Hepatitis B

Liver cell inflammation and damage caused by the hepatitis B virus are defined as hepatitis B disease. The carriage rate in our country is between 3% and 7%.

How is Hepatits B Transmitted ?

  • It is transmitted from person to person through bodily fluids.
  • Blood, Blood Products: Blood transmission occurs especially in developed countries when people who use illegal drugs intravenously spread the needles they use to other people somehow. In addition, the use of items used by these people by other people also increases transmission. However, needle transmission is vital for medical professionals, a reasonably high-risk group for hepatitis B worldwide. Medical professionals working in various medical departments are infected with hepatitis B, especially with an accidental injection of needles. Additionally, medical professionals can get hepatitis B if they are accidentally injured or come into contact with an object contaminated with the blood of sick people. There is a risk of developing this disease for the ordinary population and medical professionals due to blood transfusions. Developed countries have solved this problem by screening during blood transfusions. This type of transmission has therefore disappeared.
  • Sexual Intercourse: During sexual intercourse, the body fluids of a person infected with hepatitis B come into contact with the other partner’s vagina, rectum (especially inverse intercourse), the urinary canal (ureters), and injured or scratched areas in the mouth.
    • Tattoos and Piercings: In our country and all over the world, the needles used during tattooing and piercing are not sufficiently sterile and clean.
    • Shaving Kit, Razor, and Toothbrush: Hepatitis B can be transmitted by using razors, razors, and toothbrushes contaminated with blood and used by sick people.
    • Perinatal Transition: (Transition during Pregnancy): A condition caused by the transmission of hepatitis B from mother to child during childbirth is defined as a perinatal transition.

    The Incubation Period of Hepatitis B:

    In this disease, which usually has an incubation period ranging from 45-180 days, on average, 60-90 days is the incubation period required for the disease to occur in large part of the population. During the incubation period, especially body fluids are highly contagious. The disease is highly contagious until the formation of antibodies to hepatitis B in the body (protein-based preservatives created by the body against microbes).

    Is Dried Blood and Saliva an Infectious Risk Factör for Hepatitis B?

    YES…Blood and saliva that remain dry even for a week are enough to transmit hepatitis. Therefore, it is necessary to be very careful.

    Do Chronic Hepatitis B Patients Transmit The Disease?

    YES…There is a risk of transmission of the disease, especially for people who live with chronic hepatitis B carriers and whose sex partners are chronic hepatitis B carriers.

    Symptoms of Hepatitis B:

    Newborn infants do not show any apparent signs of hepatitis B. Advancing age is directly proportional to the onset of symptoms. Studies have shown that symptoms increase with age. The symptoms of hepatitis B are as follows:

    • Extreme fatigue in the body
    • Slight fever
    • Headache
    • Loss of appetite
    • Nausea, vomiting
    • Pain and tenderness, especially on the liver area. This pain increases with shaking and bending.
    • Constipation or diarrhea
    • Pain in muscles and joints
    • Skin rash
    • Over 5 years of age and 40% of adults may develop jaundice. Jaundice can also be seen in 10% of babies, on the other hand.

    On the other hand, some patients do not know they have hepatitis B until they donate blood or their physician accidentally orders a screening test for hepatitis B. It is possible for hepatitis to pass without symptoms or not be understood in some cases. The above symptoms can also be seen in any flu infection. However, special attention should be paid to symptoms such as pain and jaundice on the liver area. Unvaccinated individuals need to understand whether they have had the disease, mainly by screening tests. If the results are negative, they should be vaccinated, and if positive, they should be under surveillance for life. Because hepatitis B is an insidious disease that can cause cirrhosis and liver cancer. In some cases of liver cancer or sudden cirrhosis, it is determined later that the hepatitis B virus is involved. These patients are unaware of hepatitis B until this diagnosis is made.

    What Happens in The Body After Taking The Hepatitis B Virüs?

    After receiving the hepatitis B virus, most patients feel fine within 4-8 weeks with the formation of antibodies. Especially in elderly patients, the symptoms may be more severe. And, sometimes, the symptoms may be prolonged in these patients.

    In a small number of patients, the hepatitis B virus is detected in the patient’s blood and liver. These patients are chronic hepatitis B patients. In these patients, an increase in liver enzyme tests may be observed. Or, these patients live with the chronic form for years without showing any symptoms. However, as highlighted before, the household members and sex partners carry a significant risk of transmission of the disease.

    What Are The Negative Result That May Occur With The Hepatitis B Virüs?

    • Cirrhosis (It is chronic and progressive liver inflammation. It may cause death. The average life expectancy of the patient is 38-40 months.)
    • Liver cancer
    • Liver failure
    • It is a type of fatal disease called fulminant hepatitis that causes liver failure quickly (in a month, for instance).
    • Hepatitis D

    What Are The Risk Factörs For Hepatitis B?

    • Having a sexual partner who is a carrier of hepatitis B
    • Polygamy
    • Having another sexually transmitted disease
    • Sharing items such as forks, spoons, knives, razors, razors with patients with hepatitis B
    • Intravenous drug use
    • Profession (doctors, nurses, dentists, laboratory and blood center workers engaged in blood and blood products)
    • Living in countries with a high risk of hepatitis B virus for more than 6 months (China, Africa, the center and north-east of the Asian continent, the Middle East, Eastern Europe )
    • Sharing the same room with a person who has hepatitis B virus for a long time for various reasons (dormitory, prison, etc.)
    • Being homosexual or bisexual
    • Getting tattoos or piercings and working in dirty and unhygienic places
    • Shaving in barbers with poor hygienic conditions
    • Infection with the hepatitis B virus in the mother is always a risk factor for a neonatal. However, the disease will not be caught if the hepatitis B vaccine and the hepatitis B protective immunoglobin (protective serum) are injected as soon as the child is born.
    • Being bitten by a person with hepatitis B
    • Suffering from hemophilia or dialysis (These people are at an extremely high risk of hepatitis B since they are in a group where it is necessary to take blood or constantly clean the blood.)

    Can Hepatitis B Be Transmitted Through Kissing?

    NO. Hepatitis B cannot be transmitted through kissing. It is essential to be aware of this issue as Turkish people have a nature that frequently kisses as a society.

    When Should I See a Doctor for Hepatitis B?

    If you have risk factors and symptoms related to hepatitis B, as listed above, immediately consult your doctor for tests related to hepatitis. Moreover, in 35% of hepatitis B cases, the disease should be detected without any risk factors, everyone who has not been vaccinated should apply to their physician for tests, if the tests are negative, they should be vaccinated, and if positive, they should be monitored at regular intervals. Because hepatitis B is a dangerous disease in terms of chronic consequences. This disease, which can lead to severe and fatal outcomes such as liver failure, cirrhosis, and liver cancer, can face societies, families, and individuals with very dramatic results.

    Important Note 1: If anyone with whom you share the same place or house has a newly detected hepatitis B disease, immediately apply to your doctor for testing and protection.

    Important Note 2: Whether you are a woman or a man, if you have any doubts, especially after unprotected sexual intercourse, immediately apply to your doctor for testing and protection.

    Important Note 3: If you have been bitten by someone you think has hepatitis B, immediately apply to your doctor for testing and prevention.

    Important Note 4: If your profession is in the risk group (medical professionals such as doctors, nurses, dentists, laboratory and blood center workers dealing with blood and blood products), immediately apply to your doctor for testing and protection.

    I Suspected The Above-Mentioned Conditions and Consulted a Doctor. My Test Results are Negative. What Happens Next?

    There is no luxury to wait when you consult your doctor about the possibility of being exposed to hepatitis B (for instance, you had sexual intercourse with someone you think has hepatitis B, or you were bitten, or someone you live in the same place has just been diagnosed with hepatitis B disease.) Your doctor should immediately give you hepatitis B immune globulin (protective serum) and a hepatitis B vaccine that will last for three doses.

    How Long After Sexual Intercourse Can I Have Hepatitis B Immune Globulin (Protective Serum)?

    After suspected sexual intercourse, you should have hepatitis B immune globulin in the first two weeks. If you pass this period, hepatitis B immune globulin (protective serum) will not have a protective effect. Moreover, in the first two weeks, you should be included in a 3-dose vaccination program in addition to this serum.

    Progress of The Disease:

    Hepatitis B disease is a disease that has an acute and chronic progress. In its acute form, the disease can heal without being felt, or it can heal with mild symptoms with a course that continues for a few weeks. This process can usually be defined as 4-8 weeks. However, if the disease is detected in the blood and liver of a person for more than six months, it means that it has become chronic. The chronicity of the disease is a condition that should be followed in terms of its consequences. Because chronic hepatitis B disease can cause cirrhosis or liver cancer. Here we should emphasize the following point to our readers. We cannot say that all forms of chronic hepatitis B cause cirrhosis or liver cancer. However, it can lead to. Children seem to be in a higher risk group in terms of the possibility of becoming chronic in the progress of the disease. Because hepatitis B, which is transmitted to the neonatal during birth, has a 90% probability of becoming chronic. Hepatitis between 1-5 years of age has a 30% probability of becoming chronic. After the age of 5, this figure decreases to 7%.

    Hepatitis B and Blood Tests:

    When you apply to your doctor, if there is a suspicion of hepatitis B, considering both the physical examination and the reason for your application, your doctor will order blood tests related to hepatitis B. These tests are in three main groups:

    • Hepatitis B DNA: Genes of hepatitis B virus. It is defined as HBV DNA.
    • Hepatitis B antigens: Structural proteins of the hepatitis B virus that occur in the blood.
    • Hepatitis B antibodies: Protein-based preservatives produced by the body to protect against hepatitis B.

    These tests are briefly:

    • Hbs-Ag: Hepatitis B surface antigen
    • Anti-Hbs: Protective protein produced by the body against hepatitis B surface antigen
    • Hbe-Ag: One of the hepatitis B antigens is called the “early” antigen
    • Anti-Hbe: Protective protein produced by the body to neutralize the hepatitis B Hbe-Ag antigen
    • Anti-Hbc Ig-M: Hepatitis B “core” antigen (comes out at an early stage)
    • Anti-Hbc Ig-G: Hepatitis B “core” antigen (comes out at a late stage)
    • HBV-DNA: Hepatitis B genetic DNA material (in serum)

    Detailed Information About These Tests:

    Hepatitis B surface antigen (HBsAg):  A person with a positive test can transmit hepatitis B to those around him/her. If this antigen remains positive in a person’s blood for more than six months, it is a chronic hepatitis B infection.

    Hepatitis B e antigen (HBeAg): A positive antigen indicates that the person is highly contagious. In people with chronic hepatitis B infection, high levels of this antigen indicate an increased risk of liver disease in these individuals and should be considered for treatment.

    Hepatitis B core antibody (anti-HBc): This antibody is positive in all patients with HBsAg positive. All people infected with hepatitis B once or more have this antibody positive.

    Hepatitis B core antigen IgM type Antibody (IgM anti-HBc): IgM anti-HBc positivity, whether associated with HbsAg or not, indicates available hepatitis B infection or experienced hepatitis B infection in the last 6 months. The presence of this antibody when HbsAg is negative indicates acute or recent hepatitis B infection.

    Hepatitis B core antigen IgG type Antibody (IgG anti-HBc): It is an antibody that indicates hepatitis B infection. However, it does not reveal precise data on the process of the disease.

    Hepatitis B surface antibody (anti-HBs): This antibody appears in the period between the onset of hepatitis B and its resolution. It becomes positive in people who have been vaccinated against hepatitis B. And it shows protectiveness.

    Hepatitis B e antibody (anti-HBe): This antibody appears within weeks and months, and then disappears.

    Hepatitis B genetic DNA (HBV DNA): The most sensitive test is the detection of hepatitis B DNA (a genetic substance). It is an indicator of active infection.

    What Tests Are Required to Determine The Mode of Monitoring and Treatment of Patients With Chronic Hepatitis B?

    • Tomography
    • MRI
    • Abdominal ultrasonography
    • Liver biopsy (removal of pieces from the liver)

    Especially in developed western countries, HBsAg (Hepatitis B surface antigen) screening is routinely performed and recommended during pregnancy. We recommend that pregnant women in our country have an HBsAg screening test and that pregnant women who are not in the risky group should repeat this test in the later stages of pregnancy. For more information, please discuss this with your doctor.

    Is It Required To Have a Screening Test For Hepatitis B? Or Is There Any Harm In Getting Vaccinated Without Having a Screening Test?

    According to publications in developed western countries, getting a hepatitis B vaccine without a screening test is cheaper and more inconvenient. The answer of scientists to the question of “would it be harmful if a person with a previous hepatitis B infection gets vaccinated without a screening test?” is that there is no harm. The person may have contracted hepatitis B without realizing it. Screening provides information about the status of an existing hepatitis B disease. This is important in terms of the further treatment of the person and monitoring chronic problems that may occur with hepatitis B.

    What Tests Should I Take To Get The Hepatitis B Vaccine?

    • HBsAg
    • Anti-HBs

    Hepatitis B vaccine should be given when both tests above are negative.

    To remind briefly, a POSITIVE HBsAg indicates a new or past disease, while a POSITIVE anti-HBs indicates immunity against the disease. If the person has been vaccinated or has encountered the disease, his/her anti-HBs is POSITIVE. In addition, if a new infection with the hepatitis B virus is suspected, these tests may not give immediate results. For this reason, HBV DNA is the most sensitive test to look for in case of suspicion of a new infection. In addition, HBsAg and Anti-Hbc IgM should also be checked. Based on these results, protective serum (hepatitis B protective immunoglobin) and vaccine should be administered.

    Some Preventive Measures Against Hepatitis B

    • The use of condoms during sexual intercourse
    • Proper storage and disposal of injector needles (Especially medical waste should be considered.)
    • Use of latex or plastic gloves by persons dealing with blood and blood products
    • Use of clean toothbrushes and razors and prevention of shared usage of them with other people (Especially barbers should pay attention to hygiene. It is necessary to pay attention to the cleanliness of the tools in the places related to cosmetics, such as hairdressers, barbers, manicure-pedicure saloons.
    • Prevention of drug use and organization of social training for users

    Hepatitis B Vaccine:

    Hepatitis B vaccine is a vaccine that requires three doses. At the end of these three doses, it provides 95% protection.

    Newborn babies, all adults, drug users, people who have had multiple sex partners in the last six months, those with a sexually transmitted disease, homosexuals, bisexuals, hemophiliacs, dialysis patients, all healthcare workers, prison workers, prison inmates, disabled nursing home staff, people traveling to areas at risk for hepatitis B should get hepatitis B vaccine immediately.

    Can It be Determined Wheter Immunity To Hepatitis B Has Been Formed After Vaccination? Who Needs These Determinations?

    YES…Your doctor may order tests to see if there is a response to the vaccine, called antibody titer. This is not a routine practice. We have already mentioned that the vaccine is 95% effective. However, tests showing the vaccine effectiveness rate may be requested for some risky groups. Medical professionals, people who have a sexual partner with chronic hepatitis B infection, and people with severe changes in the body defense system may be asked to test whether the vaccine works. In addition, if you believe that you are not immune after hepatitis B vaccination, discuss it with your doctor. If necessary, you can test whether the vaccine creates immunity with tests.

    Reference: http://www.hepatit.org/hepatitB.html