Hepatitis B: symptoms, treatment, prevention - MEDSI

According to WHO, about 90% of those infected are unaware that they are carriers of the hepatitis B virus [1]. At the same time, they remain infectious to others, and their disease becomes chronic. In 15–40% of cases, the pathology causes life-threatening liver diseases, from which about 1 million people die annually [2].

Let's figure out how you can become infected with hepatitis B, for which symptoms it is important to see a doctor immediately, and how to protect yourself from the disease.

General information

Hepatitis B (HVB) is a viral infection of the liver that can cause both acute and chronic illness.

The virus is transmitted through contact with the blood or other body fluids of an infected person. The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus is still capable of causing infection if it enters the body of a person not protected by the vaccine.

Hepatitis B is one of the global health problems. The virus can lead to the development of chronic liver disease and pose a high risk of death from cirrhosis and liver cancer. WHO estimates that about 2 billion people worldwide have been infected with the virus, and more than 350 million people are sick.

Approximately 780,000 people die each year from this infection—650,000 from chronic cirrhosis and liver cancer and another 130,000 from acute hepatitis B.

Hepatitis B is a serious occupational risk for healthcare workers.

However, the disease can be prevented with the currently available safe and effective vaccine, which has been used successfully since 1982. Its effectiveness in preventing infection and the development of cirrhosis, as well as primary liver cancer due to hepatitis B is 95%, which is why at one time it was called “the first vaccine against cancer.”

Complications of hepatitis B

The main hepatic complications of chronic hepatitis B are cirrhosis and primary cancer (hepatocellular carcinoma). As a result of damage to liver cells, the organ tissue is replaced by connective tissue structures, which leads to fibrosis. Over time, cirrhosis forms in place of these pathological areas - irreversible changes in the liver tissue with compaction of its structure. Such changes several times increase the risk of developing hepatocellular carcinoma.

Irreversible changes in liver tissue lead to the development of liver failure. As a result, the liver ceases to properly neutralize toxins, and also does not produce proteins and enzymes necessary for life. In addition, substances that are released as a result of the death of liver cells enter the bloodstream.

The accumulation of toxic metabolic products in the body causes damage to brain cells and leads to hepatic encephalopathy, including the development of coma.

The death of hepatocytes causes a decrease in the liver's synthesis of blood clotting factors. This can lead to heavy bleeding (gastrointestinal, uterine) and the development of anemia.

Also, in the case of liver cirrhosis, the venous outflow from the organ is disrupted - the inferior vena cava system is affected, which leads to the development of ascites (fluid accumulation in the abdominal cavity), varicose veins of internal organs. Ascites often causes a life-threatening inflammatory disease - peritonitis, and bleeding from varicose veins can be fatal.

Chance of getting sick

In areas with a high prevalence of HBV, the virus is most often transmitted from mother to child during childbirth or from person to person in early childhood. Transmission of infection during the perinatal period or early childhood can also lead to the development of chronic infections in more than one third of those infected.

Hepatitis B is also spread through cutaneous or mucosal exposure to infected blood or various body fluids, as well as through saliva, menstrual, vaginal secretions and seminal fluid. Sexual transmission of hepatitis B can occur.

Transmission of the virus can also occur through the reuse of syringes and needles, either in health care settings or among injection drug users. In addition, infection may occur during medical, surgical or dental procedures, tattooing, or the use of razor blades or similar objects contaminated with infected blood.

Despite the fact that Russia is a country with a moderate rate of hepatitis B infection, the risk of becoming infected with this virus throughout life for each of us is 20-60%.

Routes of transmission of viral hepatitis B in adults

Blood is the main source of hepatitis B virus. It can also be found in other tissues and body fluids, but in lower concentrations.
The hepatitis B virus can be transmitted in several ways.

Through blood.

This may happen in the following cases:

• punctures of the skin with infected needles, lancets, scalpels or other sharp objects;
• direct contact with open sores of an infected person;
• splashes of infected blood on the skin with minor scratches, abrasions, burns or even minor rashes;
• splashes of blood on the mucous membranes of the mouth, nose or eyes;
• using other people's toothbrushes or razors.

Contact with surfaces contaminated with blood can also cause illness, but to a lesser extent.
By the way, the virus can remain stable in dried blood for up to 7 days at 25 °C.

Hand contact with blood-contaminated surfaces such as laboratory benches, test tubes, or laboratory instruments can transmit the virus to the skin or mucous membranes.

Through saliva.

The saliva of people with hepatitis B may contain the virus, but in very low concentrations compared to blood. Nevertheless, infection is possible, for example, through bites.

But it is impossible to become infected through dishes or mouthpieces (smoking or musical instruments) - such cases have not been registered.

Through semen or vaginal secretions.

Hepatitis B is found in semen and vaginal secretions. The virus can be transmitted during unprotected sex and from mother to child during childbirth.

Feces, nasal discharge, sputum, sweat, tears, urine, and vomit do not spread hepatitis B. Unless they are contaminated with blood, the risk of contracting hepatitis B from these fluids is very low.

Synovial fluid (lubricant for joints), amniotic fluid, cerebrospinal fluid, and peritoneal fluid (found in the abdomen) may contain hepatitis B virus, but the risk of transmission is unknown.

Hepatitis B is not spread by sneezing, coughing, shaking hands, hugging, kissing, breastfeeding, or sharing cutlery, water, or food.

Symptoms

The incubation period for hepatitis B lasts on average 75 days, but can increase to 180 days. The virus can be detected 30-60 days after infection.

During the acute infection stage, most people do not experience any symptoms. However, for some, acute hepatitis B infection may cause symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme tiredness, nausea, vomiting, and abdominal pain. A relatively small number of patients with acute hepatitis may develop acute liver failure, often leading to death (fulminant hepatitis).

In some people, the hepatitis B virus can also cause a chronic liver infection that can later develop into cirrhosis or liver cancer.

Complications after an illness

Hepatitis B is dangerous because of its consequences: it is one of the main causes of liver cirrhosis and the main cause of hepatocellular cancer of the liver. The likelihood that hepatitis B virus infection will become chronic depends on the age at which a person acquires the infection. Children most likely to develop chronic infections are those infected before the age of six:

• chronic infections develop in 80-90% of children infected during the first year of life;
• Chronic infections develop in 30-50% of children infected before the age of six.
• 15-25% of adults who become chronically infected during childhood die from liver cancer or cirrhosis.

Among adults:

• Chronic infections occur in <5% of infected, otherwise healthy adults;
• 20%-30% of chronically infected adults develop cirrhosis and/or liver cancer.

The probability of complete recovery from chronic hepatitis B is very low - about 10%. But a state of relative health (remission), in which the virus practically does not bother the patient, can be achieved in more than 80% of cases.

Symptoms of hepatitis B

The hepatitis B virus enters the human blood and then penetrates the liver, where it actively multiplies. From the moment of infection to the appearance of the first clinical symptoms of the disease, it takes from 6 weeks to 6 months - this is the incubation period.6 The disease develops gradually and often does not cause visible symptoms.

Clinical manifestations of hepatitis B are associated with inflammation of the liver tissue and are considered nonspecific. Patients develop general weakness, appetite worsens, abdominal pain occurs, and body temperature may rise. At night and in the morning, arthralgia is often observed - pain in the joints, which quickly disappears with movement.

The inflammatory process in the liver under the influence of hepatitis B disrupts the normal flow of bile, which causes the development of jaundice. Its main features:

yellowing of the skin, sclera (Fig. 2);

• skin itching;
• darkening of urine;
• stool lightening.

Figure 2. Manifestations of jaundice.
Photo: dariakulkova.gmail.com / Depositphotos From the moment jaundice appears, the liver begins to enlarge. Every second person with an acute form of hepatitis B also has an enlarged spleen.

As jaundice increases, the general condition worsens. Dyspeptic syndrome often develops, which manifests itself:

• nausea, vomiting;
• belching;
• feeling of heaviness in the epigastric region;
• bloating;
• tendency to constipation.

Against the background of the inflammatory process, the functions of liver cells - hepatocytes - are disrupted. Among other things, they stop producing vital blood clotting factors necessary for the natural mechanisms of stopping bleeding. This leads to the development of hemorrhagic syndrome - bleeding gums, nosebleeds, and in women - a tendency to uterine bleeding.

With hepatitis B, blood clotting may be impaired. Photo: AndreyPopov / Depositphotos

With hepatitis B, the detoxification function of the liver also suffers - its ability to neutralize metabolic products, as well as toxins from the external environment, is impaired. Their accumulation has a negative effect on the central nervous system. In severe cases and severe intoxication, people with hepatitis B may develop hepatic encephalopathy - this pathology leads to impaired consciousness of varying severity, and can even cause coma.

The total duration of the icteric period is 4–6 weeks. With a favorable outcome, the symptoms of jaundice gradually decrease, and at the same time the general condition of people with hepatitis B begins to improve. Their weakness decreases, their appetite is restored, and the size of the liver and spleen is normalized.

Acute viral hepatitis B does not always end in recovery. In approximately 8–20% of cases, the disease becomes chronic (Fig. 3) [2]. This version of the course of the infection is characterized by stages - the disease may not bother the patient for a long time, and when the viruses are activated, it may enter the active phase.

Figure 3. How often does hepatitis B become chronic? Source: WHO/NCBI

Diagnosis of hepatitis B

It is impossible to distinguish hepatitis B from other types of viral hepatitis on the basis of the clinical picture alone.
Therefore, in making a diagnosis, the main importance is given to laboratory research methods - identifying serological markers of the disease - specific antibodies - in the blood. Their determination allows not only to make a correct diagnosis, but also to clarify the form of hepatitis B, since specific markers of infection are determined in different cases (Table 1). Table 1. Features of laboratory diagnostics in patients with hepatitis B.

To assess the activity of the infectious process, the number of viral copies in blood serum is determined using the polymerase chain reaction (PCR). The PCR method allows you to identify the genetic material of viruses, therefore it is considered the “gold standard” in the diagnosis of infectious diseases.

What tests should people with hepatitis undergo?

To determine the effect of the virus on the body, people with hepatitis B must regularly undergo a number of laboratory tests:

• clinical blood and urine tests;
• biochemical blood test - determination of liver transaminase activity, bilirubin level, total protein;
• coagulogram - study of blood clotting factors.

These laboratory tests allow you to assess the functional state of the liver, monitor the dynamics of the pathological process, and evaluate the quality of treatment.

The main method of instrumental research for hepatitis B is ultrasound examination of the liver. For a more accurate diagnosis of the liver condition, patients are recommended to perform CT, MRI and elastography.

If a patient is suspected of having liver cancer, he needs to perform a puncture biopsy - take a tissue sample for detailed analysis. Cytological examination of cells obtained during the procedure allows us to reliably determine the condition of the liver in patients with viral hepatitis B.

Treatment of viral hepatitis B

The treatment regimen for the pathology depends on the stage of hepatitis B and the patient’s health status. Pathogenetic treatment consists of the use of antiviral agents. It is indicated in the case of the fulminant form of acute hepatitis B and for people with severely weakened immunity.

In the chronic form of the disease, pathogenetic therapy can significantly reduce the risk of cirrhosis and liver cancer. Main indications for prescribing antiviral drugs:

• a large number of viral copies in the blood;
• high levels of a marker of liver damage - alanine aminotransferase.

Currently, no drug can completely free the human body from the virus. But during therapy, the rate of its replication (reproduction) decreases, due to which the number of viral particles decreases, and further damage to liver cells slows down.

For pathogenetic treatment of hepatitis B, two groups of drugs are used:

• Direct acting antiviral agents.
• Immunomodulatory agents

The duration of treatment depends on the genotype of the hepatitis B virus, the drug and a number of other factors. On average, the duration of therapy ranges from 6 to 12 months.

Important! You can often see various advertising offers for drugs and traditional methods that allow you to completely get rid of the hepatitis B virus. But from the standpoint of evidence-based medicine, the effectiveness of such treatment methods has not been confirmed.

Treatment

Medical care for hepatitis B is aimed at maintaining comfort and a rational combination of nutrients, including replacing fluid lost as a result of vomiting and diarrhea. People with chronic hepatitis B who need treatment can be treated with medications, including oral antivirals (such as tenofovir and entecavir) and interferon injections. Treatment of hepatitis B may slow the progression of cirrhosis, reduce the incidence of hepatocellular carcinoma, and improve long-term survival. However, in many resource-poor areas, access to such treatment is difficult.

Liver cancer is almost always fatal and often occurs in people who are in their prime productive years and are providing for their families. In developing countries, most people with liver cancer die within months of diagnosis. In high-income countries, surgery and chemotherapy can prolong life by several years. Patients with cirrhosis sometimes undergo liver transplants, with varying degrees of success.

Hepatitis Guide

Contents Not all types of hepatitis are dangerous

Hepatitis B

Hepatitis C

There are a huge number of myths around hepatitis. Unfortunately, sometimes even people with medical education believe in them. Doctors, nurses and hospice volunteers often worry about contracting viral hepatitis, but the risk of getting the virus in a hospice is no greater than at a dental appointment, nail salon or tattoo salon.

Patients with hepatitis virus often face neglect. One of the striking cases that I know of occurred with a young HIV-infected man who was diagnosed with liver cancer along with hepatitis C. The tumor was only a few centimeters, and after its removal there was no need for chemotherapy. This lesion was discovered in August, and the patient was operated on only in January. The young man was sentenced. He was denied operations even on major oncological ones.

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The story ended happily because there were doctors who operated on him. They understood that if all rules were followed, there was no risk of infection of medical personnel. These rules are simple, but in Russia they are neglected, and then they shout loudly about the danger of those infected with hepatitis and HIV. The simplest thing to do during surgery is not to hand over sharp instruments to a colleague, but to place them on a sterile table so that another surgeon can handle them as safely as possible.

In Europe and the States, doctors treat HIV infection and hepatitis C without fear. Restriction of access to medical care due to a person having an infection can be punished very seriously - fines, dismissals, even criminal liability.

People with the hepatitis virus or HIV infection in Russia, especially in the regions, are alone in their problems. There is even no one to support them psychologically, because they are considered the most insignificant elements of society. Doctors and medical staff treat such patients extremely negatively and with great concern; many are denied medical care (especially in dentistry, dermatology, etc.). Unfortunately, this is due to the enormous ignorance of medical workers and there is no excuse for their behavior.

Among infectious disease doctors, there are professors who at lectures talk about a cure for hepatitis C, but come down from the podium and say: “Does anyone really believe in this? Hepatitis lives in the nerve ganglia.” In fact, this is far from true and currently viral hepatitis C is cured in 100% of cases, but this does not always happen on time. Treatment is becoming increasingly affordable and occurs in 8-12 weeks.

Not all types of hepatitis are dangerous

There are many types of hepatitis viruses: A, B, C, D, E, G, F, TTV. Nature does not stand still; perhaps in the future a new hepatotropic virus will appear that we will fight. Hepatitis D only occurs when the patient has a B infection. With these two types of hepatitis, an avalanche-like progression of liver disease begins, leading to the development of cirrhosis; patients very often die and it is almost impossible to treat them. Hepatitis E is now becoming more relevant due to the mass migration of people from African countries to Europe. According to WHO, up to 33 million new cases of infection are recorded worldwide per year.

Not all types of hepatitis are dangerous. G, F, TTV are viruses that live in the liver, but do not cause any consequences. However, there are some private clinics that actively treat these types of hepatitis, although they have been recognized worldwide as inactive viruses.

Hepatitis A is called the “disease of dirty hands.” It almost always occurs in an acute form and is never chronic. The virus does not have serious consequences and is almost never fatal. It is clear that in a sparsely populated area in a remote district, a patient with hepatitis A may develop a fulminant form of the disease (acute liver failure), and doctors will not always be able to save such a patient. But this is an extremely rare case.

To protect yourself from hepatitis A, it is enough to get vaccinated. All people entering a health care facility must be vaccinated or tested for antibodies to the virus, including non-medical personnel. If your mother says that you definitely “didn’t turn yellow” from hepatitis as a child, this does not guarantee that you didn’t have it. Perhaps you experienced it in a subclinical form, for example, you thought that these were signs of poisoning. If antibodies are detected, vaccination against hepatitis A is not necessary.

Wash your hands before eating, do not drink unboiled water, always wash vegetables and fruits and do not neglect heat treatment of foods. Hepatitis A is not transmitted by airborne droplets, but by the fecal-oral route.

When caring for a patient, you should wash your hands with soap, especially after visiting the restroom and cleaning the room. After you change a patient's diaper, you need to wash your hands thoroughly. This is a non-specific prevention that people should follow, regardless of what category of patients they work with.

In the Russian Federation, the presence of hepatitis A means hospitalization for 21 days. In this case, diagnosis occurs already in the “icteric” period, when the patient is not dangerous and practically does not release the virus into the environment. In my opinion, this category of patients needs regular home bed rest with careful care and supervision by a family doctor.

In terms of infecting other people, the patient is dangerous during the “pre-icteric” period. The disease manifests itself like any rotavirus infection: high fever, loose stools, weakness, so it is quite difficult to identify hepatitis A before the appearance of jaundice. Persons who have had contact with a patient with hepatitis must be under medical supervision for 45 days. There are no emergency vaccination recommendations, but theoretically, a vaccine can be given within the first 72 hours of exposure.

Unlike hepatitis A with a minimal number of deaths, hepatitis E, according to WHO, kills 44 thousand people per year out of 3.5 million infected people. The virus is most dangerous for pregnant women in the second and third trimesters. The hepatitis E virus is present in the feces of an infected person. It enters the body most often through water, poorly processed meat, raw shellfish, blood transfusion or from mother to fetus. Symptoms of this disease are jaundice, nausea, fever, weakness.

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Most patients are cured of hepatitis E, but some are left with a chronic form that no doctor knows how to treat. A vaccine has been developed for the hepatitis E virus in China, but it has not yet been approved by the WHO.

Hepatitis B is the most dangerous type of hepatitis virus

Hepatitis B is the most dangerous type of hepatitis virus. According to WHO, 257 million people are chronically infected with it, and 686 thousand die from it every year. The Asia-Pacific region is home to about 90% of all those infected in the world. It is expected that in the next generation the number of infections among residents of this region will decrease, as they began to vaccinate against hepatitis B. The vaccine was invented in 1982, and its effectiveness is 95%.

There are no drugs for a complete functional cure yet - antiviral therapy does not destroy the virus, but slows down the development of cirrhosis and liver cancer. The virus can survive outside humans for up to seven days. It is transmitted through blood and other body fluids (saliva, urine, semen, menstrual fluid, etc.), through sexual contact, from mother to fetus in utero or during childbirth. If a drop of blood from an infected person enters a swimming pool, there is a risk that the water in it will become infected. A person can get an infection in this pool through cuts on the skin, through microtrauma. People with psoriasis and xerosis, who have dry and damaged skin, are also at risk of infection.

All hepatitis in the acute phase is manifested by the same symptoms - jaundice, nausea, fever. While a person with hepatitis A gets better after turning yellow, a person with hepatitis B gets even worse. Jaundice with hepatitis B is an indicator that the immune system saw the virus and began to fight it: the body’s immune cells went to the liver and began to destroy the virus. Therefore, the patient feels bad, he has a fever, he is all yellow. In this battle the body will win with a 90% probability. And if a person does not turn yellow and does not understand how and when he became infected, most likely his body did not notice the virus.

Nonspecific prevention against hepatitis B virus – no contact with infected people. If you work with patients who may be infected with this type of hepatitis, follow the requirements for working with used disposable medical instruments, wear personal protective equipment (rubber gloves, safety glasses) when working with open wounds and biological fluids, wash your hands before performing manipulations and immediately after them, use modern blood sampling methods (vacutainers).

There is no need to put on a “plague suit” every time you enter a patient’s room. You are completely protected if you are vaccinated.

Hepatitis B is composed of three antigens: surface antigen, cardiac antigen and intermediate antigen. In order for our body to reject hepatitis B, it must have protection against the surface antigen. The vaccine against this type of hepatitis is an artificially created piece of surface antigen. It stimulates the immune system so that a person does not get sick.

Hepatitis B vaccination is recommended for people who require blood transfusions, dialysis patients, family members and sexual partners of people with chronic hepatitis B, health care workers and other people who handle blood, women planning pregnancy, people who have unprotected sex, people who use injection drugs. Also, vaccination against hepatitis B is necessary for everyone who has not been vaccinated before and does not have the necessary protection against hepatitis B (sufficient level of antibodies to HBsAg).

If you are under 35 years old, you can go to your local clinic and get vaccinated against hepatitis A and B for free. You can be vaccinated against two hepatitises at once. Vaccinations are carried out according to plan: against hepatitis B - three times at intervals of a month and six months, against hepatitis A - twice.

Hepatitis C is a gentle killer

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According to WHO, about 72 million people in the world are infected with hepatitis C. Approximately 399 thousand infected people die annually, mainly from cirrhosis and liver cancer. The hepatitis C virus is called the “gentle killer.” It is transmitted through blood through unsafe injection or transfusion of blood and its products. Sexual transmission and infection from mother to fetus are extremely rare.

Hepatitis C can be transmitted through household contact with razors and toothbrushes. There is a risk of getting the virus during manicures, dental procedures and examinations of internal organs using non-sterile equipment.

One day I turned to a friend of mine, an endoscopist from a very prestigious clinic, with a request to examine patients with hepatitis C and HIV. It turned out that this clinic has a very large flow of patients, and endoscopes do not have time to sterilize - they are simply wiped with a disinfectant.

So both children and pensioners, and not just injection drug users, can become infected with hepatitis C. If you notice that the medical institution has not processed the instruments, and you are asked to look at a certificate from the previous patient that he is not infected, you should not worry about this. Firstly, his certificate may be fake, and secondly, he may be in a phase where the virus has not yet been detected.

If hepatitis B tends to “sleep” (a person became infected 20-30 years ago and carried it in an inactive form), then hepatitis C cannot “sleep”. It multiplies at tremendous speed, synthesizing a billion viral particles every day. There are doctors who dissuade patients with a low concentration of the virus from undergoing treatment, but this should not be done under any circumstances, since the person puts both himself and others at risk.

For prevention purposes, hand hygiene and the use of gloves when working with biological fluids are necessary. The danger of hepatitis B and C is that you can become infected from one viral particle in the blood, a drop of which is not visible to the eye. Unlike hepatitis B, there is no emergency prevention for hepatitis C in the form of a vaccine or specific immunoglobulin - only treating the wound surface with an antiseptic and donating blood for antibodies to hepatitis 4-12 weeks after contact with the blood of an infected person.

Recorded by Diana Karliner

Effectiveness of vaccination

As of 2013, 183 Member States were vaccinating infants against hepatitis B as part of their national vaccination schedules, and 81% of children had received hepatitis B vaccination. This represents significant progress compared to 31 countries in 1992, when the World Assembly Health Council adopted a resolution recommending global vaccination against hepatitis B.

Additionally, as of 2013, 93 Member States have introduced hepatitis B dose provision at birth. Since 1982, more than one billion vaccine doses have been used worldwide.

In many countries where typically 8% to 15% of children had chronic hepatitis B virus infection, vaccination has reduced rates of chronic infection among immunized children to less than 1%.

Modern methods of treatment

Currently, there is no specific treatment for patients with acute hepatitis B. The acute infection is usually short-lived and often goes away on its own, due to the immune system.
Your doctor may recommend rest and proper nutrition and fluids to help your body fight the infection. Hospitalization may be required for patients who experience severe vomiting and are unable to maintain adequate nutritional levels. This may also be necessary to prevent the development of complications.

Although a chronic infection cannot be cured, there are two standard treatments that will help control the virus and prevent further liver damage:

• liver transplantation – this may be recommended in cases where the liver is seriously damaged;
• antiviral drugs, for example, Interferon - this is prescribed for a short period of time to suppress the virus.

“Antiviral therapy for chronic hepatitis B is carried out if there are certain indications,” says infectious disease specialist, hepatologist Tatyana Kovaleva.
– The specialist assesses the level of viral load, changes in liver enzymes, the degree of liver damage based on the results of ultrasound examination (ultrasound) of the abdominal organs and liver elastography (fibroscan) and then makes a decision. If antiviral therapy is prescribed, it is carried out over a long period of time, and in some cases permanently. Modern antiviral drugs lead to remission of the disease, prevent the progression of liver damage and the development of deaths. “Despite the successes of modern therapy, it is currently impossible to completely eliminate the hepatitis B virus from liver cells, since the DNA of the virus can integrate into the genetic apparatus of liver cells,” continues Dr. Tatyana Kovaleva. “Therefore, even with complete clinical recovery and the absence of the hepatitis B virus in the blood, it remains in the liver cells for life. With a pronounced decrease in immunity (use of immunosuppressive therapy, hormones, cytostatics, etc.), the hepatitis B virus can become active, which will require the re-prescription of antiviral therapy.

Vaccines

Expert opinion

CM. Harit

Professor, Doctor of Medical Sciences, Head of the Department of Prevention of Infectious Diseases, Research Institute of Children's Infections
Hepatitis B is contracted everywhere equally through blood (everyone) and through sexual contact (teenagers and adults). A drop of blood is so small that you cannot see it and it is already contagious, so families become infected through toothbrushes, razors, etc...

The basis for preventing hepatitis B is vaccination. WHO recommends that all infants should receive hepatitis B vaccine as soon as possible after birth, preferably within 24 hours. If a child does not receive this vaccination in the maternity hospital, the risk of infection increases significantly, and if a newborn is infected during the neonatal period, liver cirrhosis develops in adolescence or early adulthood.

The dose given at birth should be followed by two or three subsequent doses to complete the vaccination series. In most cases, one of the following two options is considered optimal:

• A three-dose hepatitis B vaccination regimen, in which the first dose (of monovalent vaccine) is given at birth and the second at 1 month of age, which is also very important, since this dose minimizes the risk of infection of the child from infected family members. The third dose (of monovalent or combination vaccine) is administered at 6 months, simultaneously with the DTP vaccine, which determines the duration of immunity against hepatitis B.
• A four-dose regimen in which the first dose of monovalent vaccine given at birth is followed by 3 doses of monovalent or combination vaccine, usually given along with other vaccines as part of routine childhood immunization, is indicated for children born to mothers infected or with hepatitis B.

After a full series of vaccinations, more than 95% of infants, children of other age groups and young adults develop protective antibody levels. Protection lasts for at least 20 years and possibly a lifetime.

More about vaccines

Symptoms of hepatitis B disease

The main signs of pathology include the following:

• nausea and appetite disturbances;
• increased weakness and fatigue;
• yellow tint of the skin;
• painful sensations in the area of ​​the right hypochondrium;
• dark shade of urine.

There is also a fulminant form of development of the disease, in which swelling of the brain develops within a few hours, and the patient falls into a coma. Treatment in this case turns out to be ineffective, and the patient’s death occurs within a short period. Most often, hepatitis occurs in the acute stage, when pronounced symptoms of intoxication appear, followed by icteric syndrome. At the final stage, the patient recovers.