Hepatitis B Virus Infection

Are you aware that hepatitis B virus (HBV) infection is one of the major public health problems Worldwide? Approximately 257 million people have chronic HBV infection, which   resulted in 887,000 deaths in 2015.(WHO,2017)
INTRODUCTION
HBV infection is a necro inflammatory liver diseases of variable severity (Guidottiet al.,2006). Persistent infection by HBV is often associated with chronic liver disease that can lead to the development of cirrhosis and hepatocellular carcinoma (HCC) liver cells cancer.(Ganemet al.,2004)
Hepatitis B virus belongs to the hepadnaviridae family. The virus has a circular,double stranded DNA genome(Yan et al., 2012).
Hepatitis B virus is responsible for the most frequent chronic liver disease of infectious origin in human.
In 1967, Dr. Blumberg and his colleagues discovered the virus, developed the blood test that is used to detect the virus and invented the first hepatitis B vaccine in 1969.
MODE OF TRANSMISSION
The virus is transmitted through contact with the blood or other body fluid of an infected person.
It is commonly spread from mother to child at the birth (Perinatal transmission).
It is also spread by percutaneous or mucosal exposure to infected blood and various body fluids as well as through Saliva, Menstrual, Vaginal and Seminal fluid (sexual transmission)
Transmission may occur through the reuse of needles and syringes either in health care setting or among persons who injects drugs.
EPIDEMIOLOGY
Hepatitis B virus is responsible for the most frequent chronic liver disease with approximately 257 million chronically infected individual worldwide.
Chronic hepatitis B results in more than 887,000 deaths annually from complication of end-stage liver disease and hepatocellular carcinoma(HCC)(WHO,2017).
The vast majority of new HBV infection occurs in highly endemic regions such as China, South East Asia and Sub-Saharan Africa including Nigeria (Lai et al., 2003).
SIGNS AND SYMPTOMS
Most people do not experience any symptoms during the acute infection phase. 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
  • Abdominal pain
  • If the patient is treated on time, it can lead  to:
  • Liver cirrhosis
  • Hepatocellular carcinoma

MEDICAL LABORATORY DIAGNOSIS
Diagnostic methods are often used to confirm the infection as follows:

  • Rapid Diagnostic Test (RDT) of Hepatitis B Surface Antigen detection (Chevaliezet al., 2014)
  • Hepatitis B Surface Antigen quantification (Brunettoet al., 2010)
  • Anti-Hepatitis B core antibody quantification (Yuan et al., 2013)
  • Hepatitis B Virus core-related antigen (HBcrAg) quantification (Wong et al.,2007).
  • New Hepatitis B virus DNA Assay (EASL,2012)

CLINICAL PRESENTATION

  • Pleural effusion and hepatopulmonary syndrome may  occur in patients with cirrhosis.
  • Diffuse intravascular coagulation.
  • Myocarditis
  • Arthralygias and arthritic subcutaneous modulus may also occur.
  • Pancreatitis may develop
  • Aplastic anaemia

EPIDEMIOLOGY OF HBV INFECTION IN NIGERIA
HBV infection is widespread, with prevalence ≥ 8% in parts of sub-Saharan Africa such as West Africa particularly, Nigeria, Burkina Faso, Ivory Coast e.t.c (Schweltzeret al., 2015)
In general, high levels of viremia or infection, contracted at a young age, affects mostly males and are associated with an increased risk of death or developing hepatocellular carcinoma  (Taylor et al.,2009).
KEY CHALLENGES TO HBV INFECTION CONTROL IN NIGERIA

  • Unsafe traditional practice of scarification, circumcision, tattoos.
  • Unsafe sexual exposure.
  • Low socio-economic status of the family.
  • Lack of adequate statistics on prevalence   rates.
  • Lack of adequate public awareness.

PREVENTION AND CONTROL

  • Adequate prevalence rate should be worked upon.
  • Adequate public awareness on early detection and treatment.
  • Adequate and timely vaccination should be encouraged
  • Unsafe traditional practice should be discouraged.

TREATMENT AND MANAGEMENT

  • Assessment of severity of the liver disease.
  • HBV DNA detection and level of measurement.
  • Other causes of chronic liver disease should be systemically looked for.
  • Liver biopsy is often recommended for determining the degree of necroinflammation and fibrosis.

CONCLUSION
In Nigeria, Hepatitis B Virus infection is taking centre stage now in terms of prevalence, the chronicity of the illness and high cost of treatment makes preventive strategies a reasonable option in resource limited countries.
Public health education and vaccination against the virus are therefore advocated for people in Nigeria.