Hepatitis B

Hepatitis B is one of the most common and most serious infectious diseases caused by viruses. The WHO estimates that 257 million people infected with the hepatitis B virus (HBV) are chronically ill worldwide. More than 880,000 people die every year as a result, mainly from cirrhosis or liver cancer. In Switzerland, around 62,000 people live with hepatitis B. Hepatitis B is highly contagious. The risk of contracting hepatitis B from a contaminated needle is 50 to 100 times higher than the risk of getting infected with HIV. Since the introduction of vaccines, new infections have dropped. Acute infections do not usually cause lasting damage. The infection is considered chronic if the viruses are detectable in the blood stream for more than six months.

Transmission

The virus is mainly transmitted via contaminated blood. Unprotected sexual intercourse, exchange of consumables or preparation materials during intravenous or nasal drug use and passing the virus from mother to child at childbirth are further ways of transmission. Infections via blood transfusions are virtually non-existent in Switzerland, as all blood has been tested for hepatitis B virus since 1980. Insufficiently sterile tattoos, piercings, manicures, pedicures or shaving with blades are other possible risk factors for hepatitis B infection.

People Most at Risk

Injecting drug users used to be most at risk of contracting hepatitis B. Today, people who have unprotected sexual contact – heterosexuals as well as homosexuals – are the biggest high-risk group. Also, migrants from countries with high hepatitis B infection rates are more likely to carry the virus themselves – often without knowing it. This applies to people from Asia, Africa (south of the Sahara), South America, the Middle East, the Mediterranean and Eastern Europe. Hepatitis B is one of the most common occupational diseases among healthcare professionals. Particularly vulnerable to infection are children of infected mothers.

Symptoms

The incubation period for hepatitis B is 60 to 120 days. The course of the infection varies considerably. Most people with a hepatitis B infection, acute or chronic, experience only nonspecific symptoms or none at all. Some show a yellowing of skin and eyes, have dark urine, suffer from extreme fatigue, nausea, vomiting or abdominal pain. A hepatitis B infection can progress into a chronic liver infection, which can lead to liver cirrhoses or liver cancer. While over 90 per cent of healthy adults with a hepatitis B infection recover completely within a year, up to 90 per cent of infected newborns and children will develop a chronic infection.

Diagnosis

Raised levels of certain liver enzymes could indicate a hepatitis B infection. Several laboratory tests can prove the existence of antibodies and virus proteins. These tests show whether the infection is recent or chronic and also provide proof of immunity.

Prevention

A highly effective vaccine, injected three times, provides protection against hepatitis B. In Switzerland, it is recommended that all newborns as well as all high-risk groups be vaccinated against hepatitis B. This includes the children of infected mothers, who are vaccinated immediately after birth to prevent the baby becoming infected. People living in the same household or having a sexual relationship with someone who is infected should get vaccinated against hepatitis B and so should healthcare workers. The health insurance covers the cost of the vaccination.

Using condoms during intercourse reduces the risk of infection with the hepatitis B virus. Risk of infection in everyday life is minimal. However, electric razors or toothbrushes should not be shared. Caution is also advised with tattoos, piercings as well as manicure and pedicure and commercial shaving with blades.

Treatment

As acute hepatitis B in adults usually clears by itself without causing lasting damage, no treatment is required.

Chronic hepatitis B can be treated with drugs, especially with antiviral therapies. A cure is only possible in rare cases, since even with successful therapy, the genetic material of viruses usually remains in the liver cells. Treatment reduces the viral load in the blood – and therefore the risk of inflammation of the liver and the development of liver cirrhosis and liver cancer.

Therapy is not indicated for all persons with chronic hepatitis B. However, those affected should be under regular medical supervision for monitoring.

Patients with advanced liver disease may be given a liver transplant.