Hepatitis B virus: transmission, symptoms, and severity

Hepatitis B is the known as the most serious of the common liver infections in the world. It is estimated that approximately 350 million people are chronic carriers of HBV or the hepatitis B virus in the world and of these more than 250,000 die from liver-related disease each year. (Hepatitis B Overview) The Hepatitis B infection is caused by the hepatitis B virus and it can not only be the cause of serious and chronic liver disease but can "….put people at high risk of death from cirrhosis of the liver and liver cancer." (Hepatitis B: WHO)

Hepatitis B should be understood as an infection that is related to the general diagnoses of and category of Hepatitis. Hepatitis generally refers to a condition of the inflammation of the liver. This inflammation can be the result of various disorders of the immune system as well as a result of alcohol abuse. However, Hepatis B. refers specifically to the above mentioned viral infection. (Hepatitis B Overview) The seriousness of this infection is evidenced by the fact that "…about twenty-five percent of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection." (Hepatitis B: WHO) Another important aspect to consider in this disease is that this virus is estimated by the World Health Organization to be between fifty to one-hundred times more infectious than the HIV or AIDS virus. (Hepatitis B: WHO) It is also known to be a serious occupational hazard for many health workers in regions where this disease is prevalent.

Hepatitis B also varies in terms of its severity and can manifest itself as a mild illness which may last for a few weeks in its acute phase and can develop into a serious and debilitating long-term chronic illness. (Viral Hepatitis) The acute or short-term phase of the disease usually occurs shortly after exposure to the virus. The more severe life-threatening form of acute Hepatitis B is known as fulminant hepatitis. (Hepatitis B) A patient is diagnosed with chronic or long-term hepatitis B when the infection lasts more than six months and in this case the infection usually persists for long periods of time. Chronic hepatitis B also results in a form of liver cancer known as hepatocellular carcinoma. (Hepatitis B)

However, the literature also notes that, "About 90-95% of people who are infected are able to fight off the virus so their infection never becomes chronic. Only about 5-10% of adults infected with HBV go on to develop chronic infection." (Hepatitis B) It should also be noted that, "People with chronic HBV infection are called chronic carriers. About two-thirds of these people do not themselves get sick or die of the virus, but they can transmit it to other people." (Hepatitis B)

2. Symptoms

It is estimated that approximately half the people who are infected with the hepatitis B virus have no symptoms. However, the symptoms that are manifested tend to develop with a period of between thirty and one-hundred and eighty days after exposure to the virus. (Hepatitis B Symptoms) These symptoms are often similar to those associated with influenza and this tends to mask the true nature of the illness as many people do not realize that they have hepatitis B The following is a list of the most common symptoms that occur after the initial infection.

Appetite loss

Feeling tired (fatigue)

Nausea and vomiting

Itching all over the body

Pain over the liver

Jaundice

Urine becomes dark in color

Stools are pale in color (grayish or clay colored

(Hepatitis B Symptoms)

1. Diagnosis, treatment and costs

Hepatitis B is mainly diagnosed by means of blood tests. These tests can also indicate the severity of the infection and wether it is chronic or not. A common recommendation is that a liver biopsy should be taken if the blood test indicates chronic hepatitis B (What I need to know about Hepatitis B)

In terms of prevention a vaccine has been available since 1982 and has been found to be "…ninety-five percent effective in preventing HBV infection and its chronic consequences…" (Hepatitis B: WHO) However there is no specific treatment protocol for this disease. Doctors recommend rest and a diet that is high in protein and carbohydrates. As notes above, while most adults with this virus will recover after a bout of acute hepatitis B, there is a certain percentage that will develop the chronic from of this disease. In this respect there are a number of drugs that have been found to be relatively effective. These include Alpha interferon and lamivudine, which has been effective in about forty percent of cases.

However, as one report states, "…however, approximately 15 to 25% of chronic cases develop severe liver disease and death." (Hepatitis B: Brown.Edu.) If the chronic infection worsens and causes liver failure, then the only possibility to save the patient is surgery and a liver transplant.

The costs associated with the treatment of this disease are entirely dependent on the type of treatment that is undertaken. The treatment strategy that prescribed only rest and diet is obviously the cheapest. The most expensive treatment is the use of drugs like interferon and the adefovir monotherapy strategy. (Kanwal et al.) However, it has been found that in many cases alternative strategies to medication are often more effective. The following are a list of commonly prescribed drugs as approved by the FDA and their wholesale prices as of 2005.

Lamivudine (100 mg) - monthly cost $204- annual cost $2,482

Adefovir (10 mg) - monthly cost $546 - annual cost $6,647

Entecavir (0.5 mg) - monthly cost $715 - annual cost $8,694

Peginterferon alfa-2a (180 mcg) - monthly cost -$1,540 - annual cost $18,480

Emtricitabine (200 mg) - monthly cost $318 - annual cost $3,872

Tenofovir (300 mg) - monthly cost $478 - annual cost $5,811

( Hepatitis B Foundation, B Informed Newsletter, No. 46, Summer 2006)