Incubation period
The incubation period is the time between infection with the virus and the first appearance of clinical symptoms. The incubation period in hepatitis D can vary from 4-12 weeks, up to 4 months. If it is a superinfection – a hepatitis D infection with existing hepatitis B – the time to the outbreak of the disease is usually shorter than in the case of a simultaneous infection.
For the course of hepatitis D, it is important whether the patient is infected with the hepatitis B virus and the hepatits D virus at the same time (simultaneous infection) or first with HBV and only later with HDV (superinfection). Superinfection is much more common and has a much worse prognosis. The so-called “second hit”, i.e. a second severe liver disease in succession, often damages the liver so severely that chronic hepatitis develops.
In this case, the acute inflammation of the liver does not heal even after 6 months and often leads to liver cirrhosis (connective tissue remodelling of the functional tissue of the liver) or hepatocellular carcinoma (HCC, i.e. liver cancer). 90% of all superinfections lead to chonic manifestation. Chronic HBV/HDV hepatitis is 3 times more likely to lead to death than chronic HBV hepatitis alone.
Simultaneous infection with HBV and HDV results in severe acute hepatitis, but 95% of all acute hepatitis caused by HDV heals completely. There is currently no effective therapy for HDV. Therapies with alpha-interferon are only rarely successful and lead to a reduction of the virus count, which, however, usually increases again after the end of therapy.
If the hepatitis B infection is also worthy of therapy, this can be done with so-called nucleoside analogues, which are ineffective against HDV. For the typical hepatitis symptoms such as nausea, pain in the upper abdomen, vomiting and diarrhoea, liver-sparing medication can be given. In addition, the patient should maintain strict bed rest and avoid alcohol and other liver-damaging substances.
The last option for patients with severely advanced liver damage is the transplantation of a healthy organ. A direct vaccination against hepatitis D is not possible. However, there is a hepatitis B vaccination that also protects against the hepatitis D virus, since it can only multiply in the presence of the hepatitis B virus.
It is recommended to be vaccinated against hepatitis B. The vaccination is generally given in the 2nd, 4th and 12th month of life. If the vaccination has not been administered in infancy, 3 vaccinations must also be administered at a later age.
As a rule, no booster vaccination is necessary. The booster is only recommended if there is a high risk of infection. This is the case, for example, if your partner is infected with hepatitis B, if you have frequent contact with people infected with hepatitis B (e.g. in hospital) or if there is an immune deficiency. In these cases, a booster dose should be taken every 10 years.
