HEPATITIS B

Prepared by: Jocel Florentino

Michelle Manalang
Jacqueline Casimero
Kaye Esplana
Hazel Mae Majadas
INTRODUCTION
Hepatitis B is one of the lives threatening liver infection. It is a major global health
problem. It can cause chronic infection and puts people at high risk of death from
cirrhosis and liver cancer, in highly endemic areas. Hepatitis B is most commonly
spread from mother to child birth (prenatal transmission). WHO estimated that in 2015,
257 million people were living with chronic hepatitis B infection (defined as Hepatitis B
antigen positive). Also in 2015, hepatitis B resulted in estimated 887,000 deaths, mostly
from cirrhosis and hepatocellular carcinoma (i.e primary liver cancer). As of 2016, 27
million people (10.5% of all people estimated to be living with hepatitis B) were aware of
their infection, while 4.5 million (16.7%) of the people diagnosed were on treatment.
Hepatitis B prevalence is highest in the WHO Western Pacific Region and the WHO
African Region, where 6.2% and 6.1% of the adult population is infected respectively. In
the WHO Eastern Mediterranean Region, the WHO South-East Asia Region and the
WHO European Region, an estimated 3.3%, 2.0% and 1.6% of the general population is
infected, respectively. And in the WHO Region of the Americas, 0.7% of the population
is infected. The likelihood that infection becomes chronic depends on the age at which a
person becomes infected. Children less than 6 years of age who become infected with
the hepatitis B virus are the most likely to develop chronic infections.

In infants and children:

 80–90% of infants infected during the first year of life develop chronic infections;
and
 30–50% of children infected before the age of 6 years develop chronic infections.

In adults:

 less than 5% of otherwise healthy persons who are infected as adults will
develop chronic infections; and
 20–30% of adults who are chronically infected will develop cirrhosis and/or liver
cancer.
INTERNATIONAL

i
National

Total population Percentage with Total Infected with

detected Hepatitis B Hepatitis B

7,300,00 16.7 1,219,000

Death 25%-30% 1,825,000-2,190,000

Not aware 90% 1,097,100

Liver Cirrhosis 50% 609500

Liver Cancer 70% 853,300

LOCAL
According to the World Health Organization and the Department of Health,
around one in 10 people have chronic hepatitis B, but due to lack of awareness, many
of those who have this viral disease may not even know they have it until it’s too late.
Hepatitis is a silent killer. Caused by a virus that has no symptoms, it quietly damages
the liver for decades before ending in liver cancer and cirrhosis (scarring of the liver that
reduces its ability to detoxify blood).

DEFINITION

It is a viral infection that attacks the liver and can cause both acute and chronic
diseases. The virus is most commonly transmitted from mother to child during birth and
delivery, as well as through contact with blood or other body fluids. The development of
chronic infection is very common in infants infected from their mothers or before the age
of 5. It also spread by needle stick injury, tattooing, piercing and exposure to infected
blood and body fluids, such as saliva and, menstrual, vaginal, and seminal fluids.
Sexual transmission of hepatitis b may occur, particularly in unvaccinated men who
have sex with men and heterosexual persons with multiple sex partners or contact with
sex workers.

Hepatitis B is a viral infection that causes liver inflammation and damage. Inflammation

is swelling that occurs when tissues of the body become injured or infected.
Inflammation can damage organs.

Invade normal cells in your body. Many viruses cause infections that can be spread
from person to person. The hepatitis B virus spreads through contact with an infected
person’s blood, semen, or other body fluids.
You can take steps to protect yourself from hepatitis B, including getting the hepatitis B
vaccine. If you have hepatitis B, you can take steps to prevent spreading hepatitis B to
others.
SIGNS AND SYMPTOMS

Signs and symptoms of HEPATITIS B range from mild to severe. They usually
appear about one to four months after you’ve been infected, although you could see
them as early as two weeks post-infection. Some people, usually young children, may
not have any symptoms.

Hepatitis B signs and symptoms may include:

Abdominal pain
Dark urine
Fever
Joint pain
Loss of appetite
Gray or clay-colored of the stool
Nausea and vomiting
Weakness and fatigue
Yellowing of skin and the white of the eyes (Jaundice)

Infants and children younger than age 5 typically don’t have symptoms of acute
hepatitis B. If you have chronic hepatitis B, you may not have symptoms until
complications develop, which could be decades after you were infected. For this
reason, hepatitis B screening is important, even if you have no symptoms.

If you have ever had hepatitis B, certain medicines may cause the hepatitis B virus to
begin damaging your liver and causing symptoms

DIAGNOSIS AND LABORATORY PROCEDURES

The doctors diagnose hepatitis B based on your medical and family history, and also will
examine you and look for the signs of liver damage, such as yellowing skin or belly pain.
Tests that can help diagnose hepatitis B or its complications are:
 Blood test. Blood test can detect signs of the hepatitis B virus in your body and
tell your doctor whether it’s acute or chronic. A simple blood test can also
determine if you’re immune to the condition.
 Liver ultrasound. A special ultrasound called transient elastography can show the
amount of liver damage.
  Liver Biopsy. The doctor might remove a small amount of liver for testing to
check for the liver damage. During this test, the doctor will insert a thin needle
through the skin and into the liver and remove a tissue sample for laboratory
analysis.

BRIEF ANATOMY AND PHYSIOLOGY OF AFFECTED PART

Hepatitis B virus (HBV) is a common human pathogen that causes extensive

morbidity and mortality in human population throughout the world. Although the virus
has been identified in extrahepatic tissues such as vascular endothelium, bile duct
epithelium, bone marrow, and peripheral blood lymphocytes (Blum et al. 1993), the liver
is the major and most important site of infection. It is the disruption of the normal
anatomy and functions of the liver that leads to asset of clinically and pathologically
defined acute and chronic diseases, including acute and chronic hepatitis B and
cirrhosis. Chronic infection with HBV is also associated with the development of
hepatocellular carcinoma, particularly in the setting of cirrhotic liver. Chronic hepatitis B
is a long-lasting infection. Chronic hepatitis B occurs when your body isn’t able to fight
off the virus and the virus does not go away. Your chances of developing chronic
hepatitis B are greater if you are infected with the virus as a young child. About 90
percent of infants infected with hepatitis B develop a chronic infection. About 25 to 50
percent of children infected between the ages of 1 and 5 years develop chronic
infections. However, among people infected during adulthood, only about 5 percent
develop chronic hepatitis B.

None of these diseases is specific to HBV infection: each can be caused by other
infectious and hepatotoxic agents.

PATHPHYSIOLOGY

The pathophysiology of how HBV replicates at the cellular level is complex.

Some researchers spend their entire career studying how the virus lives, replicates and
persists in the hepatocytes of the liver. For our purposes, describing the basics of
transmission and replication will aid you in understanding how the illness progresses
and why treatment modalities are often unsuccessful at controlling the disease. The
hepatitis B virus is constructed of an outer capsule containing HBsAg (hepatitis B
surface antigen), an inner core containing HBcAg (HBV core antigen), and the HBeAg
(hepatitis Beantigen). As the blood becomes exposed to HBV, the body mounts a cell-
mediated immune response by sending cytotoxic T cells and natural killer cells to the
virus and release inflammatory cytokines. The greater the immune response, the
greater the chance of fighting the virus. As the hepatocytes are attacked and infiltrated
by the HBV, they appear to have a “ground glass” look under histological exam due to
the HBsAg infiltrating the cell’s cytoplasm – this is a differentiator for HBV versus other
forms of hepatitis. Because hepatocytes are continually proliferating, the virus is
constantly being shed into the blood which contributes to chronic infection.

TREATMENT

Treatment to Prevent Hepatitis B Infection After Exposure

If you know you’ve been exposed to the hepatitis B virus and aren’t sure if you’ve
been vaccinated, call your doctor immediately. An injection of immunoglobulin given
within 12 hours of exposure to the virus may help protect you from getting sick with
hepatitis B. Because this treatment only provides short0term protection, you should get
the hepatitis B vaccine at the same time, if you never received it.

Treatment for Acute Hepatitis B infection

If you doctor determines your hepatitis B infection is acute meaning it is shirt-live

and will go away on its own, you may not need treatment. Instead, you doctor might
recommend rest, proper nutrition and plenty of fluids while your body fights the infection.
In severe cases, antiviral drugs or a hospital stay is needed to prevent complication
Treatment for Chronic Hepatitis B Infection

Most people diagnosed with chronic hepatitis B infection need treatment for the
rest of their lives. Treatment helps reduce the risk of liver disease and prevents you
from passing the infection. Antiviral medication , several antiviral medications are
entecavir (baraclude), tenofovir (vired) Lamivudine(epivir), adefovir(Hepsera) these can
help fight the virus and slow its ability to damage your liver. These drugs are taken by
mouth. Interferon injection or interferon alfa-2b(intron A) is a man-made version of a
substance produced by the body to fight the infection. It is used mainly for the young
people with hepatitis B who wish to avoid the long –term treatment or woman who
might want to get pregnant within a few years, after completing a finite course of
therapy. Interferon should be used during preganacy. Liver transplant, if you’re liver has
been severely damaged, it may be an option. During the transplant, the surgeon
removes your damaged liver and replaced it with the liver.

PROGNOSIS

Morbidity and mortality are linked to development of cirrhosis and hepatocellular

carcinoma. Survival is reasonably good (about 85% probability at 5 years) in
compensated cirrhosis but very poor in decompensated cirrhosis. Both cirrhotic and
non-cirrhotic patients with sustained reduction of HBV replication and normalization of
aminotransferase after interferon alfa therapy have a reduced risk for liver-related
complications. Once liver cancer has been diagnosed, its stage is then determined to
indicate how far cancer has progressed. Some tumors that are localized, or found in in a
confined area of the liver, may be completely removed, as the resultant loss of
remaining liver function would be fatal. Advanced cancer has either invaded a large
portion of the liver or spread to distant tissues in the body. Whereas survivability of
most cancers is expressed in term of five-year survival rate, the rapid course of this
disease following appearance of symptoms has resulted in use of a three-year survival
rate. This rate is fairly high if the cancer is localized and can be removed by surgery. If
the cancer is localized but inoperable, the rate is lower, and in more advanced stage of
the liver cancer the three-year survival is low. Unfortunately, overall survival from liver
cancer is lower that for many other types of cancer because it is not usually detected in
its early stages.
Recommendation to the Public
The researcher recommends that each of us must live our life into healthy lifestyle because
our health is our wealth. This is just one of the communicable diseases that if you will get infected, it
either stays with you for a bit or for a life time.

References

https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-b
National institute of diabetes and digestive and kidney disease.
https://lms.rn.com/getpdf.php/2128.pdf
Pathophysiology of HBV. Image courtesy of the New England Journal of Medicine
(2004)
ncbi.nlm.nih.gov/pubmed/12616450
New PubMed, Semin Liver Dis. 2003 Feb;23(1):47-58.
Gartrointestinal Section, Dept of Medicine of Pennsylvania Philadelphia USA
Division of Population, Science Fox Chase Cancer Center Philadelphia, USA
www.who.int @2020 WHO’S publications