Hepatitis B – Symptoms and causes

Overview

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, hepatitis B infection becomes chronic, meaning it lasts more than six months. Having chronic hepatitis B increases your risk of developing liver failure, liver cancer or cirrhosis — a condition that permanently scars of the liver.

Most adults with hepatitis B recover fully, even if their signs and symptoms are severe. Infants and children are more likely to develop a chronic (long-lasting) hepatitis B infection.

A vaccine can prevent hepatitis B, but there’s no cure if you have the condition. If you’re infected, taking certain precautions can help prevent spreading the virus to others.

Symptoms

Signs and symptoms of hepatitis B range from mild to severe. They usually appear about one to four months after you’ve been infected, although you could see them as early as two weeks post-infection. Some people, usually young children, may not have any symptoms.

Hepatitis B signs and symptoms may include:

• Abdominal pain
• Dark urine
• Fever
• Joint pain
• Loss of appetite
• Nausea and vomiting
• Weakness and fatigue
• Yellowing of your skin and the whites of your eyes (jaundice)

When to see a doctor

If you know you’ve been exposed to hepatitis B, contact your doctor immediately. A preventive treatment may reduce your risk of infection if you receive the treatment within 24 hours of exposure to the virus.

If you think you have signs or symptoms of hepatitis B, contact your doctor.

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Causes

Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from person to person through blood, semen or other body fluids. It does not spread by sneezing or coughing.

Common ways that HBV can spread are:

• Sexual contact. You may get hepatitis B if you have unprotected sex with someone who is infected. The virus can pass to you if the person’s blood, saliva, semen or vaginal secretions enter your body.
• Sharing of needles. HBV easily spreads through needles and syringes contaminated with infected blood. Sharing IV drug paraphernalia puts you at high risk of hepatitis B.
• Accidental needle sticks. Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood.
• Mother to child. Pregnant women infected with HBV can pass the virus to their babies during childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases. Talk to your doctor about being tested for hepatitis B if you are pregnant or want to become pregnant.

Acute vs. chronic hepatitis B

Hepatitis B infection may be either short-lived (acute) or long lasting (chronic).

• Acute hepatitis B infection lasts less than six months. Your immune system likely can clear acute hepatitis B from your body, and you should recover completely within a few months. Most people who get hepatitis B as adults have an acute infection, but it can lead to chronic infection.
• Chronic hepatitis B infection lasts six months or longer. It lingers because your immune system can’t fight off the infection. Chronic hepatitis B infection may last a lifetime, possibly leading to serious illnesses such as cirrhosis and liver cancer.

The younger you are when you get hepatitis B — particularly newborns or children younger than 5 — the higher your risk of the infection becoming chronic. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease.

Risk factors

Hepatitis B spreads through contact with blood, semen or other body fluids from an infected person. Your risk of hepatitis B infection increases if you:

• Have unprotected sex with multiple sex partners or with someone who’s infected with HBV
• Share needles during IV drug use
• Are a man who has sex with other men
• Live with someone who has a chronic HBV infection
• Are an infant born to an infected mother
• Have a job that exposes you to human blood
• Travel to regions with high infection rates of HBV, such as Asia, the Pacific Islands, Africa and Eastern Europe

Complications

Having a chronic HBV infection can lead to serious complications, such as:

• Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B infection can lead to extensive liver scarring (cirrhosis), which may impair the liver’s ability to function.
• Liver cancer. People with chronic hepatitis B infection have an increased risk of liver cancer.
• Liver failure. Acute liver failure is a condition in which the vital functions of the liver shut down. When that occurs, a liver transplant is necessary to sustain life.
• Other conditions. People with chronic hepatitis B may develop kidney disease or inflammation of blood vessels.

Prevention

The hepatitis B vaccine is typically given as three or four injections over six months. You can’t get hepatitis B from the vaccine.

The hepatitis B vaccine is recommended for:

• Newborns
• Children and adolescents not vaccinated at birth
• Those who work or live in a center for people who are developmentally disabled
• People who live with someone who has hepatitis B
• Health care workers, emergency workers and other people who come into contact with blood
• Anyone who has a sexually transmitted infection, including HIV
• Men who have sex with men
• People who have multiple sexual partners
• Sexual partners of someone who has hepatitis B
• People who inject illegal drugs or share needles and syringes
• People with chronic liver disease
• People with end-stage kidney disease
• Travelers planning to go to an area of the world with a high hepatitis B infection rate

Take precautions to avoid HBV

Other ways to reduce your risk of HBV include:

• Know the HBV status of any sexual partner. Don’t engage in unprotected sex unless you’re absolutely certain your partner isn’t infected with HBV or any other sexually transmitted infection.
• Use a new latex or polyurethane condom every time you have sex if you don’t know the health status of your partner. Remember that although condoms can reduce your risk of contracting HBV, they don’t eliminate the risk.
• Don’t use illegal drugs. If you use illicit drugs, get help to stop. If you can’t stop, use a sterile needle each time you inject illicit drugs. Never share needles.
• Be cautious about body piercing and tattooing. If you get a piercing or tattoo, look for a reputable shop. Ask about how the equipment is cleaned. Make sure the employees use sterile needles. If you can’t get answers, look for another shop.
• Ask about the hepatitis B vaccine before you travel. If you’re traveling to a region where hepatitis B is common, ask your doctor about the hepatitis B vaccine in advance. It’s usually given in a series of three injections over a six-month period.

Sept. 04, 2020

Types of Viral Hepatitis: Hepatitis A, B, C

What Is Viral Hepatitis?

Viral hepatitis is an inflammation of your liver that’s caused by a virus. There are five types, but the most common ones in the U.S. are hepatitis A, B, and C. All of them affect your liver. Some of the symptoms are similar, but they have different treatments.

Hepatitis A. This type won’t lead to long-term infection and usually doesn’t cause any complications. Your liver heals in about 2 months. You can prevent it with a vaccine.

Hepatitis B. Most people recover from this type in 6 months. Sometimes, though, it causes a long-term infection that could lead to liver damage. Once you’ve got the disease, you can spread the virus even if you don’t feel sick. You won’t catch it if you get a vaccine.

Hepatitis C. Many people with this type don’t have symptoms. About 80% of those with the disease get a long-term infection. It can sometimes lead to cirrhosis, a scarring of the liver. There’s no vaccine to prevent it.

How Do You Get Hepatitis A?

The main way you get hepatitis A is when you eat or drink something that has the hep A virus in it. A lot of times this happens in a restaurant. If an infected worker there doesn’t wash their hands well after using the bathroom, and then touches food, they could pass the disease to you.

Food or drinks you buy at the supermarket can sometimes cause the disease, too. The ones most likely to get contaminated are:

You could catch or spread it if you’re taking care of a baby and you don’t wash your hands after changing their diaper. This can happen, for example, at a day care center.

Another way you can get hep A is when you have sex with someone who has it.

How Do You Get Hepatitis B?

The virus that causes hepatitis B lives in blood, semen, and other fluids in your body. You usually get it by having sex with someone who’s infected.

You also can get it if you:

• Share dirty needles when using illegal drugs
• Have direct contact with infected blood or the body fluids of someone who’s got the disease, for instance by using the same razor or toothbrush as someone who has hepatitis B, or touching the open sores of somebody who’s infected.
• If you’re pregnant and you’ve got hepatitis B, you could give the disease to your unborn child. If you deliver a baby who’s got it, they need to get treatment in the first 12 hours after birth.   

How Do You Get Hepatitis C?

Just like hepatitis B, you can get this type by sharing needles or having contact with infected blood. You can also catch it by having sex with somebody who’s infected, but that’s less common.

If you had a blood transfusion before new screening rules were put in place in 1992, you are at risk for hepatitis C. If not, the blood used in transfusions today is safe. It gets checked beforehand to make sure it’s free of the virus that causes hepatitis B and C.

It’s rare, but if you’re pregnant and have the disease, it’s possible to pass it to your newborn.

There are some myths out there about how you get hepatitis C, so let’s set the record straight. It’s not spread by food and water (like hep A). And you can’t spread it by doing any of these things:

How Do I Know If I Have Viral Hepatitis?

The best-known symptom is jaundice, which can make your skin or the whites of your eyes turn yellow.

But not everyone who has hepatitis gets jaundice. You might just feel like you have the flu — weak, tired, and sick to your stomach. These symptoms are common for many types of hepatitis:

• Fever
• Loss of appetite
• Nausea and vomiting
• Stomach pain
• Diarrhea
• Dark-colored urine
• Light-colored bowel movements
• Joint pain

See your doctor as soon as possible if you have any of these symptoms.

Sometimes, people have no symptoms. To be sure you have hepatitis, you’ll need to get tested.

How Long Before I Have Symptoms?

Many people have mild symptoms or no symptoms, which is why hepatitis is sometimes called a “silent” disease.

Hepatitis A. The symptoms usually show up 2 to 6 weeks after the virus entered your body. They usually last for less than 2 months, though sometimes you can be sick for as long as 6 months.

Some warning signs that you may have hepatitis A are:

Hepatitis B. The symptoms are the same as hepatitis A, and you usually get them 3 months after you’re infected. They could show up, though, anywhere from 6 weeks to 6 months later.

Sometimes the symptoms are mild and last just a few weeks. For some people, the hep B virus stays in the body and leads to long-term liver problems.

Hepatitis C. The early symptoms are the same as hepatitis A and B, and they usually happen 6 to 7 weeks after the virus gets in your body. But you could notice them anywhere from 2 weeks to 6 months later.

For about 25% of people who get hep C, the virus goes away on its own without treatment. In other cases, it sticks around for years. When that happens, your liver might get damaged.

Remember, it’s possible to spread all the types of hepatitis even if you don’t show any signs of being sick.

Should I Get Tested?

If your doctor thinks you have hepatitis, there are blood tests to tell if you have type A, B, C, or another type called D. You should get lab results back within a few days.

Some types of hepatitis get better on their own. Others turn into chronic cases and can damage the liver and cause liver cancer. If your doctor thinks you could have chronic hepatitis B or C, they may perform a liver biopsy. That means they’ll remove a very tiny piece of your liver with a needle, then send it to a lab to check for liver damage.

The sooner you’re tested for a chronic form of hepatitis, the sooner you can take medicine to reduce or stop the damage the virus can cause to your liver.

Many people with hepatitis C don’t have symptoms, so they don’t know they’re infected. That’s why it’s so important to see a doctor and get tested. Chronic hepatitis C testing is recommended for anyone who:

• Was born from 1945 through 1965
• Received blood-clotting factor drugs before 1987
• Received blood transfusions or an organ transplant before 1992
• Has been on dialysis for many years
• Injected illegal drugs, even once
• Has HIV
• Has a known exposure to hepatitis C (such as a health care worker stuck by a needle with blood that is hepatitis C-positive or received an organ or blood transfusion from a donor who has hepatitis C)
• Was born to a mother who had hepatitis C

Can Hepatitis Be Treated?

If you have hepatitis A, your doctor will carefully see how well your liver is working, but there aren’t any treatments.

There are several drugs that treat long-term hepatitis B, such as:

If you have long-term hepatitis B, you might be a “carrier,” which means you can infect others.

Medications called direct-acting antiviral (DAA) treatments can cure many people with hepatitis C. If you haven’t been treated before, your doctor may suggest these drugs for hepatitis C:

Is There a Vaccine to Protect Me From Hepatitis?

There are vaccines that prevent hepatitis A and B. There isn’t one for hepatitis C.

The CDC recommends that all children get hepatitis A and B vaccines. Adults should get vaccinated if they travel to a country where there are outbreaks or if they’re at high risk for the disease.

How Long Do the Viruses That Cause Hepatitis Survive Outside the Body?

The hepatitis A virus can live outside the body for months.

Hepatitis B survives for at least 7 days while still being able to cause an infection.

Hepatitis C can live on household and clinic surfaces for up to 6 weeks at room temperature. In open air, it can survive for at least 4 days.

If I Have Hepatitis, How Can I Avoid Giving It to Someone Else?

For hepatitis A, one of the best things you can do is wash your hands a lot. That will keep the virus out of food and drinks.

If you have hepatitis B and C, you need to find ways to keep others from making contact with your blood. Follow these tips:

• Cover your cuts or blisters.
• Carefully throw away used bandages, tissues, tampons, and sanitary napkins.
• Don’t share your razor, nail clippers, or toothbrush.
• If your blood gets on objects, clean them with household bleach and water.
• Don’t breastfeed if your nipples are cracked or bleeding.
• Don’t donate blood, organs, or sperm.
• If you inject drugs, don’t share needles or other equipment.

Where Can I Get Treated For Hepatitis B?

Hepatitis B can’t be cured, but it almost always goes away on its own. There are medications that can help treat long-lasting hepatitis B infections.

Is hepatitis B curable?

There’s no cure for hepatitis B. The good news is it usually goes away by itself in 4 to 8 weeks. More than 9 out of 10 adults who get hepatitis B totally recover.

However, about 1 in 20 people who get hepatitis B as adults become “carriers,” which means they have a chronic (long-lasting) hepatitis B infection. Carriers are more likely to pass hepatitis B to other people. Most carriers are contagious — meaning they can spread hepatitis B — for the rest of their lives.

Hepatitis B infections that last a long time may lead to serious liver diseases like cirrhosis and liver cancer. About 1 in 5 people with chronic hepatitis B die from it. There are medicines that can help treat chronic hepatitis B infections.

Most babies who get hepatitis B during birth develop chronic infection, unless they get treated right away. But treatments are almost always effective if your baby gets them quickly. That’s why it’s important for pregnant people to get tested for hepatitis B.

How do I get hepatitis B treatment?

Usually for adults, hepatitis B goes away on its own and you won’t need treatment. Your doctor might tell you to rest, eat well, and get plenty of fluids. You may also get medicines to help with any symptoms you might have — but be sure to talk with your doctor or nurse before taking anything.

If you have chronic (long-lasting) hepatitis, there are medicines you can take to treat it. Your doctor will tell you about your options and help you get whatever treatment you need.

What do I need to know about having hepatitis B?

If you have chronic hepatitis B, getting the right medical care can help you stay healthy. Taking good care of your liver is important. Talk with your doctor before you take any prescription medication, over-the-counter drugs, vitamins, or nutritional supplements to make sure they won’t hurt your liver. You should also stay away from alcohol, because drinking can damage your liver.

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What Is Hepatitis B & How Do You Get It?

Hepatitis C is a virus that can cause liver disease. Sometimes called hep c or HCV for short, hepatitis C can be a mild illness that only lasts for a few weeks or months, or a serious chronic condition that lasts your whole life. Hepatitis C can lead to serious illnesses, like cirrhosis of the liver and liver cancer, and can eventually kill you if left untreated.

Hepatitis C Transmission

The hepatitis C virus is transmitted through blood — most commonly from needles and syringes used for taking drugs. But hep c can also be spread from tattoo or piercing needles that haven’t been properly cleaned, by accident in a medical setting, from blood transfusions and organ transplants performed prior to 1992, and from a parent to their baby during childbirth.

Although it’s rare, hep C can also be sexually transmitted. Condoms work well to prevent spreading hepatitis C during sex. Talk with your doctor or nurse about getting tested for hepatitis C if you think you may be at risk.

Hepatitis C Symptoms

Hepatitis C doesn’t always have symptoms. If you do have them, you’re most likely to feel the symptoms 4-12 weeks after being exposed. Those early stage (acute) hepatitis C symptoms can include:

For some people, hepatitis C goes away without treatment after about 6 months. But for most people, hep C turns into a chronic (lifelong) condition.

Chronic hepatitis C rarely has symptoms. Most people find out that they have hepatitis C when they’re diagnosed with advanced liver disease. That’s why it’s important to get checked for hepatitis C if you think you may be at risk.

Hepatitis C Testing

Hepatitis C testing involves a blood test to check for hepatitis C antibodies. If the test is positive, it’s followed up with a test called an RNA test, which determines if the virus is currently active.

Hepatitis C treatment typically consists of antiviral medicine to reduce the amount of the virus in your system. There are also new treatments that may cure it. Your doctor or nurse will likely recommend that you avoid drinking alcohol and taking certain medicines that may harm your liver.

Read more about hepatitis C. If you’re worried you may be at risk, the staff at your nearest Planned Parenthood health center can help.

What is Viral Hepatitis? | CDC

Hepatitis C Treatments Give Patients More Options

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Transformative advances in drug treatments approved by the U.S. Food and Drug Administration are giving the 3.2 million Americans with chronic hepatitis C a chance for a longer, healthier life without the virus. That’s good news for baby boomers—who make up three of four adults with the hepatitis C virus—and millions of other Americans, many of whom don’t yet know they are infected and carriers.

Hepatitis C can be cured, and today’s drug therapies are very effective and easier for patients to take, says Jeffrey S. Murray, M.D., an internist at the FDA who specializes in infectious diseases.

Hepatitis Is a Preventable and Curable Disease

Hepatitis (inflammation of the liver) refers to a group of viral infections that affect the liver. The most common types are hepatitis A, hepatitis B and hepatitis C. Each is caused by a different virus.

Hepatitis C is the most common chronic blood-borne infection in the United States. There is no vaccine for this disease, but new cases of hepatitis C can be prevented by avoiding behaviors that can spread the virus—including sharing needles, syringes or other equipment to inject drugs.

A diagnosis of hepatitis C no longer means months and months of painful drug injections, which for decades were the only option. Science is making strides in therapies, giving patients new alternatives.

“Interferon-based injections often make patients feel ill and give them flulike symptoms,” Murray says. The treatment by interferon also lasts six months to a year, and cures only 40% to 50% of hepatitis C patients.

“Patients with very advanced liver disease couldn’t take the traditional treatment because often those injections could make them worse,” he adds. “Now, patients can treat their hepatitis C with only pills—drug combinations that are faster and have a higher cure rate.”

Today’s pills have double the viral cure rates—90% to 100%—in just in 12 weeks’ time. Reducing the treatment from a year to three months is a huge advantage for people with hepatitis C, especially because it’s easier to swallow a pill than to get an injection, Murray says.

In recent years, FDA has approved multiple all-oral combination regimens, including drugs from multiple classes without the need to co-administer interferon. Patients should discuss the treatment options that would be appropriate for them with their health care provider.

Baby Boomers and Hepatitis C

For most people, hepatitis is a silent disease until it causes substantial damage to the liver. That process may take several years, and can lead to liver failure with the need for liver transplantation, and can also lead to liver cancer.

“Hepatitis C is a bit like smoking, the longer you’ve had it, the higher your risk of developing complications—in this case, liver cancer, cirrhosis (liver scarring) and end-stage liver disease. It’s a progressive disease that takes years, even decades, before the patient develops cirrhosis or cancer,” Murray says. “The good news is that when you cure hepatitis C, you also lower its risks, though you don’t completely erase the years of damage to your liver.”

Once infected with the hepatitis C virus, nearly 8 in 10 untreated people remain infected for life, according to the Centers for Disease Control and Prevention (CDC). Three in four patients with chronic hepatitis C are baby boomers (people born from 1945 to 1965), and many became infected before the virus was identified and the blood supply was tested for the disease. That’s why it’s important for baby boomers—there are about 75 million of them, according to the U.S. Census Bureau—to take a simple blood test for hepatitis C.

CDC recommends a blood test for hepatitis C as part of routine medical care for everyone born between 1945 and 1965 and those with other risk factors, including people who got a blood transfusion before 1992, have a history of injecting illegal drugs at any time, or are on hemodialysis (kidney dialysis).

“When it comes to hepatitis C, the outlook for the future is better, but the past is catching up with us—especially if you are a baby boomer,” Murray says. “Still, this is a fortuitous time because better hepatitis C treatments are available just as the patient population at risk of long-term complications is about to peak. There are treatments for chronic hepatitis and many reasons to get tested now more than ever because of the availability of safe and effective therapies.”

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Protecting Yourself Against Hepatitis B and Hepatitis C

Antibodies: Proteins in the blood that the body makes in reaction to foreign substances, such as bacteria and viruses.

Carriers: People who are infected with the organism of a disease without showing symptoms. These people can pass the disease to other people.

Cells: The smallest units of a structure in the body. Cells are the building blocks for all parts of the body.

Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman’s abdomen.

Cirrhosis: A disease caused by loss of liver cells. The lost cells are replaced by scar tissue that impairs liver function.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Hepatitis B: An infection caused by a virus that can be spread through blood, semen, or other body fluid infected with the virus.

Hepatitis B Immune Globulin (HBIG): A substance given to provide temporary protection against infection with hepatitis B virus.

Hepatitis C: An infection caused by a virus that can be spread through infected blood.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system. If left untreated, HIV can cause acquired immunodeficiency syndrome (AIDS).

Immune: Protected against infectious disease.

Immune System: The body’s natural defense system against viruses and bacteria that cause disease.

Jaundice: A buildup of bilirubin (a brownish yellow substance formed from the breakdown of red cells in the blood) that causes the skin to have a yellowish appearance.

Kidney Disease: A general term for any disease that affects how the kidneys function.

Liver Enzymes: Chemicals made by liver cells. High levels of liver enzymes may suggest liver damage.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Sexually Transmitted Infection (STI): An infection that is spread by sexual contact. Infections include chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Trimester: A 3-month time in pregnancy. It can be first, second, or third.

Vaccine: A substance that helps the body fight disease. Vaccines are made from very small amounts of weak or dead agents that cause disease (bacteria, toxins, and viruses).

Viruses: Agents that cause certain types of infections.

Hepatitis B

Basic facts

• Hepatitis B – is a viral infectious disease that affects the liver and proceeds in an acute or chronic form.
• 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 during sexual intercourse with an infected partner, unsafe injection practices, cuts with stabbing and cutting tools in medical practice, and in the home, as well as among people who inject drugs.
• According to WHO estimates, in 2019 there were 296 million people in the world living with chronic hepatitis B (i.e., positive for hepatitis B surface antigen).
• An estimated 820,000 people died of hepatitis B in 2019, mainly as a result of hepatitis-related cirrhosis and hepatocellular carcinoma (primary liver cancer).
• As of 2019, of all people living with hepatitis B, 30.4 million (10)% of people knew about their infection, and of all diagnosed patients, 6.6 million were on treatment (22 %) human.According to the latest WHO estimates, in 2019 the proportion of children under five years of age with chronic hepatitis B fell to just under 1%, while in the decades leading up to the introduction of vaccination (i.e., from the 1980s to the early 2000s – x years), this figure was about 5%.
• According to WHO estimates, in 2019, despite the availability of a highly effective vaccine, the number of primarily infected with hepatitis B was about 1.5 million.
• Hepatitis B is preventable with safe, affordable and effective vaccines.
  

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

There is a safe and effective vaccine 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.

Geographic distribution

The burden of hepatitis B is greatest in the Western Pacific and the WHO African Region, where chronic hepatitis B affects 116 million and 81 million, respectively. In the Eastern Mediterranean Region, it is estimated that chronic hepatitis
60 million people live in.In the South-East Asia Region, the European Region and the Region of the Americas, the burden of infection is lower, with an estimated 18 million, 14 million and 5 million people infected with chronic hepatitis B, respectively.

Mechanisms of transmission

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

Hepatitis B is also transmitted through needle sticking, tattooing, body piercing, and contact with infected blood and body fluids, including saliva, menstrual and vaginal secretions, and semen. Infection can also take place
the reuse of contaminated needles and syringes or piercing-cutting objects in health care facilities or in the home, as well as among people who inject drugs.The infection can be transmitted by performing medical, surgical
and dental procedures, tattooing, and the use of razor blades and similar devices that are contaminated with infected blood. In addition, the hepatitis B virus can be sexually transmitted, especially in unvaccinated people
persons with 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.The hepatitis B virus is able to survive outside the human body for at least seven days. On
during this period of time, the virus retains the ability to cause infection if it enters the body of an unvaccinated person. The duration of the incubation period for hepatitis B ranges from 30 to 180 days and averages 75
days. The virus is found in the blood for 30-60 days after infection and can persist in the body, causing chronic hepatitis B, especially when infected in infancy or childhood.

Symptoms

In most cases, the primary infection is asymptomatic. However, some patients develop acute symptoms with severe symptoms that persist for several weeks and include icteric discoloration of the skin.
and sclera, darkening of 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.

In some people, the hepatitis B virus can also cause chronic liver infection, which over time can develop into cirrhosis (scarring of the liver) or liver cancer.

Who is at risk for chronic hepatitis B?

The likelihood of developing chronic infection depends on the age at which a person contracted the hepatitis virus. Chronic infection is most likely to develop in children who are infected with the hepatitis B virus before the age of six.

Infants and young children:

• in infants infected in the first year of life, chronic infection develops in 80–90% of cases;
• in children infected before the age of six years, chronic infection develops in 30-50% of cases.

Adults:

• in adults infected with hepatitis B, in the absence of other comorbidities, chronic infection develops in less than 5% of cases;
• If a chronic infection develops in 20–30% of adults, the disease leads to cirrhosis and / or liver cancer.

Coinfection with HIV-HBV

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 is 7.4%. Since 2015, WHO has recommended that treatment be prescribed to all patients diagnosed with
HIV infection, regardless of the stage of the disease. Tenofovir, which is part of the recommended first-line treatment for HIV infection, is also active against HBV.

Diagnostics

It is impossible to differentiate between hepatitis B and viral hepatitis on the basis of clinical presentation alone; therefore, laboratory confirmation of the diagnosis is extremely important. For the diagnosis and monitoring of patients with hepatitis B, there is
several methods of laboratory blood tests. They can be used to differentiate between acute and chronic infections.

Methods of laboratory diagnosis of infection are to identify the surface antigen of hepatitis B (HbsAg).To ensure blood safety and to prevent accidental transmission of the virus to recipients of blood products, WHO recommends systematic
testing of donated blood for hepatitis B.

• Acute HBV infection is characterized by the presence of a surface antigen of the hepatitis B virus (HBsAg) and antibodies to nuclear antigen (HBcAg) – immunoglobulins of class M (IgM). During the initial phase of infection, e-antigen is also detected in patients
  hepatitis B virus (HbeAg).HBeAg is usually a marker of high viral replication. The presence of HBeAg indicates a high contagiousness of the blood and body fluids of the infected person.
• Chronic infection is characterized by persistence of HBsAg for at least six months (with or without HBeAg). Continuous HBsAg is a major marker of risk for chronic liver disease and liver cancer
  (hepatocellular carcinoma) throughout life.

Treatment

There is no specific treatment for acute 90 130 hepatitis B .Therefore, medical attention is focused on maintaining physical comfort and proper nutritional balance, including replenishing fluid losses caused by vomiting and diarrhea. Very important
avoid unnecessary drug treatment. Patients with hepatitis A should not be given acetaminophen / paracetamol and antiemetic drugs.

With chronic hepatitis B, medication can be prescribed, including oral antiviral drugs.Treatment slows down the development of liver cirrhosis, reduces the risk of liver cancer, and increases rates
long-term survival of patients. According to WHO estimates, in 2021, between 12 and 25% of people with chronic hepatitis B will need drug treatment (depending on conditions and eligibility criteria).

WHO recommends prescribing oral drugs tenofovir and entecavir, which are the most effective agents for suppressing hepatitis B virus replication.
(1 tablet per day) and is not accompanied by significant side effects, and therefore there is no need for careful monitoring of patients.

Entecavir is not a patented drug. In 2017, all low- and middle-income countries were able to legally purchase generic entecavir, although the cost and availability varied significantly. Tenofovir
is no longer protected by a patent in any country in the world. In 2016, the median price of WHO-prequalified generic tenofovir dropped from US $ 208 to US $ 32 on the international market.

In most patients, drug treatment effectively suppresses viral replication, but does not provide a complete cure for hepatitis B.Therefore, most patients who start treatment for hepatitis B should continue it for as long as
all life.

In many resource-limited regions, access to diagnosis and treatment of hepatitis B remains difficult. In 2019, out of more than 296 million people living with HBV, only 10% (30.4 million) knew about their diagnosis. Treatment coverage was only 22% (6.6
million) diagnosed patients. Many patients are diagnosed with advanced liver disease.

Among the chronic complications of hepatitis B, high morbidity and mortality rates are associated with advanced liver disease, such as cirrhosis and hepatocellular carcinoma. Liver cancer progresses rapidly, and given the limited
the possibility of its treatment, the outcome of the disease, as a rule, is unfavorable. In low-income countries, most patients with liver cancer die within a few months of being diagnosed. In high-income countries, the lives of such
patients can be prolonged for several years due to surgery and chemotherapy.Also in high-income countries, some people with cirrhosis or liver cancer undergo liver transplants, but success rates differ.
heterogeneity.

Prevention

The main method of preventing hepatitis B is vaccination. WHO recommends that all newborns be vaccinated against hepatitis B as soon as possible after birth, if possible in the first 24 hours of life, followed by two or three doses of vaccine at intervals
at least four weeks for full vaccination.Immediately after birth, vaccinating babies on time is an effective way to reduce mother-to-child transmission of hepatitis B.

According to the latest WHO estimates, globally in 2019, the proportion of children under five years of age with chronic hepatitis B has dropped to just under 1%, while in the decades leading up to vaccination (i.e. x before the early 2000s
biennium), this figure was about 5%.

Thus, one of the targets for the elimination of viral hepatitis, set in the framework of the Sustainable Development Goals, has been achieved by 2020.reduce the prevalence of HBV infection in children under five years of age to less than
1%. This success has been achieved in a number of regions with the exception of sub-Saharan Africa.

The expansion of hepatitis B vaccination coverage globally over the past two decades has been a major health advancement and has contributed to a reduction in hepatitis B infections among children.

In 2019, coverage of the population with three doses of vaccine reached 85% worldwide, while in 2000 it reached 85%.it was about 30%. However, rates of newborn immunization against hepatitis B remain patchy. So, the average
Worldwide, first-dose hepatitis B vaccine coverage is 43% worldwide, but only 6% in the WHO African Region.

A full course of vaccination results in the formation of protective antibodies in more than 95% of infants, children and young adults. The immunity acquired through vaccination lasts for at least 20 years and probably throughout life.In connection with
WHO therefore discourages booster vaccinations for persons who have received a three-dose vaccination.

In countries with low to moderate hepatitis B endemicity, vaccination is indicated for all unvaccinated children and adolescents under 18 years of age. In these countries, people in high-risk groups are more likely to be infected and are also
should be vaccinated. These risk groups include:

• individuals who frequently require blood or blood products, patients on dialysis and recipients of solid organ transplants;
• prisoners in places of deprivation of liberty;
• injecting drug users;
• persons who have household and sexual contacts with people with chronic HBV infection;
• persons with multiple sexual partners;
• healthcare workers and others who may have contact with blood and blood products while on duty;
• International travelers who have not completed the full course of HBV vaccination and who are eligible for vaccination before leaving for HBV-endemic areas.

The vaccine has an excellent record of safety and efficacy, and thanks to it the proportion of children under five years of age with chronic HBV infection in 2019 decreased to just under 1%, while in the decades before the introduction of vaccination
(i.e., from the 1980s to the early 2000s) this figure was about 5%.

In addition to infant vaccination, which includes the timely administration of the first dose of vaccine immediately after birth, WHO recommends prophylactic antiviral therapy to prevent mother-to-child transmission of hepatitis B.For pregnant
with a high concentration of HBV DNA (high viral load) and / or the presence of HBeAG in the blood, there is a high risk of transmitting the virus to an unborn child, even if the child receives the first dose of vaccine immediately after birth and undergoes a full course of vaccination
against hepatitis B. Therefore, pregnant women with a high concentration of HBV DNA during pregnancy can be shown a prophylactic course of antiviral therapy to prevent perinatal HBV infection and protect the future newborn from the disease.

In addition to vaccinating infants and preventing mother-to-child transmission, HBV transmission can be prevented through blood safety measures, including good screening of all donated blood and blood products,
used for transfusion. Globally, 97% of blood donations were screened and quality controlled in 2013, but gaps remain. Effective measures to prevent the transmission of viral hepatitis B include ensuring injection safety,
and avoiding unnecessary and unsafe injections.Between 2000 and 2010, the share of unsafe injections worldwide decreased from 39% to 5%. In addition, one of the effective measures to prevent infection is
improving the safety of sexual intercourse, 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 2016-2021. “. It highlighted the critical role of universal health coverage,
and the objectives of the strategy are in line with the targets of the Sustainable Development Goals.

The main goal of the strategy was declared to be the elimination of viral hepatitis as a public health problem. This is reflected in the global target to reduce new viral hepatitis infections by 90% and deaths by 2030
from viral hepatitis by 65%.The strategy outlines the actions that need to be taken by countries and the WHO Secretariat to achieve these objectives.

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

• raising awareness, promoting partnerships and mobilizing resources;
• Formulating evidence-based policy and generating data for action;
• Improving health equity in the hepatitis response;
• prevention of transmission of infection; and 90,014
• expanding coverage of screening, care and treatment services.

In March 2015, WHO published its first Guidelines for the prevention, care and treatment of people living with chronic hepatitis B infection.

In particular, the guidance provides the following recommendations:

• to promote the use of simple, non-invasive diagnostic tests to assess the stage of liver disease and identify indications for treatment;
• Prescribe treatment primarily to those with the most severe stages of liver disease and the highest risk of death;
• To recommend the use of nucleoside / nucleotide analogues with a high barrier to drug resistance formation (tenofovir and entecavir, and entecavir for children aged 2-11 years) as first and second line therapy.

The guideline also recommends that life-long treatment be prescribed to individuals with cirrhosis and those with high HBV DNA levels and signs of liver inflammation, and regular monitoring of patients on treatment and those on treatment
not yet prescribed to assess disease progression, determine indications for treatment, and early detection of liver cancer.

In July 2020, WHO published guidelines for the prevention of mother-to-child transmission of hepatitis B and the prophylactic use of antiviral drugs during pregnancy.

Now, in addition to the course of vaccination of infants against hepatitis B (including giving the child the first dose of vaccine within 24 hours after birth), WHO recommends prescribing to pregnant women whose HBV DNA concentration is equal to or exceeds 200,000 IU / ml,
preventive treatment with tenofovir; a course of preventive therapy should be carried out from the 28th week of pregnancy and at least until delivery.

The ability to perform tests to quantify the viral load of hepatitis B virus and to decide whether a pregnant woman has an indication for prophylactic treatment is limited in some countries or areas.This problem is especially acute
in low-income countries or areas, or in rural areas where there are large numbers of pregnant women. Now in countries and areas where HBV DNA testing is not available, WHO recommends as an alternative
perform HBeAg testing to determine if there is an indication for a prophylactic course of tenofovir to prevent mother-to-child transmission of the virus.

Testing pregnant women for hepatitis B and treating those who are indicated for it can be done in conjunction with measures to prevent mother-to-child transmission of HIV and congenital syphilis as part of antenatal care.This approach is often called
Triple elimination, as it eliminates mother-to-child transmission of three infections: HIV, syphilis and hepatitis B. Hepatitis Day (one of nine major annual health campaigns)
to raise awareness and better understanding of viral hepatitis.The date of July 28 was chosen in honor of the birthday of the scientist, Nobel laureate, Dr. Baruch Blumberg, who discovered the hepatitis B virus and developed a diagnostic
test and vaccine against this virus.

In addition, in 2021, WHO published a progress report on HIV, viral hepatitis and sexually transmitted infections, which outlines progress in eliminating viral hepatitis. The report provides global statistics
for viral hepatitis B and C, estimates of primary infection, chronic infection and mortality from the two viruses with which a high burden of disease is associated, and coverage rates for key interventions.

In 2021, the 74th World Health Assembly adopted a decision previously approved by the WHO Executive Board mandating the development of global health sector strategies on HIV, hepatitis and
sexually, for the period 2022–2030 New strategies will be developed for submission to the Assembly in 2022 through a broad consultation process with Member States, local communities and other stakeholders.
parties and taking into account the relevant strategies of UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In 2021, WHO is celebrating World Hepatitis Day under the slogan “Fighting Hepatitis Does Not Wait” to highlight the urgency of eliminating hepatitis to meet its 2030 goals.
address the latest estimates of the global and regional burden of viral hepatitis and deaths from viral hepatitis, and the need to ensure that hepatitis elimination is certified as a public health threat by 2030.

Hepatitis A

Basic Facts

• Hepatitis A is an inflammatory liver disease that can be mild or severe.
• Transmission of hepatitis A virus (HAV) occurs through the ingestion of contaminated food or water, or through direct contact with an infected person.
• Almost all patients with hepatitis A achieve complete cure and develop lifelong immunity. However, in very rare cases, infection with the hepatitis A virus can lead to fatal fulminant hepatitis.
• According to WHO estimates, in 2016approximately 7,134 people died from hepatitis A (representing 0.5% of the total deaths from viral hepatitis).
• The risk of contracting hepatitis A occurs when there is no safe water supply, poor sanitary and hygienic conditions, and inadequate hygiene practices (eg hand hygiene).
• In countries with a low risk of hepatitis A infection through food and water, outbreaks have been reported among men who have sex with men (MSM) and people who inject drugs (PWID).
• Epidemics can be long lasting and cause significant economic damage.
• A safe and effective vaccine is available to prevent hepatitis A.
• The most effective responses to the disease are ensuring safe water and food safety, improved sanitation, hand hygiene and vaccination against hepatitis A. , MSM and PWID, it is recommended to get vaccinated.
  

Hepatitis A is an inflammatory liver disease caused by the hepatitis A virus (HAV). The virus spreads primarily through the consumption of food or water contaminated with faeces by an uninfected (and unvaccinated) person
an infected person. This disease is closely related to poor water supply or food contamination, poor sanitation, poor personal hygiene, and anal-oral sex.

Unlike hepatitis B and C, hepatitis A does not cause chronic liver disease, but can be accompanied by severe symptoms and sometimes fulminant (with acute liver failure), often fatal
the outcome. According to WHO estimates, in 2016 hepatitis A killed 7,134 people worldwide (which is 0.5% of the total deaths from viral hepatitis).

Hepatitis A is present throughout the world and occurs both in the form of isolated cases and in the form of epidemics, which tend to be cyclical.Hepatitis A virus is among the most common foodborne infections. Epidemics caused by
contamination of food or drinking water can be explosive, such as the 1988 epidemic in Shanghai, which affected approximately 300,000 people ¹ . Epidemics can also be protracted and affect
entire settlements for several months as a result of human-to-human transmission. Hepatitis A virus persists for a long time in the environment and can remain viable even after food processing processes,
commonly used to control and / or inactivate bacterial pathogens.

This disease can lead to significant socio-economic consequences for the population. Recovery and return to work, school, or daily life can take weeks or months. Significant damage can be done to local businesses
catering, which has become the source of the spread of the virus, reducing overall labor productivity.

Geographic Distribution

Areas where the hepatitis A virus is spread can be subdivided into areas with high, medium or low infection rates.At the same time, the infection rate is not identical to the incidence rate, since in young children the infection
proceeds with mild symptoms.

Highly infected areas

In low- and middle-income countries with poor sanitation and hygiene, infection is widespread and most children (90%) are infected with the virus
hepatitis A before the age of 10 years, most often with an asymptomatic course of infection ² .Epidemics in these countries are rare because older children and adults tend to be immune.
Symptomatic morbidity rates in these areas are low and outbreaks are rare.

Areas with low infection rates

In high-income countries with good sanitation and hygiene conditions, infection rates are low. The disease can occur among adolescents and adults at high risk, such as people who use
injecting drugs, men who have sex with men, and those traveling to areas with high hepatitis A endemicity, as well as among isolated populations such as closed religious groups.In the United States
In America, large outbreaks of hepatitis A are reported among homeless people.

Areas with medium infection

In middle-income countries and areas with heterogeneous hygiene conditions, a large proportion of the population does not tolerate infection in early childhood and reaches adulthood without developed immunity. Improving economic and sanitation
conditions in some cases leads to an increase in the proportion of the adult population who have not previously had viral hepatitis and are not immune.The high susceptibility of older age groups in such areas can lead to more
high morbidity and increase the likelihood of major outbreaks.

Transmission of the virus

The main mechanism of transmission of the hepatitis A virus is fecal-oral, in which the infection of the virus occurs as a result of the consumption of food or water by an uninfected person contaminated with the faeces of an infected person.At the level
households, infection can occur when the infected person does not practice good hand hygiene when preparing food for other family members. Outbreaks of waterborne diseases, although rare, are usually associated with the use of
contaminated with sewage or insufficiently treated water.

The virus can also be transmitted through close physical contact (for example, through anal-oral sex) with an infected person, while the virus is not transmitted through normal household contact.

Symptoms

The incubation period for hepatitis A is usually 14-28 days.

Symptoms of hepatitis A can range from mild to severe and may include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin
integuments and sclera of the eyes). The full range of symptoms does not appear in all infected people.

Clinical symptoms of the disease are more common in adults than in children. The prevalence of severe forms of the disease and mortality are higher among the older age groups. In children under 6 years of age, infection is usually
proceeds with mild symptoms, and jaundice develops only in 10% of cases. In older children and adults, symptoms are usually more severe, and in more than 70% of cases, the disease is accompanied by the development of jaundice.In some patients, hepatitis A recurs, and an exacerbation follows the recovery period. Nevertheless, after this, the disease, as a rule, ends with a complete recovery.

Who is at risk?

Anyone who has not been vaccinated or has not had the disease in the past can become infected with the hepatitis A virus. In areas where the virus is highly circulating (high endemicity), most hepatitis A infections occur in early childhood.Risk factors include:

• unsatisfactory sanitary conditions;
• lack of safe water supply;
• the presence of an infected person among family members;
• have sex with a person with acute hepatitis A;
• recreational use of psychoactive substances;
• same-sex sex in men;
• Travel to areas of high endemicity without prior immunization.

Diagnostics

According to the clinical picture, hepatitis A does not differ from other types of acute viral hepatitis.An accurate diagnosis is confirmed by a blood test for the presence of HAV-specific immunoglobulins M (IgM). In addition to this, diagnostics can be carried out
reverse transcription polymerase chain reaction (RT-PCR), which can detect hepatitis A virus RNA, which may require referral to a specialized laboratory.

Treatment

There is no specific treatment for hepatitis A. The healing process can be slow and take several weeks or months.It is imperative to refrain from inappropriate prescription of medications. Patients with hepatitis A do not
acetaminophen / paracetamol and antiemetic drugs should be given.

In the absence of acute liver failure, hospitalization of patients is not required. Treatment focuses on maintaining a comfortable and balanced diet, including replenishing fluid losses caused by vomiting and diarrhea.

Prevention

The most effective remedies for hepatitis A are improving sanitation, increasing food safety and expanding vaccination coverage.

The prevalence of hepatitis A can be reduced by the following measures:

• ensuring an adequate supply of safe drinking water;
• Organization of proper wastewater disposal in settlements; and
• following good personal hygiene practices such as regular hand washing before meals and after using the toilet.

Several injectable inactivated hepatitis A vaccines are available on the world market. All have comparable protective efficacy and similar side effects.None of the vaccines are licensed for use in children under one
of the year. An attenuated live vaccine is also used in China.

Within a month after a single dose of vaccine, nearly 100% of vaccinated people develop protective levels of antibodies to the virus. Even if exposed to a source of infection, administering one dose of vaccine within the first two weeks after exposure to the virus
has a protective effect. However, manufacturers recommend that two doses of the vaccine be given to build up long-term immunity for about 5 to 8 years after vaccination.

Millions of people worldwide have been vaccinated with inactivated injectable hepatitis A vaccine and no serious adverse events have been reported. Vaccination against hepatitis A can be given as part of routine childhood immunization programs,
as well as in combination with other vaccines recommended for international travelers.

Immunization measures

A comprehensive plan for the prevention and control of viral hepatitis should include vaccination against hepatitis A.When planning large-scale vaccination programs, a careful cost-benefit assessment should be performed and
alternative or complementary preventive measures such as improved sanitation and health education to improve public hygiene.

Whether or not this vaccine should be included in the childhood immunization schedule depends on the local epidemiological situation. It is necessary to take into account the proportion of people susceptible to infection in the population and the level of risk of contact with sources of the virus.In general, universal vaccination of children appears to be most appropriate in countries with moderate endemicity. Countries with low endemicity may consider vaccinating adults in high-risk groups. In countries with
the high level of endemicity, the use of the vaccine is limited, since the majority of the adult population is naturally immune.

As of May 2019, 34 countries have included or are planning to include hepatitis A vaccination for children at risk groups.

In many countries, the immunization course with inactivated hepatitis A vaccine involves two doses of vaccine, but other countries may consider adding a single dose of hepatitis A vaccine to the immunization schedule
inactivated vaccine. In some countries, vaccination is also recommended for people at increased risk of hepatitis A, such as:

• recreational drug users; 90,014 90,096 travelers to countries where the virus is endemic; 90,014 90,096 men who have sex with men; and 90,014 90,096 patients with chronic liver disease (due to the increased risk of serious complications from hepatitis A infection).

In case of disease outbreaks, recommendations for hepatitis A vaccination should also take into account the local epidemiological situation. An assessment should be made of the feasibility of a rapid large-scale immunization campaign.

Community outbreak vaccination campaigns are most effective in smaller communities when vaccination is started early and coverage is wide across all age groups.Vaccination work
should be accompanied by health education to improve sanitation and hygiene and food safety.

WHO activities

In May 2016, the World Health Assembly adopted the first ever Global Health Sector Strategy on Viral Hepatitis 2016–2021. It highlights the critical role of universal coverage
health and formulated targets aligned with the Sustainable Development Goals.The main goal of the strategy is the elimination of viral hepatitis as a public health problem, which is expressed in global targets
to reduce by 2030 the number of new infections with viral hepatitis by 90% and mortality from viral hepatitis by 65%. The strategy outlines the actions to be taken by countries and the WHO Secretariat to meet these objectives.

To support countries in achieving the global hepatitis targets in the 2030 Agenda for Sustainable Development.WHO is working in the following areas:

• raising awareness, promoting partnerships and mobilizing resources;
• Evidence-based policy development and evidence for action;
• Ensuring health equity in the hepatitis response;
• prevention of the spread of infection; and 90,014 90,219 expanded coverage of screening, care and treatment services.

WHO published the Progress Report on HIV, Viral Hepatitis and Sexually Transmitted Infections 2021, which provides information on the progress made in eliminating these diseases. The report provides
statistics on viral hepatitis B and C, the number of new infections, the prevalence of chronic infections and deaths from these two particularly dangerous viruses worldwide, and coverage of key control measures
as of the end of 2020

Since 2011, WHO, together with countries, civil society and partners, has hosted annual World Hepatitis Day events (as part of one of the nine major annual campaigns
on health issues), aimed at raising awareness of the problem of viral hepatitis and understanding its significance. This day is held on July 28 in honor of the birthday of the scientist, Nobel laureate, Dr. Baruch Blumberg,
who discovered the hepatitis B virus and developed a diagnostic test and vaccine against this virus.

World Hepatitis Day 2021 will be held under the slogan “The fight against hepatitis cannot be postponed”, reflecting the urgency of efforts to eliminate hepatitis in order to achieve the elimination targets.
disease by 2030 Key findings are drawn from recent global and regional estimates of viral hepatitis prevalence and mortality rates, with a view to prioritizing hepatitis elimination
as a major public health threat by 2030

Is it possible to cure hepatitis B. How to treat.- “GEPATIT.RU”

Hepatitis B is an incurable, chronic, lifelong disease. The course of the disease is not accompanied by severe symptoms. One can not suspect the presence of a virus for many years, and only by accidental examination can it be detected. Sometimes, with a long-term illness, there may be joint pain, fatigue, decreased performance, insomnia.Patients often complain of heaviness in the right hypochondrium.

For the diagnosis of chronic viral hepatitis B, one marker is sufficient – HBsAg positive. It is usually done at any visit to a medical institution, for example, when preparing for an operation, pregnancy, IVF, etc. This indicator means that the hepatitis B virus is present in the liver. It will remain there forever.

However, this does not mean at all that nothing can be done with the virus and irreversible changes in the liver (cirrhosis and primary liver cancer) are inevitable. Viral hepatitis B is a controlled disease , which means that if you keep it under control, you can live a long life with a normal healthy liver. Moreover, viral hepatitis B does not always need to be treated with antiviral drugs !

If the virus is detected for the first time, it is necessary to undergo a complete examination in order to obtain complete information about your virus and about the condition of the liver. Virological markers of hepatitis B allow you to find out the activity and aggressiveness of the virus, whether it has drug resistance mutations, to count the amount of the virus in the blood, to determine its genotype.

In addition, it is extremely important to test for hepatitis D, which can enter the body along with the B virus. This virus is highly aggressive and quickly causes fibrosis in the liver with an outcome in cirrhosis. Treatment of the hepatitis D virus is prescribed immediately upon detection – with interferon preparations.

The state of the liver is assessed by different methods: ultrasound, biochemical parameters, elastometry (FibroMax, FibroTest) – degree liver fibrosis on the METAVIR scale – F0 healthy liver, F4 cirrhosis.
Depending on the results of this survey, different decisions are made:

1. if the virus is not active and does not pose a threat to life, the liver is in good condition, then antiviral treatment is NOT RENDERED;

2. if the virus is active and the liver is already affected by the virus, then the doctor must prescribe antiviral drugs in order to stop the destructive processes in the liver and return it to a healthy state.

In all cases, the patient should be informed about how to control viral hepatitis throughout his life.The main control parameters are the state of the liver according to the data of elastometry (FibroTest, FibroMax) – that is, the degree of fibrosis, as well as the activity of the virus – its amount in the blood. It is advisable to be under the supervision of a qualified hepatologist who will be able to make the right decisions in time if the situation changes.

Unfortunately, for viral hepatitis B there is no single standard of treatment and decision-making on its appointment. That is why it is so important to be examined in a timely manner and consult a specialist who knows how to treat viral hepatitis B.

How is hepatitis B treated?

Purpose of hepatitis B treatment

Complete removal of the hepatitis B virus from the body is impossible, since the DNA of the virus is embedded in the host’s genome. At the same time, the virus is not always dangerous and does not always require treatment. Treatment is only necessary if the virus is active and changes occur in the liver that can lead to cirrhosis.

The goal of chronic hepatitis B (CHB) therapy is to prevent the progression of the disease to cirrhosis, thereby increasing the quality and duration of life.

In the presence of cirrhosis, the goal of treatment is to prevent decompensation of cirrhosis and the development of terminal liver damage, primary liver cancer, and death.

This goal can be achieved with consistent suppression of HBV replication. Parallel suppression of viral replication and reduction of the inflammatory process in the liver reduces the risk of liver cirrhosis and liver cancer.

Treatment regimens and antiviral drugs for CHB

There is no single standard treatment for hepatitis B virus infection.Decisions are made individually, depending on the virological parameters and the degree of liver damage.

Currently, there are two different treatment strategies: the course use of alpha interferons, including pegylated ones, or nucleoside / nucleotide analogs (AN).

Nucleoside analogs: lamivudine, telbivudine, entecavir.

Nucleotide analogs: adefovir and tenofovir.

The advantage of treatment with interferons is that the course of treatment is limited and is 1 year.In addition, the resistance of the virus to interferon does not develop, and a persistent virological response persists for a long time even after a course of therapy. It is also possible to completely remove the virus with the formation of immunity (formation of anti-HBsAg), although this occurs in about 20-30% of cases.

At the same time, a significant drawback of this tactic is serious side effects, as well as the need for subcutaneous administration, which significantly reduce the patient’s tolerance and motivation for treatment.

Interferon preparations are contraindicated in decompensated cirrhosis due to HBV infection, autoimmune disease, as well as in patients with uncontrolled severe depression and psychosis, and during pregnancy.

Entecavir and tenofovir have potent antiviral properties and are characterized by a high genetic barrier to the development of resistance. Their long-term use does not cause the development of a mutation of resistance (resistance) to the drug in the virus.Therefore, they can be used with confidence as first-line monotherapy.

Lamivudine, telbivudine and adefovir are recommended for the treatment of CHB only when more powerful ANs are unavailable or when intolerance to more active drugs develops.

Lamivudine is an inexpensive drug, but long-term monotherapy is very often accompanied by a mutation of the virus and the development of resistance. Adefovir is less effective and more expensive than tenofovir.Resistance to it occurs more often.

Telbivudine is a potent inhibitor of HBV replication but rapidly develops resistance in patients with high baseline HBV DNA levels or detectable HBV DNA levels after 6 months. treatment. The incidence of telbivudine resistance is relatively low in patients with low baseline viremia (<2 x 108 IU / ml in HBeAg-positive and <2 x 106 IU / ml in HBeAg-negative patients) who are undetectable after 6 months.therapy.

Course therapy with pegylated interferon

A 48-week course of PEG-IFN therapy is recommended in HBeAg-positive patients. This provides the highest likelihood of seroconversion with the emergence of anti-HBe. This strategy can also be used in HBeAg-negative patients, since this is practically the only option for obtaining a persistent virological response after the completion of antiviral therapy.

The patient should be provided with complete information about the advantages, adverse events and disadvantages of interferon therapy compared with AN, so that he can participate in the decision on the choice of the drug.

Long-term treatment with nucleoside / nucleotide analogs

This strategy is required in HBeAg positive patients without HBe seroconversion and in HBeAg negative patients. The same strategy is recommended in patients with cirrhosis, regardless of HBeAg status or HBe seroconversion during treatment. The most potent drugs with an optimal resistance profile, i.e. tenofovir and entecavir, should be used as first-line monotherapy.

With monotherapy with tenofovir and entecavir for 3 years or more, it is possible to maintain virological remission in most patients.

When taking any drug, it is necessary to achieve and maintain a negative level of HBV DNA, confirmed by real-time PCR. In addition, it is necessary to monitor the state of the liver during treatment ( biochemical parameters , ultrasound, FibroMax elastometry , FibroTest ).

Since complete removal of the virus cannot be achieved, lifelong monitoring of the activity of the virus and the condition of the liver is recommended.

90,000 Viral hepatitis

VIRAL HEPATITIS IS CURABLE!

Viral hepatitis is currently a major public health problem due to its widespread occurrence. Now in the world there are more than 500 million patients with viral hepatitis B and C. At least 30% of them will develop cirrhosis of the liver or hepatocellular carcinoma (liver cancer) in the coming years. Currently, five viruses have been discovered that cause hepatitis: A, B, C, D, and E.Virus A – the cause of delayed hepatitis, B, C, D – acute or chronic. Hepatitis E is more likely to cause acute hepatitis, but in immunocompromised patients (eg HIV), it can become chronic. In Ukraine, among the causes of chronic hepatitis, the hepatitis C virus dominates. Chronic hepatitis B occurs 5 times less often.

Hepatitis is easily transmitted through drug administration. Hepatitis B – sexually. Shaving razors, manicure accessories, tattooing, visiting a dentist, gynecologist, surgery, all of which can be a risk factor for infection, are of some importance.

Approximately 75% of patients with acute hepatitis are asymptomatic. But in 5% of patients with hepatitis B and 80% with hepatitis C, the disease becomes chronic, which can transform into cirrhosis of the liver. Therefore, the hepatitis C virus is often called the “affectionate killer”. The first symptoms may occur several years after infection, when the disease is more difficult to treat and the overall prognosis is poor.

The most common symptoms of the disease are weakness, fatigue, joint pain, skin rashes, fever, sleep disturbances.It is because of the absence of symptoms that the correct diagnosis may be made too late.

Chronic, lifelong infection and progressive liver disease develops in the majority of those infected and progresses to cirrhosis within 20-30 years.

Those who use drugs and alcohol develop cirrhosis much faster – during the first 5 to 10 years. Since the disease progresses without treatment, it is very important to timely establish the presence of viral hepatitis and begin the necessary treatment.

The main method for diagnosing hepatitis is a blood test for the presence of antibodies to hepatitis viruses and the presence of particles of the virus itself (markers of hepatitis).

Markers of hepatitis B give information about the presence of the virus itself and antibodies to its various sites, the activity of the virus and its reproduction. In addition, a liver examination is required to establish the diagnosis of hepatitis and the extent of liver damage. The presence of an inflammatory process in it, destruction of liver cells caused by a virus, possible fibrosis (proliferation of connective tissue) is determined by biochemical indicators (basic ALT and ASAT).Ultrasound gives general information about the inflammatory process in the liver, an assessment of the state of the liver tissue and blood vessels. Sometimes it is necessary to do a biopsy to clarify the degree of fibrosis or a study that replaces a biopsy (FibroTest or FibroScan).

The present time can be called without exaggeration a revolution in the treatment of chronic viral viral hepatitis. First of all, this concerns hepatitis C. Three-component therapy, including Pegylated interferon, Ribavirin and one of the viral protease inhibitors (Boceprevir, Telaprevir or Semiprevir), allows to achieve recovery in 60-80% of cases (all of these drugs are registered in Ukraine).This year, interferon-free treatment regimens will become available, characterized by high efficiency (more than 90%), no need for injecting drugs and minor side effects.

The decision to prescribe antiviral therapy may depend on many factors and is made only by a doctor. For successful treatment, it is especially important that the treatment is carried out by a specialist who has experience in the use of modern antiviral drugs, since they can cause serious side effects and require qualified control.This is especially important in the case when the patient has concomitant diseases of the cardiovascular, respiratory, endocrine systems, and also if the patient requires individual, different from standard treatment regimens.

You can safely contact our clinic, the doctors of which will help resolve the most difficult issues regarding the nuances of diagnosis and treatment of viral hepatitis. We already have experience in treating patients using the most modern, including interferon-free treatment regimens.

90,000 Why are viral hepatitis A, B and C dangerous?

I recently had a similar case. A woman with chronic hepatitis B came to the appointment; she has had it for about 15 years. She lives with her husband and son. Since the form is chronic, the investigation of close contacts should have been carried out at the very beginning, so I just asked if loved ones were vaccinated and how long ago they had been checked. It turned out that about six years ago, everyone had been vaccinated. Three months later, she comes back with her son, who was tested at the university, and he was diagnosed with hepatitis B.Despite being vaccinated, the vaccine did not protect him. If it had been checked on time – about 6 years ago – for the presence of antibodies, then it could have been protected against hepatitis B. There are such unpleasant and offensive situations, because the vaccine is there and it can be reused.

Considering that chronic hepatitis B and C are most often asymptomatic, it would be good if every person, and not just at-risk groups, were screened annually for hepatitis B and C. Because we all go to beauty or dentistry salons and we do not always know for sure how the tools are processed there.

I always ask my patients with chronic hepatitis: if they go to dentistry, to a beautician, if they go to a manicure or pedicure, always inform their doctor or master about the diagnosis. Because we cannot afford to hope for the decency of a person, especially if it is some kind of private trader, that he will properly sterilize the instruments. And if they are not properly sterilized, he will infect the next client or patient with these instruments. ”

Our next hero contracted hepatitis B as a child.True, in his case it was also medical negligence.

Andrey (name has been changed), 37 years old: “Apparently, one of the children had hepatitis, and they passed it on to others through a syringe”

I got sick at about 10-11 years old, then I was in elementary school in a small town South Kazakhstan region. Medical workers came to our lesson – either from the SES, or from the clinic – and carried out some planned activities. As far as I remember, they took tests, in general, they did something with the blood. A nurse came, who, in order to save money, took a blood sample with one needle.I just wiped the syringe with alcohol and invited the next one. And when she took my blood, there was some kind of unpleasant premonition. I have a lot of doctors in my family, and I understood that the syringe should be disposable. But what a small child could do, when people in white coats came, was simply to do what was required.

The unpleasant sensations seemed to have been forgotten, but a few days later, when I was at school, I had a hell of a headache. Then the temperature rose: I remember sitting in class and crying in pain.They let me go home, and by that time the temperature was already under 40 degrees, and then brown urine came out. When the parents saw this, they realized that it was not a cold, but something serious. Then there was a hospital, diagnosed with hepatitis B. From our class, several people entered the infectious diseases ward at once, it was clear that this was a massive infection. Apparently, one of the children had hepatitis, and he was passed on to others through a syringe. I don’t know if there was any investigation, what measures they took afterwards, but most likely not.These were the dashing 90s – the period from 93 to 96.

I remember the time in the hospital, where I spent about two months – these were vivid impressions. We whiled away our leisure time playing games, learning to make devils out of droppers, some toys. After discharge, I was prescribed the strictest diet, and for the first six months or a year I strenuously observed it – I did not eat anything except broths. It was very difficult, because my mother cooks deliciously. I constantly wanted to eat all the dishes that she made for other family members, but it was impossible.I remember how I was indignant: “Again this broth! This rice again! ” But I am grateful to my mother, thanks to this diet, my liver more or less recovered. True, as I got older, I quit the diet and did not stick to it anymore.

90,000 Completely defeated virus – Vedomosti

The first scientific article about the discovery, thanks to which the hepatitis C virus was identified, was published in the journal Science in 1989.Since then, the fatal disease has been thoroughly studied and a therapy has been found that will completely cure about 95% of sufferers her patients.

For a mainly blood-borne disease, hepatitis C is impressive in its spread. According to the WHO, 71 million people worldwide suffer from chronic hepatitis C. And 400,000 die each year from this type of hepatitis and the diseases it causes. In Russia, according to the Rospotrebnadzor Viral Hepatitis Monitoring Center, the estimated number of cases of chronic viral hepatitis C ranges from 3 million to 5 million. The frequency of registration of chronic hepatitis C in Russia in 2019 isamounted to 31 cases per 100,000 population, ie, more than 45,000 new cases.

WHO considers hepatitis to be as dangerous as tuberculosis and HIV. It is no coincidence that the Nobel Prize has been awarded the Nobel Prize for the second time in the fight against this disease – in 1976 the award was received by Dr. Baruch Blamberg, who not only discovered and described the hepatitis B virus, but also developed a vaccine that protects against it. And Blumberg’s birthday, July 28, was selected by WHO as World Hepatitis Day.

In the 1970s. Harvey Alter and his colleagues studied the nature of hepatitis in patients who received blood transfusions. Her testing for the presence of hepatitis A and B viruses did not rule out cases of infection. In 1978, Alter showed empirically that plasma transfusion from patients with then not described hepatitis can cause disease in chimpanzees. This indicated that the disease was caused precisely by the causative agent of the infection.

A in the 1980s. Michael Houghton and his colleagues, then at the pharmaceutical company Chiron, searched for the causative agent by sifting through collections of DNA fragments collected from infected chimpanzees.They monitored which of its fragments would react to antibodies in the blood of people infected with hepatitis of a then unknown species. So Houghton’s team managed to identify the causative agent of the disease – the hepatitis C virus, an RNA virus from the flavivirus family.

The researchers then developed a blood test and showed that it could identify samples suspected of transmitting unexplained cases of hepatitis. This made it possible to screen donated blood around the world, dramatically reducing the number of newly infected people.“Before these discoveries, blood transfusions were like Russian roulette,” Niels-Goran Larsson, a member of the Nobel Committee, told Science. “These scientists made blood transfusions safe and that prevented countless deaths.”

Hepatitis C has become completely curable in the last decade. “In the 1990s, this type of hepatitis was considered incurable,” says Professor Pauline Stepensky, head of the bone marrow transplant and immunotherapy department at the Hadassah University Hospital in Jerusalem.- Of course, the victory over such a disease is a great achievement from the point of view of both science and applied medicine. The probability of a complete cure of the disease with modern means is about 95%. ”

The breakthrough came from the development of direct-acting antiviral drugs. Today they cost $ 10,000–20,000 for a course of original drugs. Since the cost is so high, there is still a long way to go before complete cure of hepatitis worldwide. But in the scientific, and not the epidemiological, understanding, the disease has already been defeated, and the path to this victory did not take so many years.And this fact, quite possibly, gave an occasion to remember those who began the path to this victory, and to mark them with the main award of the scientific world. This is especially important now, in the midst of the global fight against another deadly virus.

In fact, Harvey J. Alter, Michael Houghton and Charles Rice were not considered the main contenders for the 2020 prize. A week before the decision of the Nobel Committee, the science portal NewsWise published the predictions of the board members of the American Physiological Society – internationally recognized scientists.Most believed that a group of scientists would receive the award this year for the development of CRISPR genome editing technology. And according to the forecasts of the Clarivate Analytics company, which calculates the citation in the scientific base of Web of Science, the main contenders for the award in medicine and physiology were biochemists from Harvard Pamela Bjorkman and Jack Strominger, who study the structures and functions of proteins of the main human histocompatibility complex, which play a major role in the development of immunity.

University of Montana professor of physiology, Jason Carter, predicted the Hepatitis C Discovery Award of scientists surveyed by NewsWise.But here’s what’s interesting: among the nominees, he named Charles Rice and Ralph Bartenschlager from the University of Heidelberg in Ohio. However, the latter was not among the awardees. This often happens: the Nobel Prize rules allow no more than three people to be awarded, although large scientific teams, as a rule, are involved in the work and achievement of the result.

Viral hepatitis: what you need to know about them and should you be afraid of them?

For the World Hepatitis Day, the infectious disease specialist of the Yakut Republican Center for the Prevention and Control of AIDS Elena Krotova answered questions about viral hepatitis.

Viral hepatitis is an inflammatory liver disease of an infectious nature and a high prevalence. In Yakutia, according to the Regional Register, there are about 16 thousand cases. Without treatment, viral hepatitis can go to a stage dangerous for a person, everyone can be at risk.

Please tell us what types of viral hepatitis exist? Are there any special features?

– Today, in clinical practice, a fairly large number of viral hepatitis is known, there are up to eight types of them, but the most common are hepatitis A, E, B, C and D.Features of hepatitis mainly depend on the transmission routes. Viruses A and E, which are transmitted through dirty hands, raw water, do not cause a chronic process. A person suffers from them like an intestinal infection: it is acutely tolerated, the feces brightens, the urine darkens, the sick person turns yellow. Within a month, a person recovers, a good immunity is formed, and there are no repeated cases of infection. Viruses B, C and D, which are transmitted by blood contact, tend to be chronic. Sometimes a person can transfer them acutely, but it also happens that viruses enter the body unnoticed by the immune system.In such cases, the disease is completely asymptomatic, a chronic process is formed, and even reaches advanced stages, such as cirrhosis of the liver and liver cancer.

What are the ways of getting viral hepatitis?

– The most insidious hepatitis is parenteral, which are transmitted by blood contact. In order to transmit the disease, a violation of the integrity of the skin must occur, that is, the transmission of viruses occurs from blood to blood.Therefore, first of all, we determine whether patients have had operations during their life, whether they have ever had blood transfusions, treatment with reusable instruments, acupuncture, whether the patient has done tattoos in a handicraft way, not in a tattoo parlor, whether they have visited a dentist and manicure offices. Viral hepatitis can also be transmitted sexually, if these contacts were unprotected, and from mother to child during childbirth or breastfeeding.

How to avoid contracting viral hepatitis?

– If we are talking about intestinal hepatitis, then we have a vaccine that actually protects one hundred percent against the hepatitis A virus, which is rare in Russia lately.This is a traveler’s disease, and vaccination is recommended for people traveling to countries with an unfavorable situation in this regard. There is also a genetically engineered vaccine against the hepatitis B virus, which also automatically protects against the hepatitis D virus. Unfortunately, there is no vaccine against hepatitis C, and most likely there will not be. It remains only to refrain from blood contact situations, if possible.

What if a person is already infected with viral hepatitis?

– If, nevertheless, an infection occurred and the patient was diagnosed, then he must register with the polyclinic at his place of residence and undergo a certain list of examinations to clarify the stage of the disease.This is a complete blood count, biochemical blood test, polymerase chain reaction, ultrasound of the abdominal organs, FGDS and elastometry. The specialist doctor determines the approaches to treatment, treatment can be supportive, in the form of hepatoprotectors, or specific treatment can be applied in the form of antiviral therapy. The side effects of treating viral hepatitis are very rare and individual. Chronic viral hepatitis C is curable in the early stages, scientific developments are underway for the treatment of chronic hepatitis B and D viruses and new drugs have begun to be used.