Hepatitis B is an infectious disease transmitted through body fluids such as blood or semen. In Germany, the majority of infections occur through unprotected sexual intercourse. The disease is initially manifested by non-specific symptoms such as fatigue, fever and nausea. Later, jaundice may also occur. Acute hepatitis only needs to be treated if it takes a severe course. If the infection becomes chronic, on the other hand, treatment must be given in any case. You can safely protect yourself from the hepatitis B virus with a vaccination.
Causes of infection
Hepatitis B is one of the most common infectious diseases worldwide. Infection with the hepatitis B virus (HBV) causes inflammation of the liver. The virus is transmitted through body fluids such as blood, saliva, breast milk, tear fluid or semen. In Germany and other industrialized nations, more than half of infections are due to sexual contact. In addition, infection via blood also plays a role. Due to the good hygienic conditions in Germany, the risk of becoming infected in the course of a blood transfusion is extremely low. More risky are contaminated objects such as tattoo instruments, ear piercers, shared toothbrushes or razors. In drug addicts, infection can also occur through repeatedly used syringes and needles.
Symptoms of hepatitis B
After infection with the hepatitis B virus, between one and six months may pass before the first symptoms appear. Typically, there is then fatigue, tiredness, fever, headache and aching limbs, as well as nausea and diarrhea. In about one in three people affected, the typical symptoms of jaundice also become apparent: The skin and the inside of the eyes turn yellowish. In addition, the stool becomes lighter and the urine darker. In about one in ten patients, acute hepatitis develops into chronic hepatitis. In the chronic stage, the disease can lead to serious complications. Among other things, this can lead to cirrhosis of the liver. In addition, the risk of developing liver cancer increases.
Hepatitis B in pregnancy
Pregnant women who have hepatitis B can transmit the virus to the baby around birth. In Germany, however, this rarely happens because pregnant women are tested for hepatitis B and preventive measures are initiated if necessary. This involves administering a passive-active vaccination against the virus to the newborn child within twelve hours of birth. In addition, special antibodies are administered to the infant so that the risk of infection is reduced to about five percent. Preventing infection is important because chronic hepatitis develops in many infected infants.
Acute and chronic course
In most infected individuals, hepatitis B heals within four to six weeks. After that, you have lifelong immunity to the virus – so you can only get sick once in your lifetime. In very rare cases, the infection can cause such severe damage to the liver that a liver transplant is subsequently necessary. If the hepatitis is still not cured after six months, it is called chronic. This occurs in about one in five to one in ten adults, but affects 90 percent of all infants who were infected with the virus by their mother. Chronic hepatitis can manifest itself in different ways. Some show no symptoms despite infection, while others develop chronically elevated liver enzymes. In some cases, the liver inflammation is so aggressive that it causes severe changes to the organ and eventually leads to cirrhosis. Overall, about one in three cases of liver cirrhosis is caused by hepatitis B. In addition, the risk of developing liver cancer also increases.
Therapy of hepatitis B
To prove that an infection with the hepatitis B virus is present, a blood test is performed. Here, elevated liver values – such as an elevated GPT value – already indicate liver inflammation. However, in order to diagnose the infection with certainty, certain virus components and specific antibodies against the virus must be detected in the blood. If an infection is suspected, the attending physician must report this to the public health department.The actual detection of the disease and the death of an indicated patient must also be reported. The public health department must be informed of the infection even if the sick patient does not show any symptoms. An acute hepatitis B infection often heals on its own. Therefore, in most cases, only the symptoms that occur need to be treated. Only in very severe cases are drugs used to inhibit the multiplication of the virus. It is important for those affected to take it easy on themselves physically and to avoid foods that are particularly hard on the liver. For this reason, alcohol must also be avoided at all costs in the case of a hepatitis B infection.
Treatment of a chronic infection
If chronic inflammation is present, the disease is usually treated with medication. Antiviral drugs that inhibit the multiplication of viruses are then frequently used. Virustatics include substances such as tenofovir and entecavir. These agents are used relatively frequently because they rarely lead to resistance. When treatment with the viral drugs begins depends on the amount of virus present in the body. In addition to virustatics, interferon can also be used for a secondary period of no more than twelve months. Taking the drug may cause side effects such as weight loss, hair loss and flu-like symptoms. However, the side effects disappear once the drug is no longer taken. If liver failure occurs in the course of chronic hepatitis B – rarely also in acute infection – liver transplantation is the only way to save the patient’s life.
Vaccination is the best protection
To safely protect against hepatitis B, vaccination against the virus is recommended. Vaccination has been one of the standard childhood immunizations recommended by the Standing Committee on Immunization (STIKO) since 1995. Vaccination stimulates the body to produce antibodies against the virus, so that in the event of infection, the viruses can be quickly rendered harmless. Unvaccinated adults should get vaccinated if they belong to one of the following groups:
- Travelers who will be in a country with an increased risk of hepatitis B for an extended period of time.
- Individuals who are privately exposed to an increased risk of infection, something because they live in a household with someone who has chronic hepatitis B disease or because of their sexual behavior.
- Doctors, nurses, staff in kindergartens and children’s homes, and anyone else who regularly comes into contact with blood or other bodily secretions.
- Persons with immunodeficiency or certain diseases on whose course an infection with hepatitis B would have a particularly unfavorable effect.
Combination of hepatitis A and B vaccination.
Against hepatitis B can be either a single vaccination or a combination vaccine, by which one is also protected against hepatitis A in addition. The single vaccine, like the combination vaccine, can initially be given twice at four-week intervals. For long-term protection, a third vaccination should be given six months later. After that, you will be protected from hepatitis B for at least 10 years. If there is no increased risk of exposure, booster vaccination is not considered necessary in adulthood. For infants, basic immunization against hepatitis B has been recommended since summer 2020 according to the 2+1 vaccination schedule. In this scheme, the baby receives vaccination at 2, 4, and 11 months of age. The previously recommended vaccination at 3 months of age is omitted.
Other protective measures
If you have not been vaccinated against hepatitis B, you should follow the following measures to prevent infection:
- Use condoms during sexual intercourse. This will not only prevent hepatitis B, but also protect you from other sexually transmitted diseases such as AIDS.
- Do not use items such as razors, nail scissors, nail files or toothbrushes together with a person infected with hepatitis B.
- In countries with low hygienic standards, do not use a blood supply unless it is an emergency. Syringes or needles used in hospitals may also be contaminated.
