HEPATITIS B ‘’THE SILENT KILLER’’

By: Zara Muhammad Ngubdo

Hepatitis B is a persistent life-threatening liver infection caused by the hepatitis B virus (HBV). It is one among the five categories of the deadly hepatitis virus which enclose A, C, D and E and is today, a global health problem that put individuals prompt to risks of death from cirrhosis and liver cancer. A recent report by the World Health Organisation exhibited that more than 686,000 people die every year owing to complications of hepatitis B, with cirrhosis and liver cancer.

The virus has grown to become a major disturbing health issue that is posing untold hardships among the global citizens. Geographically, the breakthrough and prevalence of hepatitis B virus is at intense capacity in the Sub-Saharan Africa and East Asia where 5-10% of the adults’ population are persistently infected. Also high rate of chronic infections in the Amazon and the eastern and central Europe had killed many with thousands of the populace vulnerable to it. In the Middle East and Sub-Continent however, an estimated 2-5% of the general population are chronically infected and less than 1% of the population of Western Europe and North America are infected with the virus.

Albeit the research conducted by the Centre for Disease Control and Prevention (CDC) revealed that almost 2, 000 to 4,000 people in the United States die every year due to complications cause by hepatitis B, other experiments carried by health experts and medical practitioners worldwide indicated that Hepatitis B virus can be acute or chronic.

Acute (HBV) infection is characterised by the presence of HBsAg and immunoglobulin M (igM) antibody to the core antigen, HBcAg. During the initial phase of infection, patients are also seropositive for hepatitis B e antigen (HBeAg). HBeAg is usually a maker of high levels of replication of the virus. The presence of HBeAg indicates that the blood and body fluids of the infected individual are highly contagious. Also, acute hepatitis causes symptoms to appear quickly in adults while children rarely develop acute hepatitis B.

However, most people do not experience any symptoms during acute infection phase, others have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. A small parcel of persons with acute hepatitis can develop acute liver failure which can lead to DEATH.

There is no specific treatment for acute hepatitis B. Therefore, care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhoea. The chronic (HBV) infection is characterised by the persistence of HBsAg for at least 6 months (with or without concurrent HBsAg). Persistence HBeAg is the principal maker of risk for developing chronic liver disease and liver cancer (hepatocellular carcinoma) later in life. Chronic hepatitis B develops slowly; symptoms may not be noticeable unless complications develop. Chronic (HBV) infection can be treated with drugs, including oral anti viral agents. Treatment can slow the progression of cirrhosis, reduce incidence of liver cancer and improve long term survival.

The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. The incubation of the hepatitis B virus is 75 days on average, but can vary from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B.

In highly endemic places, hepatitis B virus is commonly spread from mother to child at birth (prenatal transmission), or through horizontal transmission (exposure to infected blood), especially from an infected child to an un infected child during the first five years of life. The development of chronic infection is very common in infants infected from their mothers or before the age of five years.

Hepatitis B virus is also spread by percutaneous or mucosal exposure to infected blood and various body fluids, as well as saliva, menstrual, vaginal, and seminal fluids. Sexual transmission of hepatitis B can occur, particularly in un vaccinated men who have sex with men and heterosexual persons with multiple sex partners or contact with sex workers. Infection in adulthood leads to chronic hepatitis in less than 5% of cases.

Transmission of the virus may also occur through reuse of needles and syringes either in heath care centres or among persons who inject drugs. Furthermore, infection may occur during medical, surgical or dental procedures, through tattooing, or through the use of razors and similar objects that are contaminated with infected blood.

In preventing hepatitis, the hepatitis B vaccine is the mainstay of hepatitis B prevention. World Health Organisation (WHO) recommends that all infants should receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours. The birth dose should be followed by 2 or 3 doses to complete the primary series. In most cases, 1 of the following 2 options is considered appropriate: A 3-dose schedule of hepatitis B vaccine, with the first dose (monovalent) being given at birth and the second and third (monovalent or combined vaccine) given at the same time as the first and third doses of diphtheria, pertussis (whooping cough), and tetanus (DTP) vaccine; or

A 4-dose schedule, where a monovalent birth dose is followed by three monovalent or combined vaccine doses, usually given with other routine infant vaccines. The complete vaccine series induces protective antibody level in more than 95% of infants, children and young adults. Protection lasts at least 20 years and is probably lifelong. Thus, World Health Organisation (WHO) does not recommend booster vaccination for persons who have completed the 3 dose vaccination schedule. The vaccine has an excellent record of safety and effectiveness. Since 1982, over 1 billion doses of hepatitis B vaccine have been used worldwide. In many countries where between 8-15% of children used to become chronically infected with hepatitis B virus, vaccination has reduced the rate of chronic infection to less than 1% among immunised children.

All children and adolescents younger than 18years and not previously vaccinated should receive the vaccine in countries where there is low or intermediate endemicity. World Health Organisation (WHO) also organises world hepatitis day on July 28 every year to increase awareness and understanding of viral hepatitis. Thus it remain a collective responsibility of the governments of all federation, United Nations Organisations, private sectors, non governmental organisations, World Health Organisations, global citizens and other humanitarian agencies to establish a framework of taking majors of preventing persons from being infected with Hepatitis B virus.

Ngubdo is a 400 Level student of the Department of Mass Communication University of Maiduguri


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