Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer.
In the first part of the article, you have read the epidemiology, mode of transmission of Hepatitis B virus, its sign and symptoms, groups at risk, the relationship of HBV and HIV infection, and how the diagnosis is confirmed. In this part of the article, we shall discuss about its treatment and prevention.
If you want to read a short note on Hepatitis B in Indian context, read it HERE.
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Treatment of Hepatitis B
There is no particular treatment for intense hepatitis B. In this manner, care is pointed toward keeping up comfort and satisfactory dietary equilibrium, including the substitution of liquids lost from regurgitating and lose bowels. Most significant is the shirking of pointless prescriptions. Acetaminophen/Paracetamol and medicine against vomiting ought not to be given.
Persistent hepatitis B contamination can be treated with medications, including oral antiviral medications. Therapy can reduce the progression of cirrhosis, diminish the frequency of liver malignant growth and improve long-term survival. Only few (10% to 40% based on various eligibility criteria) individuals with persistent hepatitis B infection will require treatment.
WHO recommends the use of oral medicines (tenofovir or entecavir)-as the most effective medications to suppress hepatitis B infection. They lead to drug resistance rarely in comparison to other medications, are easy to take (1 pill daily) and have not many side-effects, so need limited monitoring.
In the vast majority, in any case, the treatment doesn’t treat hepatitis B infection. It just suppresses the replication of the infection. Subsequently, the vast majority who start hepatitis B treatment should proceed with it forever.
Long term HBV infections are cirrhosis and hepatocellular carcinoma. The liver carcinoma advances quickly since the treatment options are not much; the outcome is generally poor.
Prevention of Hepatitis B
The hepatitis B antibody is the pillar of hepatitis B prevention. WHO suggests that all babies get the hepatitis B antibody as quickly as time permits after birth, ideally within 24 hours followed by a 2-3 dosages of hepatitis B immunization, at an interval of a month. A timely immunization of a child at the time of birth is a successful measure to reduce the transmission of hepatitis B from mother-to-child.
As per WHO latest estimates, the proportion of children under five years of age chronically infected with HBV came down to just under 1% in 2019 from around 5% in the pre-vaccine era ranging from the 1980s to the early 2000s.
This marks the achievement of one of the milestone targets to eliminate viral hepatitis in the Sustainable Development Goals ─ to reach under 1% prevalence of HBV infections in children under five years of age by 2020.
In 2019, coverage of 3 doses of the immunization arrived at 85% overall as opposed to 30% in 2000.
The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. This protection lasts at least 20 years and is probably lifelong. Therefore, WHO does not recommend booster dose of the vaccine for persons who have completed the 3-dose vaccination schedule.
All kids and teenagers more youthful than 18 years and not recently inoculated ought to get the antibody if they live in nations where there is low or middle endemicity. In those settings, it is conceivable that more individuals in high-hazard gatherings may obtain the contamination and they ought to likewise be immunized. This incorporates:
- individuals who habitually require blood or blood items, dialysis patients, and beneficiaries of strong organ transplantations;
- individuals in jails;
- individuals who infuse drugs;
- family and sexual contacts of individuals with constant HBV disease;
- individuals with numerous sexual accomplices;
- medical services laborers and other people who might be presented to blood and blood items through their work; and
- explorers who have not finished their HBV arrangement, who ought to be offered the antibody before leaving for endemic zones.
Besides infant vaccination, including a timely birth dose, WHO recommends the use of antiviral prophylaxis for the prevention of hepatitis B transmission from mother-to-child. Pregnant women with high levels of HBV DNA (viral load) and/or the presence of HBeAG have an elevated risk of transmitting the virus to their child, even among infants who receive the timely birth dose and the complete hepatitis B vaccine series. As such, pregnant women with high HBV DNA levels may be eligible for antiviral prophylaxis during pregnancy to prevent perinatal HBV infection and protect their infants from contracting the disease.
In addition to infant vaccination and prevention of mother-to-child-transmission, implementation of blood safety strategies, including quality-assured screening of all donated blood and blood components used for transfusion, can prevent transmission of HBV. Safe injection practices, eliminating unnecessary and unsafe injections, can be effective strategies to protect against HBV transmission. Unsafe injections decreased from 39% in 2000 to 5% in 2010 worldwide. Furthermore, safer sex practices, including minimizing the number of partners and using barrier protective measures (condoms), also protect against transmission.
Ref: WHO
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