Hepatitis B virus (HBV) infection remains a significant global public health challenge, causing substantial morbidity and mortality. The World Health Organisation (WHO) estimates that 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new infections each year.
In 2019, Hepatitis B resulted in an estimated 820, 000 deaths, mostly from liver cirrhosis and hepatocellular carcinoma (primary liver cancer). The burden of HBV infection is higher in the WHO African Region and Western Pacific Region.
According to the Uganda Population-based HIV Impact Assessment (UPHIA) 2016–2017 national survey, Hepatitis B infection prevalence among Ugandan adults was 4.3% with the northern region of the country having the highest prevalence (4.6%) and the southwest the lowest (0.8%).
In highly endemic areas, Hepatitis B is most spread from mother to child at birth (perinatal transmission) or through (exposure to infected blood, especially from an infected child to an uninfected child during the first 5 years of life. The development of chronic infection is common in infants infected from their mothers or before the age of 5 years.
Hepatitis B is also spread by needlestick injury, tattooing, piercing and exposure to infected blood and body fluids, such as saliva and menstrual, vaginal and seminal fluids. Transmission of the virus may also occur through the re-use of contaminated needles and syringes or sharp objects either in health care settings, in the community or among persons who inject drugs. Sexual transmission is more prevalent in unvaccinated persons with multiple sexual partners.
Hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases, whereas infection in infancy and early childhood leads to chronic hepatitis in about 95% of cases. Hence, this is the basis for strengthening and prioritizing infant and childhood vaccination.
It’s important to note that the hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. The incubation period of the hepatitis B virus ranges from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B, especially when transmitted in infancy or childhood.
Majority of the people do not experience any symptoms when newly infected with Hepatis B virus. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. People with acute hepatitis can develop acute liver failure, which can lead to death.
There is no specific treatment for acute hepatitis B and ttherefore, care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhoea. Most important is the avoidance of unnecessary medications.
However, Chronic hepatitis B infection can be treated with medicines, including oral antiviral agents (ARVs). Treatment can slow the progression of liver cirrhosis, reduce incidence of liver cancer and improve long term survival.
Therefore, the WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours, followed by 2 or 3 doses of hepatitis B vaccine at least 4 weeks apart to complete the vaccination series. Protection lasts at least 20 years and is probably lifelong.
In addition to infant vaccination, the WHO recommends the use of ARVs for the prevention of hepatitis B transmission from mother-to-child. Implementation of blood safety strategies and safer sex practices, including minimizing the number of partners and using barrier protective measures (condoms), also protect against transmission of hepatis B virus.
The authors are; Aisha Naiva, BScN Nurse & Pharmacovigilance focal person at Kawolo General Hospital and
Lilian Nuwabaine, BScN Nurse & MSN-Midwife & Women’s’ Health Specialist working with Aga Khan University
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