Hepatitis B

What is Hepatitis B?

Hepatitis B is one of the most common viral hepatitis (viral hepatitis) worldwide. Most patients become involved in intercourse with the pathogens. The infection can acute or chronic run. Worldwide, according to the World Health Organization, about 240 million people are chronically infected with hepatitis B.

In endemic areas such as sub-Saharan Africa and the East Asian region, the infection rate ranges from five to ten percent of the population. In Germany, hepatitis B is comparatively rare, accounting for less than one percent. Nevertheless: 55 percent of the cases of hepatitis reported in Germany are type B infections. The disease and its consequences (liver cirrhosis, liver cancer) kill around 780,000 people a year worldwide.

Hepatitis B is notifiable, This means: the attending physician must report the name of patients suspected or confirmed to have hepatitis B to the responsible health authority. Deaths from hepatitis B must also be reported to the health department. The Office forwards the data to the Robert Koch Institute, where it is statistically recorded.

Hepatitis B: symptoms

Hepatitis B is usually not so easy to recognize for those affected. Many signs of infection are nonspecific (such as tiredness, nausea). Often there are no symptoms at all (asymptomatic infection). This is particularly treacherous because the highly contagious hepatitis B virus can then be unknowingly transmitted to many healthy people.

Note: About one third of all infected adults show no symptoms. In another third, symptoms such as fatigue, lack of appetite, nausea, and muscle and joint pain, but no jaundice. Finally, jaundice is present in the last third (in addition to the other complaints).

Incubation period of hepatitis B

The time between infection and onset of the first symptoms of hepatitis B (incubation period) is 30 to 180 days. On average, 60 to 120 days (two to four months) pass until the disease breaks out.

Acute Hepatitis B: Symptoms

Acute hepatitis B begins with unspecific complaints such as loss of appetite, aversion to certain foods, nausea and vomiting, muscle and joint pain, and mild fever.

After about three to ten days can – but need not – one jaundice (Icterus): The skin, mucous membranes and the whites of the eyes (sclera) turn yellowish. This is often observed in infants and people with weak immune systems. Furthermore, the Discolor stool and the Urine dark become.

Chronic hepatitis B: symptoms

Hepatitis B is considered to be chronic if specific antibodies to the pathogen are detectable in the blood for more than six months. Symptoms do not necessarily occur in those affected. If yes, then they show up in the form of:

• fatigue
• Joint and muscle pain
• anorexia
• weight loss
• occasional pressure sensations under the right costal arch

In about one percent of patients develops from chronic inflammation liver cancer or one Shrink liver (liver cirrhosis), The risk of liver cancer is even around 100 times higher in hepatitis B patients than in the “normal population”! The development of liver cirrhosis is favored by alcohol abuse and an additional hepatitis C infection.

Additional infection with hepatitis D

Hepatitis B patients may also become infected with hepatitis D. In this so-called superinfection, liver disease is more severe than with hepatitis B infection alone. In addition, the additional type D virus infection further increases the risk of cirrhosis. Liver cancer is also favored: in a combined infection with hepatitis B and D, the malignant tumor forms earlier than in a B infection alone.

Note: Hepatitis D infection is only possible in the presence of hepatitis B viruses.

Hepatitis B: transmission

Hepatitis B viruses are very common sexual contact passed – over semen, vaginal secretions or saliva. But other body fluids such as breast milk, tears or blood can transmit the pathogens. So the disease is often over infected blood passed. Therefore, people who handle blood and needles or other sharp objects are particularly at risk for hepatitis B infection. This includes:

• medical staff
• dialysis patients
• drug addicts
• Patients receiving blood or plasma (blood products are strictly controlled before administration)
• People who pierce their ears, tattoos or piercings under unhygienic conditions

Attention: Contagion is also possible through shared toothbrushes and from the mother to her child (during pregnancy or childbirth as well as during breastfeeding). If a mother is known to have a hepatitis B infection, the child will be vaccinated within 12 hours after birth.

Hepatitis B: examinations and diagnosis

For the diagnosis of hepatitis B, the doctor takes blood from the patient. In the laboratory, it is investigated whether direct and / or indirect evidence of hepatitis B viruses can be found:

• Viral DNA: The genetic material of hepatitis B viruses (HBV DNA) is an important indication of type B hepatitis.
• Virus antigens: These are specific components of the protein envelope of the viruses (HBs-Ag, HBc Ag and HBe Ag). They allow (as the viral DNA) a direct pathogen detection.
• specific antibodies: In a hepatitis B infection, the immune system forms specific antibodies against the pathogen (such as Anti-HBc). Their presence is an indirect pathogen detection.

From the presence or absence of antigens and antibodies, the doctor can draw valuable conclusions. Some examples:

A current hepatitis B infection This is the case if the genome of the virus, the virus antigen HBs-Ag and the antibody type anti-HBc can be detected in the patient’s blood. The antibody type anti-HBs is missing in this case.

At a Healed hepatitis B circulating in the blood antibodies of the type anti-HBc (and usually also anti-HBs). The virus antigen HBs-Ag, however, is undetectable.

If only antibodies of the anti-HBs type are found in the blood, but no other antibodies and also no antigens of hepatitis B viruses, this indicates that the person in question has a effective vaccination against hepatitis B has.

Further investigations

In the blood sample of the patient, other parameters are determined. So can elevated liver values (such as GPT, GOT, Gamma-GT) indicate liver damage.

By means of a ultrasound The doctor can assess the structure and size of the liver. In the case of chronic hepatitis B, tissue samples can also be taken from the liver (liver biopsy) to determine the extent of tissue damage.

Hepatitis B: treatment

At a acute infection As a rule, no specific hepatitis B therapy is necessary – the disease almost always spontaneously heals spontaneously. If necessary, however, the doctor can treat the symptoms.

In addition, patients should take bed rest, take good care of themselves, and eat high carbs but low in fat. Very important is also the renunciation of alcohol – whose detoxification would burden the diseased liver additionally. For the same reason, if possible, no liver-damaging medication such as painkillers and female sex hormones (pill) should be taken.

A chronic hepatitis B is usually treated with antiviral drugs. These include:

• Nucleoside and nucleotide analogs: They inhibit the proliferation of hepatitis viruses. Are used e.g. Lamivudine, entecavir, telbivudine or tenovovir dipivoxil. The active ingredients are taken as a tablet.
• Interferon-αandPEGylated interferon α (PEG-interferon α): They are also antiviral and also stimulate the immune system. Their application takes place as an injection.

The goal of drug therapy is to lower the amount of virus in the blood as much as possible. This reduces the risk of liver cirrhosis and liver cancer as a result of chronic hepatitis B. However, the disease with the drugs is usually not curable.

Note: In some patients with chronic hepatitis B, the viruses multiply only slightly, the liver values ​​are often normal and the liver is (still) little damaged. Then the therapy is often limited to regular check-ups.

If chronic liver inflammation has led to severe cirrhosis of the liver, the last option is one liver transplantation.

Hepatitis B: course and prognosis

In approximately nine out of ten adults with acute hepatitis B, hepatitis ceases spontaneously and without sequelae within a few weeks. Only rarely does it run very hard and heavy (brilliant course).

In up to ten percent of adult patients, the acute infection continues to develop into chronic hepatitis. Particularly vulnerable are people with a weakened immune system: In these cases, a hepatitis B infection becomes chronic in 30 to 90 percent of cases.

In children, hepatitis B almost always (about 90 percent) has a chronic course.

Possible Consequences of chronic hepatitis B are liver cirrhosis and liver cancer.

Hepatitis B: Prevention

The most effective way to stop getting hepatitis is by taking a hepatitis vaccine. The active hepatitis B vaccine stimulates the immune system to produce specific antibodies against the pathogen. It is available as a single vaccine or as part of combination vaccines (such as with the hepatitis A vaccine). Depending on the vaccine and vaccination schedule, three or four doses of vaccine may be needed for long-term protection (basic immunization). Talk to your doctor about what makes sense in your case and ask him and your health insurance provider if the costs of the vaccination are covered.

Note: Antibody production takes some time. After a blood test one to two months after the vaccination, the doctor can then check whether the vaccine was successful. This is especially important for medical personnel, for example.

Unlike active vaccination, the passive hepatitis B vaccine immediate protection against the pathogen. Namely, ready antibodies against hepatitis B are administered. This may be necessary, for example, when healthy people have come in contact with infected blood of a patient (for example, in needlestick injuries). The instant passive vaccine then bridges the time until the co-administered active vaccine exerts its protective effect.

Newborns of hepatitis B infected mothers will also receive an active and passive hepatitis B virus vaccine within 12 hours of birth.

Note: Passive vaccination does not last long. The administered (foreign) antibodies are namely degraded by the organism with time.

Further protective measures

To prevent hepatitis B, you should always use a condom during intercourse. This is especially true when the sexual partner changes frequently.

In addition, healthy people and Hepatitis B– Do not share the toothbrush, nail scissors or razor.