Hepatitis BAcute Hepatitis B is an inflammation of the liver caused by hepatitis B viruses. It often runs its course without noticeable symptoms. Liver damage threatens if the disease becomes chronic. Read more about causes, treatment and prevention of hepatitis B. Hepatitis B (HBV) is the most common form of hepatitis. One of the most common infectious diseases worldwide. About 2 billion people worldwide are or have been infected with hepatitis B. About 90 percent of this liver inflammation is acute. Cures within six months. In up to 10 percent, hepatitis B can become chronic. Longer lasting.Hepatitis B can be prevented by vaccination or treated after HBV infection.Hepatitis B can be prevented by vaccination or treated after HBV infection.
All forms of hepatitis
Frequency
Hepatitis B virus infections are most common in sub-Saharan Africa and East Asia. There, 5 to 10 percent of adults are chronically infected. Other elevated HBV occurrences are in the Amazon region and southern parts of Eastern and Central Europe. In Western Europe and North America, less than 1 percent are chronically infected with HBV.
Hepatitis B in Germany
Germany is one of the countries with a very low prevalence of hepatitis B. However, the number of cases has recently increased significantly. By September 2020, the Robert Koch Institute had already recorded more than 5.000 of new infections. Although these are a good 1.500 fewer infections than in the same period last year, but significantly more than a few years ago. In 2015, for example, a total of 3.738 HBV infections were reported to the RKI. Acute hepatitis B is usually more severe than hepatitis A. Does not heal as quickly as this. In many cases, an initial infection with hepatitis B viruses goes unnoticed. When symptoms do occur, they are often very nonspecific. Symptoms include poor performance, fatigue, loss of appetite, pain in the limbs and joints, or a slight increase in body temperature.
The symptoms characteristic of liver inflammation, such as upper abdominal pain, itching and a yellowing of the skin and mucous membrane (icterus), usually follow 3 to 10 days later in the case of hepatitis B (so-called icteric phase). In addition to yellow skin. Mucous membrane is dark discolored urine conspicuous. These symptoms subside after 2 to 4 weeks.
Children (especially boys) often develop an intermittent reddish rash with vesicles or nodules and swelling of the spleen and lymph nodes (Gianotti-Crosti syndrome).
Typical of hepatitis B is also a pronounced aversion to certain (previously liked) foods as well as to nicotine and alcohol.
Complications of acute hepatitis B: Very rarely, acute hepatitis B can be so severe and violent that it leads to liver failure coma. Then only a liver transplant can help. The severity of hepatitis B does not depend on the virus, but on the strength of the body's own immune system.
Chronic hepatitis B
Acute hepatitis B is cured after 1 to 6 months in more than 90 percent of cases. However, it becomes chronic in up to 10 percent of adult patients. Chronification is particularly common in newborns who have been infected during birth. Here, about 90 percent of newborns are affected. In addition, 30 to 90 percent of infants up to the age of 3 develop HBV. Hepatitis B can be contracted at any time during the first year of life. People with weakened endogenous immune system chronic HBV infections. chronic HBV infections in people over the age of 60 and in people with a weakened immune system. Chronic hepatitis B can also go unnoticed. However, it can also cause the following symptoms:
– Fatigue and poor performance – Joint and muscle pain – Unpleasant feeling of prere under the right ribcage – Skin and mucous membrane symptoms (so-called liver skin signs such as smooth, red tongue, lips that appear painted, star-shaped vascular dilatations: "spider naevi") – Itching, parchment-like, thin skin – White-colored nails and reddened palms of the hands.
Complications of chronic hepatitis B: In some patients with chronic hepatitis B, the liver shrinks and hardens. Cirrhosis of the liver is the consequence, in which the liver function fails or leads to varicose veins in the esophagus (esophageal varices). Liver cirrhosis usually develops 20 years after infection with the hepatitis B virus. In addition, patients with chronic hepatitis B have a significantly higher risk of developing liver cancer compared with the normal population.
Concomitant infection with hepatitis D: Patients with hepatitis B sometimes also become infected with the hepatitis D virus. A so-called co-infection occurs. This is more severe than simple hepatitis B.
Causes
Hepatitis B is caused by the hepatitis B virus. The incubation period (i.e., the time from infection to onset of the disease) is between 1 and 6 months.
The hepatitis B virus is transmitted through blood and other body fluids such as semen, breast milk, saliva or tear fluid. Most infections are due to unprotected sexual intercourse (via semen or saliva during oral sex) and infected blood. Even small amounts of infected body fluid are sufficient to cause infection.
Infected blood, for example, can adhere to instruments that have not been properly cleaned (z. B. during ear piercing or tattooing). However, toothbrushes or razors that are used together can also be contaminated with the virus and transmit hepatitis B.
Drug addicts, who become infected with the hepatitis B virus through used syringes and needles, are a high-risk group.
Pregnant women transmit hepatitis B to their child
Pregnant women with the hepatitis B virus can infect their babies during or after birth (for example, during breastfeeding). To reduce this risk, all mothers are tested for hepatitis B as part of maternity care. In the case of hepatitis B, the newborn is vaccinated against hepatitis B within twelve hours of birth.
Don't worry about dialysis and blood transfusions
Many people are afraid of becoming infected with the hepatitis B virus during dialysis or blood transfusions. This fear is relatively unfounded. In Germany, blood and blood products are now tested so thoroughly that the risk of infection can only be classified as extremely low.
Treatment
The treatment of hepatitis B depends on the course of the disease. Special drugs do not exist yet. This is why it is important to spare the liver. Vaccination offers protection against the hepatitis B virus (HBV). HBV vaccination is recommended for all people who are exposed to an increased risk of infection.
Protecting the liver against hepatitis B
In up to 90 percent of cases, hepatitis B runs its course with only mild symptoms. Sometimes the infection is not even noticed. No special treatment is needed for mild courses. In cases with pronounced symptoms, you should avoid physical exertion and, if possible, stay in bed during phases with a particularly pronounced feeling of illness.
Low-fat diet and no alcohol
Eat a low-fat diet. A light diet is recommended. In this way you relieve the liver, which bears the main burden in the utilization and breakdown of fats. Alcohol is particularly harmful to the liver. It is therefore essential to avoid alcohol in all forms of hepatitis. Even the smallest amounts put a significant strain on the liver.
Paracetamol and the pill
Many drugs are processed in the liver. Some even damage the liver. Therefore, you should refrain from taking liver-damaging medications during hepatitis B. These include, for example, the painkilling and fever-reducing drug paracetamol, as well as female sex hormones in the contraceptive pill. For pain and fever, you can use ibuprofen and metamizole after consulting your doctor. It is best to talk to your gynecologist about alternative contraceptives.
If acute hepatitis B is very severe, your doctor may prescribe virus-inhibiting agents, such as lamivudine.
Drug therapy for chronic hepatitis B
In the drug therapy of chronic hepatitis B, virus-inhibiting agents such as adefovir, entecavir, lamivudine and telbivudine are the drugs of choice. These agents must be taken over several months and years.
Another therapeutic approach is to inject interferon under the skin. So-called pegylated interferons have the advantage that, as depot preparations, they only have to be injected once a week. However, interferon treatment is also prolonged. It usually lasts 1 year.
If interferon cannot be given or if interferon therapy has not worked, nucleos(t)id analogues such as entecavir and tenofovir can be used.
Complication cirrhosis of the liver
In cases of hepatitis B with end-stage liver cirrhosis, only liver transplantation can help.
Prevention and vaccination
Hygiene and general precautions are the most likely to help prevent hepatitis B. These include:
– no unprotected sexual intercourse. Condoms protect against hepatitis B infection. – Never share syringes and use them only once. – Do not borrow shaving utensils, toothbrushes, and nail scissors and files from potentially infected persons. – Paying attention to appropriate hygiene in tattoo and piercing studios (prefer certified stores).
Active hepatitis B vaccination
The best protection against hepatitis B is the vaccination. Available are active protective vaccination and vaccination after presumptive contact with the hepatitis B virus (HBV).
Vaccination recommendations active HBV vaccination
The Standing Commission on Vaccination (STIKO) of the Robert Koch Institute (RKI) has recommended active HBV vaccination for all infants and young children since 1995. But why should all children be vaccinated if the risk of infection is generally not very high?? The answer: when infants or young children become infected with HBV, hepatitis B is chronic in 90 percent of cases. The risks of the disease and the burden of a then necessary therapy justify, according to most medical experts, to vaccinate even children with a low probability of infection. According to the current STIKO vaccination recommendation (August 2020), unvaccinated children should be vaccinated until the age of 18. The vaccine can be given after the first year of life.
Furthermore, the official vaccination recommendation applies to adults who live together with a chronic hepatitis B patient or who come into frequent contact with blood or other body fluids containing pathogens in their work. In addition, HBV vaccination may be useful for sexually active people with alternating sex partners.
Vaccination schedule: Basic immunization of infants
According to the STIKO recommendation updated in August 2020, infants receive the first two of usually 3 vaccinations for basic immunization against hepatitis B at the ages of 2 and 4 months. The series is concluded with a 3. Vaccination completed at 11 months of age, but no earlier than 6 months after the 2. Vaccination.
For premature infants, the STIKO recommends an additional vaccine dose at 3 months of age, for a total of 4 vaccine doses.
Hepatitis vaccination before bir.
pregnant women can transmit the hepatitis B virus to their child during birth. For children of mothers with chronic hepatitis B or unknown hepatitis B status, vaccination immediately after birth is strongly recommended to protect the child from the consequences of possible infection.
Active vaccination can also be combined
In active vaccination, the vaccine causes the body to produce antibodies. This vaccination also protects against hepatitis D infection. Vaccination protection lasts at least 10 years. Furthermore, there is still a combined hepatitis A and B vaccine that protects against B hepatitis and hepatitis A.
Passive vaccination against hepatitis B is advisable after contact with the pathogen
Passive vaccination against hepatitis B is advisable after a suspected hepatitis B infection, for example, after a needle stick injury of medical personnel or city sanitation workers. Antibodies against hepatitis B viruses are injected – if possible within the first 6 to 12 hours after the presumed infection. These help the body's defense system to fight invading hepatitis B viruses. In addition, the vaccination protection should be improved by an active vaccination against hepatitis B.
No connection between hepatitis B vaccination and MS
Especially in vaccine-critical publications it can be read repeatedly that the vaccination against hepatitis B can cause severe disease relapses in multiple sclerosis (MS). In fact, it happens that people with MS get a relapse after a vaccination. But this does not mean that this relapse is caused by the vaccination. Several studies have investigated the frequency of relapses in vaccinated and non-vaccinated MS patients. There were no striking differences in any of these studies. The conclusion: If an MS-flash falls in the time after a vaccination, then it concerns with high probability not a connection, but a coincidence.