Hepatitis B is a dangerous viral infection that causes inflammation in the liver. Many people have an acute (“short-term”) hepatitis B infection, and the body can clear the virus on its own. However, this may take up to 6 months. Some people will develop chronic (“long-term”) hepatitis B, which can increase the risk of liver failure, cirrhosis (permanent scarring of the liver), and even liver cancer. Children who get hepatitis B are at a higher risk of developing a chronic infection. The hepatitis B virus is spread through blood and bodily fluids and can be contracted through sexual contact, sharing needles, razors, or toothbrushes, contact with the open wound of someone who is infected, accidental sticks from an infected sharp object such as a needle or knife, and through childbirth (passed from mother to child). The virus can live on surfaces for up to a week. So, for example, if you are stuck with a needle containing the dried blood of someone with hepatitis B (even an amount so small you can’t see), you could still become infected. It is unlikely that you could get the virus from someone coughing or sneezing on you or from sharing eating utensils or food.
Symptoms of hepatitis B infection include stomach pain, nausea and vomiting, fever, loss of appetite, joint pain, tiredness, weakness, jaundice (yellowing of the skin and whites of the eyes), dark urine, pale faeces, and swelling/fluid in the belly and arms/legs. Not all infected people will have these symptoms. However, the disease is still contagious. Treatment for hepatitis B infection may be different depending on whether the infection is chronic or acute. Acute hepatitis B treatment includes rest, fluids and nutrition, symptom management, and monitoring by a healthcare provider for signs of liver damage Chronic hepatitis B treatment may need antiviral medication, immune system boosting medication, and in severe cases, a liver transplant may be required. There is no cure for hepatitis B. If the body does not clear the virus on its own and chronic infection develops, medications can help to decrease symptoms, prevent liver failure, and decrease the likelihood of spreading the virus.
You must take medications with care and caution if you have hepatitis B because many are processed through the liver and can cause extra stress on your already inflamed liver. You will need to discuss any medications you are taking with your doctor and/or pharmacist, including OTC and herbal/dietary supplements. You may need to temporarily discontinue some medications or take a different dose to allow your liver time to rest and heal. You should also avoid drinking alcohol because it can damage the liver. Chronic hepatitis B may require permanently discontinuing alcohol and certain medications.
Rehydration is important to replace the loss of fluids/body water due to fever, vomiting, and decreased oral intake in patients with acute hepatitis B. Oral rehydration solutions that contain electrolytes/salts (ex.-potassium, magnesium, sodium) are available. Water alone may not be the best method of rehydration, because vomiting causes a loss of electrolytes, which are necessary for many body processes. It is important to use clean or bottled water and follow the instructions carefully when mixing powdered oral rehydration solutions. In severe cases of dehydration, intravenous (IV) fluids may be administered at a healthcare facility. These include 0.9% sodium chloride solution (normal saline/NS), 5% dextrose in water (D5W), and lactated ringers solution (LR). Electrolytes may be added to these IV solutions.
Pain/Fever Reducers, also called “analgesics” or “antipyretics,” can be used to help make patients with Hepatitis B more comfortable, treating symptoms such as fever and abdominal pain. Examples include acetaminophen, aspirin, and ibuprofen. Acetaminophen works by stopping pain signals and stimulating the brain to cause temperature regulation. Ibuprofen and aspirin are NSAIDs (non-steroidal anti-inflammatory drugs) that treat pain and fever by decreasing inflammation in the body. Aspirin should NOT be given to children under 16 years old due to a serious potential reaction called Reye’s Syndrome. Opioid pain medications may be used for severe pain. Examples include morphine, hydrocodone, meperidine, oxycodone, and hydromorphone. It is important that these medications, especially acetaminophen, are taken at the lowest possible dose that brings symptom relief to minimize stress on the liver (recommended max daily dose of acetaminophen is 3-4 grams, or 3000-4000 mg, per day)
Antiviral Medications are usually not needed for acute cases of hepatitis B but will be used in some patients who cannot clear the virus on their own and develop chronic hepatitis B. Antivirals help the body fight the virus, help to slow/prevent liver damage from the virus, and can help decrease the risk of passing hepatitis B to another person, but they do not cure the disease. They work by slowing down the virus’s growth/reproduction in the body. Most hepatitis B antivirals are oral medications that are taken long-term, sometimes for life. Examples are tenofovir, entecavir, lamivudine, telbivudine, and adefovir dipivoxil.
Interferon Injections are man-made proteins like the ones your body makes to fight infection and inflammation. These are given daily or weekly to help your body fight the hepatitis B virus and to treat inflammation in the liver. They are usually given for 6 months to one year. Examples are pegylated interferon (peginterferon) and interferon alpha.
Hepatitis B Vaccine may be given to people who are exposed to hepatitis B to help prevent infection. The vaccine works by injecting an inactivated form of the virus into the body, which stimulates the immune system to recognize and fight the virus. The vaccine should be received within 24 hours of known exposure if possible.
Hepatitis B Immune Globulin is an injection containing antibodies that can help the immune system fight off possible infection if you are exposed to hepatitis B. This is only short-term protection against infection, so the hepatitis B vaccine should be given at the same time for long-term protection.
Common side effects that you may experience while taking these medications include nausea, diarrhoea, constipation, dizziness, drowsiness, headache, fever, body aches, and irritation at the injection site. A reaction to the hepatitis A vaccine that includes aches, fever, or injection site reactions can be a sign that the vaccine has caused the desired immune response.
Rarely, an allergic reaction to a medication or vaccine can occur. If you experience a rash accompanied by swelling, hives, shortness of breath, and nausea/vomiting, you should seek medical attention.
Kidney Damage is a possible side effect of a few of the hepatitis B antivirals. It is important that you follow up with your doctor regularly and have routine bloodwork done, which can usually detect a change in kidney function before you experience symptoms. If you experience decreased urine (pee) output, or if your urine is dark in colour, you should contact a healthcare provider right away.
Hepatitis B is relatively common in South Africa. However, the hepatitis B vaccine has been part of the childhood vaccine programme in South Africa since 1995. It is a 2-3 shot series. The vaccine is recommended for all babies soon after birth since hepatitis B can be transmitted from mother to child during childbirth. If a mother is known to have hepatitis B infection, the baby should also receive hepatitis B immune globulin. If you were born before 1995, you should discuss receiving the vaccine with your healthcare provider. Other important ways to prevent hepatitis B include practicing safe sex (always using a condom), avoiding shared needles/drug use, using gloves when cleaning up the blood/body fluids of others, ensuring the proper sterilization/cleaning of needles/instruments used for tattoos, piercings, or medical procedures, disposing of needles properly (in a hard, closed container), avoiding sharing toothbrushes, razors, and nail care tools (clippers, etc.). It is recommended that when cleaning blood, you use a solution of 1 part bleach to 10 parts clean water. You should discuss your risk of getting hepatitis B with your healthcare provider and consider getting screened (tested).