, Benedetti J, Ashley R, et al. Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. N Engl J Med, 1991. 324(18):1247–52

20. Brown ZA, Vontver LA, Benedetti J, et al. Effects on infants of a first episode of genital herpes during pregnancy. N Engl J Med, 1987. 317(20):1246–51

21. Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database Syst Rev, 2008. Issue 1: Art. No. CD004946.

22. Pinninti SG, Angara R, Feja KN, et al. Neonatal herpes disease following maternal antenatal antiviral suppressive therapy: a multicenter case series. J Pediatr, 2012. 161(1):134-8.

23. American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. No. 82 June 2007. Management of herpes in pregnancy. Obstet Gynecol, 2007. 109(6): 1489–98.

24. Kimberlin DW, Balely J, Committee on Infectious Diseases, Committee on Fetus and Newborn. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Pediatrics, 2013. 131(2):e635-46.

25. Martin ET, Krantz A, Gottlieb SL, et al. A pooled analysis of the effect of condoms in preventing HSV-2 acquisition. Arch Intern Med, 2009. 169(13): 1233–40.

26. Wald A, Langenberg AGM, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA, 2001. 285(24): 3100–6.

27. Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med, 2004. 350:11–20.

Hepatitis B

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Hepatitis B

Key Facts

Hepatitis B is an acute or chronic viral infection that affects the liver.
Transmission of the virus most often occurs perinatally from mother to child, as well as through contact with blood or other body fluids, in particular through sexual contact with an infected partner, unsafe injection practices and stabbing.
WHO estimates that in 2019 there were 296 million people living with chronic hepatitis B worldwide, with about 1.5 million new infections occurring each year.
An estimated 820,000 people died from hepatitis B in 2019, mainly as a result of cirrhosis of the liver and hepatocellular carcinoma (primary liver cancer).
Hepatitis B is preventable through safe, affordable and effective vaccines.

Overview

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). This disease is a major public health problem worldwide. The infection can become chronic with a high risk of death from cirrhosis and liver cancer.

A safe and effective vaccine is available that provides 98-100% protection against hepatitis B. Prevention of viral hepatitis B helps prevent the development of complications such as chronic hepatitis and liver cancer.

The burden of hepatitis B is greatest in the WHO Western Pacific Region and the WHO African Region, where chronic hepatitis B affects 116 million and 81 million people, respectively. Sixty million people are infected in the Eastern Mediterranean Region, 18 million in the South-East Asia Region, 14 million in the WHO European Region and 5 million in the WHO Region of the Americas.

Transmission

In highly endemic areas, hepatitis B is most commonly transmitted either from mother to child at birth (perinatal transmission) or through horizontal transmission (contact with contaminated blood), especially between infected and uninfected children in the first five years of life. It is very common for infants who are infected from their mother or children who become infected before the age of 5 to develop a chronic infection.

Hepatitis B is also transmitted through needle sticks, tattoos, piercings, and contact with infected blood and body fluids, including saliva, menstrual and vaginal fluids, and semen. Transmission can also occur through the reuse of contaminated needles and syringes or sharps in health care settings or in the home, and among people who inject drugs. The hepatitis B virus can be transmitted sexually, especially in unvaccinated individuals who have multiple sexual partners.

Chronic hepatitis B develops in less than 5% of people who become infected in adulthood and in about 95% of those infected in infancy and early childhood. This confirms the need to strengthen and prioritize vaccination efforts for infants and young children.

The hepatitis B virus can survive outside the human body for at least seven days. During this time, the virus retains the ability to cause infection if it enters the body of a person who is not protected by the vaccine. The incubation period for hepatitis B ranges from 30 to 180 days. The virus is found in the blood for 30 to 60 days after infection and can persist in the body, causing chronic hepatitis B, especially when infected in infancy or childhood.

Symptoms

Most primary infections are asymptomatic. However, some patients develop acute conditions with severe symptoms that persist for several weeks and include icteric discoloration of the skin and eyes (jaundice), dark urine, severe weakness, nausea, vomiting, and abdominal pain. In rare cases, acute hepatitis can lead to the development of acute liver failure with a risk of death. As a result of HBV infection, some individuals may develop long-term complications of progressive liver disease such as cirrhosis and hepatocellular carcinoma, which cause high morbidity and mortality.

HIV-HBV coinfection

About 1% of people living with HBV infection (2.7 million people) are also infected with HIV. At the same time, the average prevalence of HBV infection among HIV-infected people in the world is 7. 4%. Since 2015, WHO has recommended treatment for all patients diagnosed with HIV infection, regardless of the stage of the disease. Tenofovir, which is part of the combination regimens recommended as first-line therapy for HIV infection, is also active against HBV.

Diagnosis

Based on the clinical picture alone, it is impossible to differentiate between hepatitis B and other types of viral hepatitis, so laboratory confirmation of the diagnosis is essential. Several blood tests are available for diagnosing and monitoring patients with hepatitis B. They can be used to differentiate between acute and chronic infections. To ensure blood safety and prevent accidental transmission of the virus, WHO recommends systematic testing of all donated blood for hepatitis B.

As of 2019, 30.4 million people were aware of their infection (approximately 10.5% of all people living with hepatitis B), with 6.6 million people diagnosed (22%) receiving treatment. According to the latest WHO estimates, the proportion of children under the age of five with chronic hepatitis B fell to just under 1% in 2019, compared with more than 1% between the 1980s and early 2000s. their share was about 5%.

When population levels of hepatitis B surface antigen seroprevalence are high (defined as HBsAg seroprevalence >2% or >5%), WHO recommends that all adults have access to and be able to have HBsAg testing combined with prevention and treatment services when needed.

Treatment

There is no specific treatment for acute hepatitis B. Therefore, medical care is about maintaining physical comfort and proper nutritional balance, including replenishing fluid losses caused by vomiting and diarrhea. It is extremely important to refrain from unjustified prescribing of drugs. Acetaminophen, paracetamol and antiemetics should be avoided.

Chronic hepatitis B may be treated with medication, including oral antivirals. Treatment can slow the progression of cirrhosis of the liver, reduce the risk of developing liver cancer, and improve long-term survival rates for patients. WHO estimates that between 12% and 25% of people with chronic hepatitis B will need medication in 2021, depending on conditions and eligibility criteria.

WHO recommends the oral drugs tenofovir or entecavir, which are the most effective agents for suppressing hepatitis B virus replication. Most patients who start treatment for hepatitis B must continue it throughout their lives.

In low-income countries, most liver cancer patients die within a few months of diagnosis. In high-income countries, patients present to hospitals at an earlier stage of the disease, and the lives of such patients can be extended by several months or years with the help of surgery and chemotherapy. In high-income countries, people with cirrhosis or liver cancer sometimes undergo liver transplantation with mixed success.

Prevention

WHO recommends that all newborns be vaccinated against hepatitis B as soon as possible after birth, within the first 24 hours of life if possible, followed by two or three doses of the vaccine at least four weeks apart for full vaccination. Acquired immunity persists for at least 20 years and probably for life. WHO does not recommend booster vaccinations for individuals who have completed the 3-dose vaccination.

In addition to infant vaccination, WHO recommends prophylactic antiviral therapy to prevent mother-to-child transmission of hepatitis B. Transmission of the virus can also be prevented through blood safety and safe sex practices, including minimizing the number of sexual partners and using barrier contraception (condoms).

WHO activities

In May 2016, the World Health Assembly adopted the first Global Health Sector Strategy on Viral Hepatitis 2016–2020. The strategy highlights the critical role of universal health coverage and sets targets aligned with the Sustainable Development Goals. The strategy was to achieve the goal of eliminating viral hepatitis as a public health problem by 2030 (defined as a reduction of 90% new cases of chronic infections and a 65% reduction in mortality compared to the 2015 baseline) and included an action plan to achieve elimination through the implementation of key prevention, diagnosis, treatment and community outreach strategies. In May 2022, the Seventy-fifth World Health Assembly took note of a set of new comprehensive global health sector strategies for HIV, viral hepatitis and sexually transmitted infections for the period 2022–2030. Based on these previous and newly adopted strategies, many Member States have developed comprehensive national hepatitis programs and strategies to achieve elimination, guided by the global health sector strategy.

To support countries in achieving the global hepatitis elimination targets of the 2030 Agenda for Sustainable Development, WHO works in the following areas:

raising awareness, promoting partnerships and mobilizing resources;
developing evidence-based policies and collecting evidence for action;
ensuring health equity in the fight against hepatitis;
prevention of the spread of infection; and
expanded coverage of screening, care and treatment services.

WHO organizes an annual World Hepatitis Day event (one of the nine major annual public health campaigns) to raise awareness and understanding of the problem of viral hepatitis. In 2022, WHO is celebrating World Hepatitis Day under the slogan “ Providing Hepatitis Care Nearby” ” and calls for streamlining the delivery of viral hepatitis services, making them more accessible to the public.

World Hepatitis Day 2021

N.A. Semashko Central City Clinical Hospital in Rostov-on-Don

MEDICAL INFORMATION AND ANALYTICAL CENTER

Prevention of viral hepatitis

9 0289 (reminder for the public)

Hepatitis A – is an acute infectious liver disease caused by hepatitis A virus A . About 10 million people are infected with the virus every year worldwide. In Russia, hepatitis A, B, C, D are most common. Children and adolescents in organized groups, employees of closed institutions are most at risk of infection. The incubation period lasts from 15 to 50 days. The transmission of the virus is carried out in the alimentary way – through contaminated food and water, toys, dirty hands. The virus is stable in the external environment, to temperatures up to 60 ° C, it persists for months in fresh and salt water. Hepatitis A is characterized by inflammatory and necrotic changes in the liver tissue and intoxication syndrome, enlargement of the liver and spleen, clinical and laboratory signs of liver dysfunction, in some cases jaundice with dark urine and discoloration of feces. Clinically, this manifests itself in the form of the following symptoms: a feeling of weakness and malaise, loss of appetite, nausea and vomiting, muscle pain. Having penetrated into the human body, the hepatitis virus A multiplies intensively in the liver, from there it enters the intestine through the bile ducts, and then into the external environment. The spread of the virus is facilitated by the poor sanitary condition of the home and place of work, non-observance of personal hygiene rules, crowding of the population, violation of the rules for preparing and storing food, and the use of poor-quality drinking water. Hepatitis is dangerous for the development of cirrhosis of the liver.

Hepatitis B — an infection caused by the hepatitis B virus, formerly known as serum hepatitis. Infection occurs during medical procedures with violation of the skin, through the mucous membranes during sexual contact, as a result of household contact (through brushes, washcloths, shaving accessories; through abrasions, microtraumas), from mother to child (during and after childbirth, during child care and while breastfeeding). Only people get sick with hepatitis. When the virus enters the body, an infection develops with an acute or chronic course. The source of infection may be a human carrier. Acute hepatitis occurs in an icteric, anicteric or erased form. The incubation period (from the moment of infection to the onset of the disease) ranges from 30 days to 6 months (most often 60-120 days). For hepatitis B is characterized by a virus carrier that can develop both after an acute illness and after asymptomatic infection, when a person does not even suspect that the causative agent of hepatitis B is in his body.

Hepatitis C ami acute hepatitis C and virus carriers. The disease is transmitted through damaged skin and mucous membranes. Infection with the hepatitis C virus leads to the development of an infection with an acute course. In Russia, acute hepatitis C most often affects people aged 15-29years. For one case of jaundice, there are 5-6 cases of anicteric hepatitis. The incubation period is 7 weeks with a range of 1 to 30 weeks. A distinctive feature of the disease is the development of chronic hepatitis in 60-70% of people who have had acute hepatitis. However, a hepatitis C vaccine has not yet been developed.

Hepatitis D – is a Delta infection caused by the hepatitis D virus. Infection with hepatitis D occurs only when the virus enters directly into the blood. The incubation period lasts from 3 to 7 weeks. Clinical manifestations of the disease: increased fatigue, loss of appetite, nausea, mild fever. A feature of the disease is bleeding gums, nosebleeds, bruising with minor bruises. Ways of infection transmission: sexual, from a mother infected with the delta virus to a newborn, there are also family foci of infection with close household contacts, as well as an artificial transmission route during medical and non-medical manipulations (in case of violation of the integrity of the skin with non-disinfected instruments).

Alcoholic hepatitis – develops without infection with the virus. The disease can proceed in an acute form. Long-term alcohol intake can lead to the development of chronic hepatitis with the gradual formation of liver cirrhosis.

How to protect yourself from hepatitis and keep your health?

Lead a healthy lifestyle.
Follow the rules of personal hygiene, wash hands thoroughly with soap before eating, before preparing food, after visiting the toilet and public places.