The Virus

Hepatitis B virus (HBV) infection is a blood-borne disease transmitted from person to person by the exchange of bodily fluids. The most common methods of transmitting the virus are mother to child, percutaneous (either by needle stick injury in the hospital or sharing hygiene equipment, such as razors and nail clippers, with a person with Hepatitis B), and by sexual intercourse with a person who has Hepatitis B. It is not spread through ordinary contact such as shaking hands or kissing. There are certain groups of people who are at higher risk of infection. This is based on occupational and environmental risk and includes healthcare workers, persons who inject drugs, persons with multiple sexual partners, persons living with people who have Hepatitis B, and those receiving numerous blood transfusions, among others.

A Silent Disease

After infecting individuals, Hepatitis B virus affects the liver and can cause significant acute inflammation leading to fulminant hepatitis and possibly death. However, most commonly Hepatitis B causes a chronic infection leading to low grade liver inflammation which, over time, leads to cirrhosis and hepatocellular carcinoma. It is well known that the chances of chronic infection are highest when individuals are exposed at a young age, which makes the Hepatitis B vaccine a crucial tool to prevent infection. Sadly, Hepatitis B rarely yields any symptoms until the disease is in late stage. Therefore, infected individuals could have the virus for years without knowing. This particular issue is what makes awareness of Hepatitis B so critically important; If we do not think about it and we do not think about checking for it, we will miss the chance to find the virus until it has caused severe damage.

Treatment

Once chronic infection is established, anti-viral treatment is available to suppress viral replication and thus inflammation. However, once end-stage complications such as cirrhosis and hepatocellular carcinoma occur, definitive treatment options such as liver transplantation are not available in many parts of Africa. Of the great majority of individuals infected, only some need treatment (as the virus can remain “dormant” for years). As of today, most treatment options include “viral suppression”, which involves taking a medication daily to “suppress” the virus and limit inflammation and damage. The decision to treat or not treat a person with Hepatitis B is based on several parameters such as age, viral replication, liver inflammation, and liver damage among others. In general, it is recommended that clinicians with experience or training in Hepatitis B management make the decision (with the patient) on whether to start or not treatment.

The Vaccine

Vaccination against Hepatitis B is highly efficient when administered at the appropriate time and intervals. The vaccination regimen consists of 2 or 3 vaccines (depending on the brand) given over a period of 6 months. Ideally the vaccine should be administered at birth. However, it is never too late for vaccination (unless an individual has acquired hepatitis B already). Vaccination of those at risk, which includes health-care workers and those living with persons with Hepatitis B should be a priority.