What is Hepatitis B?
Hepatitis B is a liver disease caused by the Hepatitis B virus (HBV). The virus infects liver cells, causing inflammation that can lead to serious and potentially life-threatening liver disease. In many cases, the infection progresses slowly and silently, gradually damaging the liver over time.
Hepatitis B is the leading cause of liver cancer and remains one of the leading causes of death worldwide.
Long-term HBV infection can result in:
Hepatitis
Liver inflammation
Liver fibrosis
Scarring of the liver
Liver cirrhosis
Severe liver scarring
Liver cancer
Hepatocellular carcinoma
Liver failure
Why is Hepatitis B Called the "Silent Killer"?
Hepatitis B is often referred to as the "Silent Killer" because most infected individuals do not experience noticeable symptoms, especially during the early stages of infection.
Cleared within a few months
Some people naturally clear the virus within a few months through their body's immune response. This is known as acute Hepatitis B infection.
Virus remains for more than six months
However, if the virus remains in the bloodstream for more than six months, the infection is considered chronic Hepatitis B.
After entering the body, HBV multiplies rapidly until the immune system produces antibodies against it. While most healthy adults successfully eliminate the virus, some people are unable to do so and become lifelong carriers. The likelihood of developing chronic infection is closely related to the age at which the infection occurs.
Risk of Chronic Hepatitis B by Age
According to the World Health Organization (WHO):
90% of infected newborns develop chronic Hepatitis B.
50% of infected children aged 1–5 years develop chronic infection.
5–10% of infected healthy adults develop chronic infection.
Global Burden of Hepatitis B
According to the World Health Organization (WHO):
Approximately 254 million people worldwide are living with chronic Hepatitis B.
Around 1.2 million new infections occur every year.
Nearly 1.1 million people die annually from Hepatitis B-related liver cirrhosis and liver cancer.
In Bangladesh, it is estimated that around 4% of the population are Hepatitis B carriers, although the exact prevalence is not yet known. Many of these individuals develop chronic liver disease and its complications.
Pregnant women infected with Hepatitis B have a high risk of transmitting the virus to their newborns during childbirth.
It is important to remember that Hepatitis B is significantly more infectious than HIV (the virus that causes AIDS).
Signs and Symptoms
Most people with Hepatitis B do not experience symptoms, and the infection is often detected only through blood testing.
How is Hepatitis B Transmitted?
Hepatitis B is a highly contagious virus that spreads through contact with infected blood and certain body fluids, including vaginal secretions.
Common routes of transmission include:
- From an infected mother to her baby during childbirth
- Transfusion of infected blood or blood products
- Sharing contaminated needles or syringes, particularly among people who inject drugs
- Ear or nose piercing and tattooing using unsterilized needles
- Medical or dental procedures performed with improperly sterilized instruments
- Sharing personal items contaminated with blood, such as:
- Toothbrushes
- Razors
- Shaving blades
- Unprotected sexual contact with an infected person
Can Hepatitis B Spread Through Social Contact?
No. Hepatitis B does not spread through casual social contact.
Does NOT spread through casual social contact, such as:
- Handshakes
- Hugging
- Sharing meals
- Using the same glasses, cups, plates, spoons, or clothing
The virus is not transmitted through these everyday interactions.
However, Hepatitis B CAN spread through items contaminated with infected blood, including:
- Razors
- Blades
- Shaving equipment
- Toothbrushes
- Needles and syringes
Who Is at Risk of Hepatitis B Infection?
The following groups are at increased risk of Hepatitis B infection:
Newborn babies born to mothers infected with Hepatitis B.
People who inject drugs and share needles or syringes.
Household members and sexual partners of individuals with Hepatitis B.
Healthcare professionals who are frequently exposed to blood, including:
How Can Hepatitis B Be Prevented?
The Hepatitis B virus is highly infectious and can survive in dried blood outside the body for up to two weeks.
The most effective way to prevent Hepatitis B infection is vaccination.
Additional preventive measures include:
- Avoid direct contact with infected blood and other body fluids, including vaginal secretions.
- Ensure that all donated blood and blood products are properly screened before transfusion.
- Never share razors, blades, toothbrushes, needles, or other sharp instruments.
- Use only new or properly sterilized blades and shaving equipment at barbershops and salons.
- Practice safe sex and avoid exposure to infected body fluids.
Hepatitis B During Pregnancy
A mother infected with hepatitis B can transmit the virus to her baby during childbirth. Since infection at birth carries a very high risk of developing lifelong chronic hepatitis B, preventing mother-to-child transmission is a major public health priority.
Screening During Pregnancy
Because effective vaccines and preventive treatments are available, every pregnant woman should be screened for hepatitis B during pregnancy.
- HBeAg testing
- HBV DNA (viral load) testing
- Liver Function Tests (LFTs)
She should then receive appropriate care and treatment under the supervision of a liver specialist.
Protecting the Family
If a pregnant woman is hepatitis B positive, her healthcare provider will take measures to prevent transmission to the newborn.
Family members should also be tested for hepatitis B, and those who are not infected should receive the hepatitis B vaccine.
To effectively prevent transmission:
- The newborn should receive the birth dose of the hepatitis B vaccine within 24 hours of birth.
- When indicated, Hepatitis B Immunoglobulin (HBIG) should also be administered within the same time frame.
When these preventive measures are followed correctly, the risk of mother-to-child transmission can be reduced dramatically.
Remember: Mother-to-child transmission during pregnancy and childbirth remains one of the most common routes of hepatitis B infection worldwide. Early screening, appropriate treatment, and timely newborn vaccination are the most effective strategies for preventing lifelong hepatitis B infection.
Hepatitis B Vaccination
Hepatitis B can be effectively prevented through vaccination.
Important: Individuals should undergo Hepatitis B screening before vaccination. Vaccinating someone who is already infected does not provide any additional benefit.
Recommended Vaccination Schedule
According to the World Health Organization (WHO), the vaccine may be administered using either of the following schedules:
If an adequate antibody response is not achieved, an additional booster dose should be given after the third dose.
Vaccine Effectiveness
The Hepatitis B vaccine produces a protective immune response in approximately 85–100% of healthy individuals.
An Anti-HBs antibody test should be performed 1–3 months after completing the vaccination series to measure immunity.
Excellent protection
Adequate protection
Inadequate protection; an additional booster dose is recommended.
Hepatitis B Management
Learning that you have been infected with the hepatitis B virus through a blood test is understandably concerning. However, with regular medical follow-up, appropriate treatment when needed, and adherence to your doctor's advice, most people with chronic hepatitis B can live long, healthy, and productive lives.
The management of hepatitis B continues to improve as medical science advances. It is important to receive care based on the latest evidence and treatment guidelines. Regular monitoring helps assess the health of your liver and detect complications early. Common investigations include:
- Liver Function Tests (LFTs)
- Liver ultrasonography (Ultrasound)
- FibroScan (to assess liver fibrosis)
- Liver biopsy (in selected cases)
If liver cancer is suspected, your doctor may recommend additional imaging tests such as an abdominal ultrasound or CT scan.
Protect Your Liver
Although hepatitis B may or may not cause significant liver damage, preventing additional liver injury is essential. Many substances that enter the body through food, breathing, or the skin are processed by the liver. Therefore, individuals with chronic hepatitis B should take extra care to protect their liver by following these recommendations:
- Avoid alcohol and smoking.
- Get tested for hepatitis A and hepatitis E.
- Receive the hepatitis A vaccine if you are not already immune.
- Maintain a healthy body weight.
- Follow a balanced, nutritious diet and avoid excessive fatty foods, which can contribute to fatty liver disease.
- Take care of other medical conditions and have regular health check-ups.
- Attend regular follow-up visits with your liver specialist.
Remember, early detection and timely management of liver damage or liver cancer significantly improve treatment outcomes.
Treatment of Hepatitis B
Most people with acute hepatitis B do not require specific antiviral treatment. Supportive care, including adequate rest, is usually sufficient while the body clears the infection. Common symptoms during the acute phase may include:
- Jaundice
- Nausea
- Vomiting
- Fatigue and weakness
A small number of people develop fulminant hepatitis, a rare but life-threatening form of acute hepatitis B that requires immediate hospitalization and specialized medical care.
In most cases, acute hepatitis B resolves completely within six months. Once the virus is cleared, the individual develops natural immunity and is generally protected against future hepatitis B infection.
People with chronic hepatitis B, however, may require treatment to reduce liver damage and suppress viral replication. If you are diagnosed with hepatitis B through laboratory testing, you should consult a hepatologist (liver specialist) or a gastroenterologist for a comprehensive evaluation.
- How long you have been infected
- Whether the virus is actively replicating
- The extent of liver damage, if any
Based on these findings, an individualized treatment plan will be developed.
If treatment is indicated, two main types of therapy are currently used:
1. Interferon Therapy
- Interferon alfa
- Pegylated interferon alfa
2. Oral Antiviral Medications
- Tenofovir
- Entecavir
- Lamivudine
- Adefovir
- Telbivudine
Your doctor will determine the most appropriate treatment based on your clinical condition and current international treatment guidelines.
Laboratory Blood Tests for Hepatitis B
Hepatitis B is diagnosed and managed through a series of blood tests. These tests help determine whether a person has a current infection, has recovered from the infection, or has developed chronic hepatitis B. In most cases, the tests are repeated after 6 months to determine whether the infection has resolved or progressed to a chronic condition.
Misinterpretation of laboratory reports can sometimes lead to confusion, even among healthcare providers. Therefore, anyone diagnosed with hepatitis B should consult a hepatology or liver disease specialist for proper interpretation and medical advice.
Below are some important terms and laboratory markers commonly used in hepatitis B diagnosis.
Antigen
An antigen is a foreign substance, usually a protein, that enters the body and triggers an immune response. In hepatitis B, proteins found on or within the hepatitis B virus (HBV) are referred to as antigens.
Antibody
An antibody is a protein produced by the body's immune system to fight against antigens. Different antibodies are measured during hepatitis B testing, including:
Common Hepatitis B Blood Tests
Hepatitis B Surface Antigen
HBsAg is the primary marker used to detect a current hepatitis B infection.
- A positive result indicates that hepatitis B virus is present in the body.
- A negative result indicates that hepatitis B surface antigen is not detected.
HBsAg appears early during infection, often before symptoms develop, making it useful for identifying both symptomatic and asymptomatic infections. If the body's immune system successfully clears the virus, HBsAg disappears from the bloodstream.
Hepatitis B e Antigen
HBeAg is another viral protein found during active hepatitis B infection.
Its presence generally indicates:
- Active viral replication
- Higher levels of hepatitis B virus in the blood
- Increased infectivity
HBeAg is an important marker for assessing the activity of the infection.
Antibody to Hepatitis B Surface Antigen
Anti-HBs develops after the disappearance of HBsAg.
A positive Anti-HBs result usually indicates:
- Recovery from a previous hepatitis B infection, or
- Successful hepatitis B vaccination.
The presence of Anti-HBs generally provides protection against future hepatitis B infection.
Antibody to Hepatitis B Core Antigen
Anti-HBc is produced after exposure to the hepatitis B core antigen.
A positive result indicates previous or ongoing hepatitis B infection. In some cases, it may also indicate occult (hidden) hepatitis B infection, where the virus remains in the body despite the absence of detectable HBsAg.
Additional Tests After Hepatitis B Diagnosis
If hepatitis B infection is confirmed, further laboratory tests are often required to determine the severity of the disease, viral activity, and the need for treatment.
Hepatitis B e Antibody
Anti-HBe develops after the disappearance of HBeAg.
Its presence usually suggests:
- Reduced viral replication
- Lower infectivity
- Improvement in disease activity
Healthcare providers often use this marker to monitor treatment response and disease progression.
Viral Load
The HBV DNA test measures the amount of hepatitis B virus present in the bloodstream (viral load).
This test is usually performed alongside other hepatitis B blood tests and provides valuable information regarding:
- Viral replication level
- Disease severity
- Need for antiviral treatment
- Monitoring response to antiviral therapy
- Long-term prognosis
Although the HBV DNA test is relatively expensive, it is one of the most important investigations for making treatment decisions and monitoring patients receiving antiviral therapy.