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 Health & You:
AFRICA AND HEPATITIS B VIRUS INFECTION: A BURDENED DISEASE CONDITION
Jun 03, 2013
By: Eze Nkeiruka Perpetua








Nigeria: -

CONTENT

What is Hepatitis?

Hepatitis and your liver

Epidemiology

How does it affect the liver?

Acute hepatitis B infection

Chronic hepatitis B infection

Mode of Transmission

Clinical Manifestation

Individual Suitable for testing

Prevention

Laboratory Diagnosis

Management

 

 

WHAT IS HEPATITIS?

The term ‘hepatitis’ simply means inflammation (irritation and swelling) of the liver .Inflammation of the liver can result from infection, exposure to alcohol, certain medications, chemicals poisons or from a disorder of the immune system .There are different types of Hepatitis A,B,C,D,E,F,G.

HEPATITIS AND YOUR LIVER

The liver is one of the largest and most important organs in the body; it operates as your body’s battery and keeps it clean and healthy. As part of the digestive system, the liver’s job is to enhance the energy, filtration, and storage capacities of the body while the liver can perform over 500 functions. Key functions include:

  1. Breaks down and converts sugar, fat and protein into energy.
  2. Fights infections.
  3. Filters and removes toxins from blood.
  4. Stores sugars, vitamins and minerals.
  5. Produces bile to help digestion of fats.
  6. Produces substances needed for stopping excessive bleeding from cuts or injuries.

The liver is four times larger than what is needed to survive and is the only internal organ that can regenerate itself. it is made up of millions of liver cells called Hepatocytes.

 

EPIDEMIOLOGY

According to the recent World Health Organizations estimate, two billion people worldwide have serologic evidence of past or present HBV infection, and 350 million are chronically infected and at risk for HBV-related liver disease. Approximately one third of all cases of cirrhosis and half of all cases of hepatocellular Carcinoma can be attributed to chronic HBV infection .HBV is estimated to be responsible for 500,000 -700 ,000 deaths each year.

The global epidemiology of HBV infection has traditionally been described according to three categories of endemicity-High, intermediate and low depending on the proportion of the population that is seropositive for HBsAg. Countries with high endemicity are those where HBsAg Seroprevalence is greater than or equal to 8 percent; countries with intermediate endemicity are those where Seroprevalence is 2-7 % and those with low endemicity are those where Seroprevalence is less than 2 percent.

Approximately 60 percent of the world’s population lives in areas where HBV infection is highly endemic including china,Indonesia,Nigeria and much of the rest of Asia and Africa.

 

HOW DOES IT AFFECT YOUR LIVER

When you are infected with the Hepatitis B Virus (HBV), the virus travels in your blood to your liver. Once inside your liver, the virus enters healthy liver cells and becomes part of the cell. It also multiplies, making new copies of itself that then spread the virus to more liver cells. As your body’s immune (defence) system fight the Hepatitis B Virus, it also kills the infected liver cell at the same time. If enough liver cells are killed, this can eventually lead to damage which can cause your liver to not work as well as it should, in other words there is a balance between the protective and destructive effects of the immune response to the hepatitis B Virus.

ACUTE HEPATITIS B VIRUS

This refers to a newly acquired infection. Affected individual notice symptoms approximately 1-4 months  after exposure to the virus. In most people with acute hepatitis, symptoms resolve over weeks to months and they are cured of the infection. However, a small number of people develop a very severe, life threatening form of acute hepatitis called FULMINANT hepatitis.

CHRONIC HEPATITIS B INFECTION

This is an infection with HBV that lasts longer than 6 months once the infection becomes chronic, it may never go away completely.

 

MODE OF TRANSMISSION

HBV is transmitted by percutaneous or mucosal exposure to infected blood or other body fluids. This transmission has been observed with numerous forms of human contact:

  • Perinatal/ mother-to-child
  • House hold contact( non-sexual)
  • Sexual
  • Needle sharing
  • Occupational/health-care-related

The highest concentrations of infectious HBV found in blood and serum. Other serum-derived body fluid’s such as infectious. Persons with chronic HBV infection are the major reservoir for transmission, anybody testing positive to HBsAg is potentially infection to both household and sexual contact, Because HBV can remain stable and infectious on environmental surfaces for at least 7days, transmission may occur indirectly via contaminated surfaces and other objects.

Transmission of HBV can also occur in situations where there is frequent and prolonged close personal contact with an infected person.

 

CLINICAL MANIFESTATION

  • Appetite loss
  • Feeling tired(Fatigue)
  • Nauseated and vomiting
  • Itching all over the body
  • Pain over the liver(on the right side of the abdomen, under the lower rib cage)
  • Jaundice(a condition in which the skin and the white of the eyes turn yellow in color)
  • Urine becomes dark in color
  • Stools are pale in color

  

INDIVIDUAL SUITABLE FOR TESTING

  • Individuals with clinical symptoms or abdominal liver enzyme levels
  • Children born to infected women
  • Household or sexual contacts of infected persons or carriers
  • Individuals participating in high-risk sexual activities(multiple sexual partners, men who have sex with men)
  • Intravenous drug users
  • Haemodialysis patients
  • Recent visitors or immigrants from areas
  • Health Care workers.

 

PREVENTION

  • Educating ourselves and having a proper awareness on HBV.
  • Proper blood donor selection and screening of donated blood.
  • Wearing of protective clothing and gloves by health workers when handling infected blood and contaminated instruments used on infected patients.
  • Disinfection and sterilization of all reusable instruments and surfaces contaminated with HBV positive blood.
  • Passive immunization by administering by hepatitis B immunoglobulin within a week of exposure and to newborn infants of HBsAg positive mothers.
  • Active immunization of individual with high risk of HBV infection and who known to be Sero-negative including children, infant born and health workers.
  • Practise safe sex.
  • Promote community health education programme.
  • Promote vaccination to interrupt community wide outbreak.
  • Encourage proper community and home sanitation.

 

LABORATORY DIAGNOSIS

The specimen of choice for the diagnosis of HBV infection is blood. Serological tests for viral antigens and antibodies are typically used for diagnostics screening and can be performed on either serum or plasma. Both HBV antigen and antibody are stable at room temperature for days at 4◦c for months and frozen at -20◦c to -70◦c for many years. EDTA blood can be stored for up to 5 days at 4◦c without affecting viral load. EDTA in plasma is known to stabilize viral nucleic acids.

 

TEST AVAILABILITY

Test for antibodies and antigens are availability for hepatitis including those specific for hepatitis B core, surfaces, and e protein. Techniques for antibody detection include enzyme immunoassay (EIA) and Recombinant immunoblot assay(RIBA).EIA technology is also used for antigen testing. Branched DNA b(DNA),solution, hybridization-hybrid capture (Digene), transcription-mediated amplification (TMA),and polymerase chain reaction (PCR) are used for DNA testing to determine the presence of viraemia and measure the viral load.

 


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