Viral hepatitis B: at constant risk

(ORDO NEWS) — Despite the big step in the development of medicine in the 20th century, the emergence of effective and modern vaccines, there are still diseases that pose a significant danger to the human body.

One of them is viral hepatitis B (Hepadnaviridae or HBV). In 2014, the infection ranked as the 15th leading cause of death worldwide. There is still no effective treatment against this insidious enemy that affects the liver, and vaccines for prevention appeared only in the 1980s, so not all the adult population of the planet is covered by immunization.

The situation is aggravated by the fact that not all carriers are aware of the presence of a dangerous virus in their body, and continue to spread it – today there are about two billion people infected with hepatitis B in the world, and 240 million have the disease in a dangerous chronic form.

The main danger of viral hepatitis B is its ability to lead to severe liver damage with subsequent development of cirrhosis and cancer. In this case, the disease can proceed in different ways.

Studies show that about two-thirds of patients have mild or no symptoms of the infection. In such cases, the manifestations of hepatitis are so non-obvious that the patient does not attach much importance to them and does not seek medical help. And even a doctor can not always recognize the disease during the examination.

In most cases, viral hepatitis B is asymptomatic in children under five years of age and people with immunodeficiencies. In adults and children older than this age, symptoms also do not always occur – on average in 40 percent of cases.

The usual symptoms of HBV, such as jaundice, abdominal pain, high fever, may not be observed at all, the matter is limited only to a feeling of fatigue and mild nausea.

At the same time, viral hepatitis B has a rather long incubation period. On average, it is from two to four months, but can vary from one to six months. It depends on how many viral particles have entered the body.

According to the World Health Organization for 2019, of all carriers of viral hepatitis B worldwide, only 30.4 million people (slightly more than 10 percent) were aware of their diagnosis.

All these people are quite capable of infecting others, for example, during unprotected sexual intercourse, and over time they themselves can get an extremely unpleasant surprise in the form of liver damage and other dangerous complications.

By the set of symptoms, it is quite difficult to distinguish viral hepatitis B from other infectious diseases. The only reliable diagnostic method is laboratory. It includes the determination in the blood of DNA, pathogen antigens and antibodies that the body’s immune system produces to fight HBV.

May be chronic

If laboratory tests show positive results for the presence of viral hepatitis B in the body for six months or longer, it is considered that the infection has flowed into a chronic form.

The risk of chronicity depends on the age at which the disease began: when newborns are infected, the probability of hepatitis becoming chronic is 90 percent, if a child aged one to five years is ill, the probability is 50 percent, the risk of getting a “chronicle” in adulthood is significantly below – at the level of five to 10 percent.

Sometimes the diagnosis is made years after the virus enters the body. Sometimes this comes as a complete surprise to a person who previously considered himself absolutely healthy.

By the way, infection of the child can occur, including from the mother during childbirth. Doctors take this problem very seriously, given the fact that not all infected women are aware of the dangerous virus in their bodies.

Therefore, during pregnancy, all expectant mothers are required to take blood tests for antibodies and viral hepatitis B and C. The study is performed twice: when registering at the antenatal clinic and in the third trimester (from 27 to 40 weeks of pregnancy).

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Chronic hepatitis B, like acute hepatitis B, can proceed in different ways, depending on how severely the liver tissue is affected. Many patients, especially children, may have no symptoms at all. But there comes a time when the disease begins to manifest itself in full force and immediately in the form of complications: cirrhosis, liver cancer, brain damage (hepatic encephalopathy).

Sometimes there are so-called extrahepatic manifestations: polyarteritis nodosa – a condition in which the arteries are damaged and the blood supply to the organs is disturbed, and glomerulonephritis – kidney damage.

It is believed that such conditions arise as a result of an overactive reaction of the immune system to the antigens of the virus. Many patients with chronic hepatitis B suffer from general malaise, loss of appetite and weight loss, constant fatigue, and discomfort in the upper abdomen.

The chronic form of the disease also manifests itself in the form of jaundice, but such cases are recorded by doctors extremely rarely.

Due to such a large set of variants of the clinical picture of the disease, viral hepatitis B is very insidious – like its closest brother, hepatitis C. It is especially dangerous when a person is infected with both viruses at the same time. In such cases, the volume of liver damage increases much faster.

Leads to cirrhosis and cancer

Even if chronic hepatitis B is asymptomatic, over time it can lead to dangerous complications. One of the most unfavorable scenarios is the development of primary liver cancer, hepatocellular carcinoma. This malignant tumor annually claims about 745 thousand human lives worldwide and is the second most common cause of death from cancer among men.

In Russia, more than seven thousand new cases of hepatocellular carcinoma and intrahepatic bile duct cancer are diagnosed annually. In 60-70 percent of cases, viral hepatitis B and C are the cause of malignant liver tumors.

In general, hepatocellular carcinoma (another name is hepatocellular carcinoma) is much less common than many other cancers. But with chronic viral hepatitis B, the risk of its development increases by 25 times, and with cirrhosis caused by hepatitis C – by 17 times.

The process of liver cancer development in hepatitis usually looks like this. The causative agent of infection penetrates the organ and causes inflammation. Normal liver cells – hepatocytes – die and are gradually replaced by connective tissue. cirrhosis develops. The function of the liver is disturbed, but at the same time, the powerful potential of the organ for regeneration is preserved.

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Hepatocytes try to restore their numbers and begin to actively divide. On the one hand, this is good. But there is a downside – active cell division leads to the accumulation of “critical errors” in the process of DNA duplication. Mutations occur that can turn a normal cell into a cancerous one.

This cell and its descendants begin to multiply uncontrollably, invade surrounding tissues, and spread throughout the body. Hepatocellular carcinoma is difficult to fight, which is why timely vaccination against viral hepatitis B and surgical treatment in case of an already developed infection are so important.

Intervention is not for everyone

For acute viral hepatitis B, there is no specific treatment directed directly at the virus. All doctors can do is improve the patient’s condition, reduce symptoms and hope that the immune system will cope with the infection, preventing it from becoming chronic.

In mild cases, you can limit yourself to diet, fractional drinking and rest. With a more severe course of the disease, it is necessary to administer intravenous solutions to relieve intoxication. Hyperbaric oxygen therapy, plasmapheresis, administration of cryoplasma, albumin solution may be prescribed.

Sometimes the patient’s condition worsens so much that he has to be transferred to the intensive care unit. In most cases, modern doctors give a favorable prognosis. But the question is what will happen next: recovery or the transition of the infection to a chronic form?

Antiviral drugs are available to treat chronic hepatitis B, but they do not kill the virus. The goal of therapy is to slow down the replication (reproduction) of the pathogen, reduce the risk of developing cancer, the growth of liver cirrhosis

On average, only 12 to 25 percent of people with chronic hepatitis B need treatment. Usually, once therapy is started, it continues for life. Drugs help only as long as the patient takes them. In addition, all people with chronic viral hepatitis B should be constantly monitored by a doctor and undergo follow-up examinations. This helps to control the activity of the infectious process.

The only option is vaccination.

In an infected person, the hepatitis B virus is present in the blood, saliva, and other body fluids . You can get infected in different ways: during unprotected sexual contact, when using non-sterile injection needles; through insufficiently well processed dental, surgical instruments; when in contact with blood, and when using shared objects that can damage the skin and mucous membranes, such as toothbrushes or razors. In addition, the child can get an infection during childbirth.

You can, of course, take all the precautions given these routes of infection and hope that the virus does not enter the body. But there is a much more effective way to protect. There is a vaccination against hepatitis B. In Russia, it is included in the National Immunization Calendar and is supplied for the all-Russian vaccination program by the Nacimbio holding of the Rostec State Corporation.

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NPO Microgen, which is managed by Nacimbio, produces a vaccine to protect against this form of viral hepatitis as part of a combined preparation of hepatitis B and antigen-reduced diphtheria-tetanus toxoid (DPT-Hep B vaccine).

The drug is indicated for a vaccination course in previously unvaccinated patients against diphtheria, tetanus and hepatitis B, as well as for planned age-related revaccination against diphtheria and tetanus in previously unvaccinated patients against hepatitis B.

The use of combined vaccines is in line with the current recommendations of the World Health Organization in the field of immunoprophylaxis of infectious diseases. The presence of several components allows you to protect patients with a single injection from more viruses, reduces pain load and reduces the workload of medical personnel.

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Hepatitis B is an incurable disease, so it’s best to take care of yourself in advance. The first vaccination is done in the hospital, in the first 24 hours of a newborn’s life. Further, vaccination is carried out in accordance with the scheme 0-1-6.

That is, the second vaccination is given a month after the first, and the third – six months after the start of immunization. Adults who were not vaccinated in childhood can be vaccinated according to a similar scheme. For children from high-risk groups, a 0-1-2-12 scheme is provided.

The child falls into the high-risk group if the mother is a carrier of HBsAg antigens, is infected or had the disease in the third trimester of pregnancy, if during pregnancy she was not examined for hepatitis B; if you used narcotic or psychotropic substances, if there are carriers of HBsAg antigens or those infected with hepatitis B in the family.

Today, the effectiveness of HBV vaccination is very high. According to the World Health Organization, after full immunization, the level of protection in children is more than 95 percent, in adults it drops to 90 percent by age 40, and to 65-75 percent by age 60.

At the same time, it is not too late to get the first vaccination against a life-threatening and health-threatening disease at any age, saving yourself from the fatal surprises that hepatitis B can bring.

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