VIRAL HEPATITIS: The Smallest Demon Imaginable Part 2/2 (HBV) [Archives:2001/36/Health]

September 3 2001

Marwan Ahmed Alghafory,
Faculty of Medicine,
Ain Shams – Cairo, Egypt
[email protected]
As a follow-up to last week’s article on Hepatitis, I present here the most dangerous Hepatitis virus to humans, HBV. In brief, HBV is the real demon as it usually ultimately leads to fatal consequences.
The HBV basically complicates liver cirrhosis, and this leads to portal hypertension with its catastrophic consequences including:
1-splenomegaly (enlargement of the spleen)
2-ascites (accumulation of fluid within the abdominal cavity.
3-varicosity in certain areas e.g.:
— at the lower end of esophagus, leading in most severe cases to fatal hematemesis (vomiting of blood)
ii- at the lower end of the rectum, causing piles.
iii- around the umbilicus causing the so-called: kaput medusa.
Besides, the effects of liver cirrhosis produced by viral hepatitis include: edema due to decrease in plasma proteins, failure in activation of estrogen which may reach a certain level in males causing feminization symptoms like enlargement of the breast, and the voice becomes highly pitched.
Liver cell failure and hepato-cellular carcinoma may also occur with those resistant demons i.e. HBV & HCV.
The mechanisms of this severe destruction (as mentioned last week) are attributed to the body system as it tries to rid the body of the virus-infected cells. The infected cells exhibit a new antigen on their surfaces, thus becoming targets of the natural killers, and cytotoxic cells.
In Yemen, the level of infected HBV patients is in the rise due to the insufficient medical facilities and the unawareness among the public of the effects of the deadly disease led to the death of many Yemenis. Despite the fact that there is a vaccine available for uninfected citizens, yet a small percentage of adults are immunized. The Public Health Ministry should exert more effort to spread awareness of this dangerous disease and limit its effects on society.
Up till the late 1960s, diagnosis of long-incubation serum hepatitis was made on the basis of jaundice and other symptoms and signs of hepatitis appearing within 60 to 120 days following injection of infected human blood or plasma fractions, or the use of inadequately sterilized syringes and needles.
In 1965, the Australia antigen was discovered by Bluberg and his colleagues, who subsequently associated its presence in the serum with the presence of hepatitis B virus infection. This discovery led to considerable knowledge about the transmission, and has permitted the development of a very effective vaccine for its prevention.
Geographical Distribution
The prevalence of HBV infection remains higher in developed countries. However, developing countries also have this disease spreading quickly. In most of the developing countries, including Yemen, HBV infections could be reduced by applying serological tests, screen blood transfuses, and blood products, and by using disposable syringes and needles.
Transmission of Disease
HBV are transmitted by transfusion and injection of blood products including needle sticks either by medical or dental procedures. Illicit intravenous drug abusers sharing the same needles are also risking the transmission of this disease. The disease is also transmittable through heterosexual and homosexual acts and from mother to their unborn or newborn infants.
Even though HBV is similar to HIV in transmission from a person to another, yet it ranks as the most infectious of the blood-borne viruses. In developed countries, HBV is frequently transmitted through horizontal transmission within families and among playmates, and by heterosexual sex. In the past 30 years, the incidence of HBV infection has increased remarkably in the developed world despite all the available facilities and strict control of blood transmitting tools. This increase is attributed to usage of drugs and homosexuality, as these two are the most risky factors of HBV and HIV transmissions in such societies.
Multiple investigations however have failed to establish a role for vector-borne (mosquito bites, etc.) in transmission of HBV and HIV. In my personal opinion, this is due to mercy of God upon his people, especially in developing countries.
Clinical manifestations
1- Acute infection: Occurs from 1 to 4 months after exposure (the incubation period). Prodromal symptoms may be experienced during this period. Approximately 15% of adult patients show symptoms of fever, malaise, distal joint pain, and urticaria. Jaundice occurs in 25-30% of the HBV infected cases. There may be tenderness over the upper quadrant (area lodging the liver) and the liver itself may be a swelling in the liver as a whole.
2- Chronic infection and complications: Involves acute HBV infection and is self- limited in 95% of infected adults, but self-limitation in infants drops to 80 to 90%.
The chronicity is attributed to the immune system’s intention to rid the body of the infected cells , and hence only those of intact immunity develop hepatocellular carcinoma, or liver cell failure, but not those of immuno-deficiency diseases.
Prevention and Control
The simple procedures to prevent the disease are vaccinations, immune globulin, and adequate healthcare as follows:
1- Vaccination: It is a must for people who are frequently exposed to blood or blood products as those with haemolytic anemia, and haemodialsis (especially patients with renal failure). Vaccinations are done by injecting the individual with HBV antigen, which will stimulate the immune system to produce specific antibodies directed against the virus if it ever invades the body.
2- Immuno globulin: Previously prepared antibodies are provided for immediate protection to individuals exposed to infection, e.g. infant born from an infected mother.
3- Healthcare: During healthcare procedures, screening the blood donors should take place to prevent any blood positive HB surface antigens to be used in transfusion. The instruments used should be disinfected from any effects by certain chemicals, e.g. ethylene oxide, or 2% glutraldhyde. Disposable syringes should always be used. According to the clinical state of the healthcare service provider, either or both interferon and Ribavirin are to be used.
HBV is invading the world and its consequences are truly devastating. What needs to be done today is come out with a strategic vision in the entire world to stop the spread of this deadly virus. AIDS has been given reasonable attention and all sorts of campaigns are being launched. However, HBV is not given that great attention, despite the fact that unlike AIDS, HBV does have a vaccine.
For all readers in Yemen, who have not yet vaccinated themselves and their children, I recommend that they quickly do so. But before that, they must first examine whether they are infected or not. If they are, they need to consult their doctors as quickly and as frequently as possible, as their case may be quite dangerous.