Times of India
28 July 2011
By, Umesh Isalkar
Pune, India

The Virus Can be Inside the Body and the Person Will not Show Symptoms for Years
A blood test for hepatitis B virus is a must if you are over 20. For, one can harbour the deadly virus inside the body and remain asymptomatic, doctors have said.

Hepatitis B is a life–threatening liver infection caused by the virus. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer, according to WHO.

Since the vaccine against the virus has been in use for the last 20 years, those who are born earlier are unlikely to be vaccinated and can test positive for the virus, health experts added. Thursday is world hepatitis day.

If detected, early treatment and medical intervention can be sought and if the test is negative, safe and effective vaccination will ward off the life–threatening infection.

"Patients who acquire hepatitisB virus atbirthor in early childhood remain without symptoms for 30–40 years of age even though they harbour thedeadly virus.The crux of the problem lies in finding out these innocent carriers who can become victims of this virus,"said gastroenterologist and hepatologist Parmial Lawate.

When these become symptomatic, the liver disease has often progressed to cirrhosis. "Patients then have many life–threatening symptoms such as haematemesis, (vomiting of blood), ascites (fluid accumulation in abdomen), hepato renal syndrome (kidneys refuse to function), hepatic encephalopathy (deterioration of brain function) andhepaticcoma," Lawate added.

Gastroenterologist Shabeer Kayamkhani said that since most patients remain asymptomatic they do not consult their doctors and hence their HBsAg (hepatitis B surface antigen) status remains unknown till they have the symptoms. A simple blood test could identify their HBsAg status. "The prevalence rate of seropositivity of hepatitis B virus is 3 % in our population," he said.

"Vaccination is better than suffering from the infection and its long–term consequences. The vaccine has not yet been included in the government's mandatory vaccination programme, but paediatricians have been recommending hepatitis B vaccination for more than 10 years now. Those who are not sure about being vaccinated at birth can also do the antibody test to get an idea of their immunisation status," pathologist Avanti Golwilkar–Mehendale of Golwilkar Metropolis said.

During the screening, if someone who is asymptomatic is found to be HBsAg positive then a few precautions are mandatory. One should get close relations like wife, children, and other family members tested for HBsAg and if they are found negative, a full vaccination schedule should be implemented, Golwilkar–Mehendale said.

Doctors differentiate between acute and chronic hepatitis B viral infection. Kayamkhani said, "We define acute infection with symptoms. The person develops jaundice and has yellowing of eyes and skin, dark urine and extreme fatigue, vomiting and abdominal pain in acute hepatitis B viral infection."

However, in chronic infection, patients remain asymptomatic and only when their body immunity tries to get rid of the virus, does the patient become symptomatic. It can eventually lead to inflammation of liver cells leading to liver cirrhosis and liver cancer as well.

Hence, a simple blood test which does not cost more than Rs 100 to Rs 150 is recommended. The test can show whether he is carrying the hepatitis B infection in his blood or having chronic infection.

Asymptomatic patients often have HBsAg positive liver disease but do not adhere to treatment. Medication has to be continued for a long period depending upon the viral load status to avoid complications.

What You Should Know

• Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease
• The virus is transmitted through contact with the blood or other body fluids of an infected person – not casual contact
• About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection.
• An estimated 1 million persons die each year due to the acute or chronic consequences of hepatitis B
• About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.
• The hepatitis B virus infectious than HIV
• Hepatitis B virus is an important occupational hazard for health workers
• The developed countries of Northern Europe and America have considerably controlled the infection by means of effective vaccination and improved sanitation, particularly measures taken for transfusion safety
• In India, nearly 3–4% of the population is infected by the virus, and chronic hepatitis B constituting more than 50% of the chronic hepatitis cases in the country. Nearly 40 million people out of the global HBV infection pool of 350 million are from India
• India, with a carrier rate of 3%, contributes nearly 10% of the hepatitis B virus (HBV) carriers in the world. In this perspective, the HBV epidemiology in India becomes relevant not only nationally, but also internationally, because of the possibility that India may soon have the largest HBV infection pool in the world

One Can Get Hepatitis B

• From being born to a mother with hepatitis B
• Having sex with an infected person
• Being tattooed or pierced with unsterilised tools that were used on an infected person
• Getting an accidental needle stick with a needle that was used on an infected person
• Using an infected person’s razor or toothbrush
• Sharing drug needles with an infected person
• Blood transfusions

Go For a Simple Blood Test

• Get yourself tested for HBsAg (hepatitis B surface antigen)
• If by chance you are found to be HBsAg positive then get your liver enzymes done
• If your liver enzymes are elevated then you need a few more blood tests to determine the line of treatment. These tests are HBeAg and HBV DNA (estimation of viral load in blood)
• If you are HBsAg positive, but the liver enzymes are in a normal range and your viral load is almost negligible, then you are termed as inactive carrier and you don't require any specific treatment at this point of time. However, you should get your liver enzymes test done periodically as one may lapse into active viral replicative stage without becoming symptomatic
• If you are HBsAg positive and your liver enzymes are elevated and you are tested positive for HBeAg and your viral load is high (positive for HBVDNA) then you need to consult your doctor as he may prefer to start treatment

One Cannot Get Hepatitis B

• From shaking hands with an infected person
• From hugging an infected person
• From sitting next to an infected person