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  Hepatitis B

Hepatitis B:

It belongs to the family of Hepadnaviridae. Virion measures approximately 42 nm in size that includes a circular dsDNA genome. It is also termed as “Dane particle.”

Antigens of HBV:

HBsAg - surface antigen
HBcAg - core antigen
HBeAg - secreted protein

978_hepatitis B.jpg

Figure: Hepatitis B typical series of events following infection

Pathogenesis:

Infection is parenterally transmitted. Incubation period ranges from 2-5 months. Prime virus replication occurs in the liver. Virus particles and viral surface proteins are shed in the blood stream. Lengthened viraemia is viewed and the patient’s blood is highly infectious. HBV causes a more rigorous disease than Hepatitis A. Asymptomatic infections take place often. 5% of infected individuals fail to remove the virus totally and become persistently infected. High risk group comprises babies, young children, and immuno-compromised patients. HBV persists in the hepatocytes and on-going liver damage occurs due to the host immune response against the infected liver cells.

Two kinds of chronic infection are observed:

• Chronic Active Hepatitis:

There is aggressive devastation of liver tissue and quick progression to cirrhosis or liver failure.

• Chronic persistent Hepatitis:

The virus persists, however there is minimal liver harm.

Patients who become persistently infected are at threat of developing hepatocellular carcinoma (i.e., HCC). Fulminant hepatitis is very rare and accounts for less than 1percent of infections.

Epidemiology:

Globally there are 450 million persistent carriers of hepatitis B. Carriage rates differ markedly in different regions.

Mode of transmission:

Hepatitis B is parenterally spread.

1) Blood: Via blood transfusions, serum products, sharing of needles, tattooing, razors, acupuncture, renal dialysis, organ donation and so on.

2) Sexual intercourse

3) Horizontal transmission in families, children, ‘close personal contact’.

This is the main mode of transmission in South Africa where the bulk of individuals become infected at among three and nine years of age. Horizontal transmission also takes place in children’s institutions and mental homes.

4) Vertical transmission: Perinatal spread from a carrier mother to her baby.

 

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