The hepatitis B virus has been around for generations, but it receives relatively little attention from the media or from the public at large. Most people are unaware that they're infected, and the serious, sometimes deadly consequences can take decades to appear. But make no mistake, hepatitis B has quietly become a major health threat to millions of people in Thailand, and millions more throughout Asia and around the world.

THE ABCs OF HEPATITIS

The word hepatitis means inflammation of the liver, which is usually caused by a viral infection. There are many types of hepatitis (A, B, C, D, and E). While hepatitis A is the most prevalent, it goes away on its own and does not lead to long term liver damage. Hepatitis B has far more serious consequences, including liver scarring, cirrhosis of the liver, and liver cancer. It can also be fatal.

It’s estimated that more than 350 million people around the world have been infected with the hepatitis B virus, and nearly 75% of them are Asian. Thailand has one of the highest rates of infection; nine million Thais have the HBV virus.

To gain a better understanding of this serious threat, Better Health spoke with Dr. Virasak Wongpaitoon, M.D., a gastroenterologist and hepatologist with many years’ experience treating patients infected with hepatitis.

HOW DOES INFECTION OCCUR?

The hepatitis B virus is transmitted through three main routes: unprotected sexual contact, exposure to blood or bodily fluids such as semen or vaginal secretions of a person who carries the virus, and ‘vertical’ transmission from mother-to-child during childbirth. Most patients diagnosed with chronic hepatitis B as adults became infected during infancy or childhood. In addition to the risk of mother-to-child infection during childbirth, Dr. Virasak noted that children are at higher risk due to normal activities and surroundings. “There is a high incidence of hepatitis B infection in places with lots of children,” he explained. “At school or on the playground, children play together, and it’s common that they scrape or cut themselves and expose an open wound. Because children’s immune systems are still developing, they’re more vulnerable to infection.” Many children's immune systems are strong enough to completely kill the virus. In others, most of the virus is killed off, but they still carry the virus and can infect others. In serious cases, the HBV virus proves too strong for the immune system, and symptoms of chronic hepatitis B will eventually become apparent during adulthood (usually between the ages of 20 and 40).

Dr. Virasak stressed one of the most dangerous aspects of the HBV virus: Most people don’t realize they’ve been infected. “Infection typically produces no symptoms at all, or only mild symptoms such as a fever or aches and pains that go away within a few days,” he explained. “There is a high prevalence of hepatitis B in Thai people because there are few symptoms at the time of infection. As a result, patients don’t seek medical treatment, the disease continues to progress, and they can spread the virus to others.”

INFANT AND CHILDHOOD DANGERS

In the majority of infections that occur during adulthood (termed ‘acute’), the body’s strong immune system is able to produce antibodies that completely kill off the HBV virus within a few months after infection. These antibodies provide lifetime protection against becoming re-infected. Patients who are unable to kill off the virus within six months face the future health threats of ‘chronic’ hepatitis such as cirrhosis and liver cancer. And as HBV carriers they can pass the infection on to others.

When infection occurs during infancy or childhood, the hepatitis B virus is much more threatening. With few or no symptoms at the time of infection, it’s often years before an infected child has a blood test for hepatitis B. That’s more than enough time during the critical years before the immune system has fully developed for the HBV virus to multiply and progress to the point of inflicting serious liver damage usually without any noticeable signs or symptoms of the disease.

VACCINATION AND PREVENTION

Despite its serious nature, hepatitis B can be easily prevented through vaccination, regular medical check-ups, and avoiding the risk factors for transmitting the virus.

The vaccine against hepatitis B has proven highly effective in offering a lifetime of protection against the virus. These days, most newborns receive the vaccine soon after birth.

Avoiding the major risk factors for transmission of the virus is critical to reducing the rate of HBV infection. In addition to practicing safer sex, “if you haven’t been tested for the virus,” Dr. Virasak advised, “or if you haven’t been vaccinated, talk to your doctor. And don’t share personal items such as razor blades and toothbrushes.”

IF YOU THINK YOU ARE INFECTED . . .

For patients who worry that they may be infected with the HBV virus, a simple blood test is used to check for the presence of the virus in the bloodstream. If the virus is detected, additional tests may be recommended to check for the presence of antibodies, and your doctor may also prescribe a liver function test and ultrasound examination to determine the extent of any damage to the liver.

Recently-infected patients (i.e. those with acute hepatitis B) require a lot of rest until any symptoms go away. Among patients diagnosed with chronic hepatitis B, those who show no symptoms and have normal liver function usually don't require medication. Some patients with chronic hepatitis B may need medication that can effectively reduce or completely eliminate the HBV virus. Your doctor will set up a schedule for regular check-ups and monitoring of the disease’s progression to ensure earlier detection of potential problems including cirrhosis, scarring and cancer.

To lessen the risk of future health problems, Dr. Virasak recommends that all patients with HBV “should consult their doctor before taking any medication, abstain from drinking alcohol, get regular medical check-ups, and lead a healthy lifestyle. That means reducing stress, practicing good nutrition and exercise habits, and avoiding the risk factors that can spread the virus to others.”