Contents

o Overview .......................................................................................... 6
o What is hepatitis B?.......................................................................... 6
o Why is it called “Hepatitis B”? ........................................................ 6
o Epidemiology: .................................................................................. 7
o Symptoms and Causes ...................................................................... 8
o How do you get hepatitis B? ............................................................ 9
o Spread of Hepatitis B ....................................................................... 9
o Susceptible to get hepatitis B? ....................................................... 10
o How do you get chronic hepatitis B? ............................................. 10
o What is reactivated hepatitis B? ..................................................... 11
o How long are you contagious with hepatitis B? ............................ 12
o Possible Complications Of Hepatitis B Infection .......................... 12
o Diagnosis and Tests ........................................................................ 14
o How is hepatitis B diagnosed? ....................................................... 14
o Management and Treatment ........................................................... 17
o Prophylactic Treatment .................................................................. 17
o Acute Treatment ............................................................................. 18
o Treatment For Chronic Infection ................................................... 18
o Medication ...................................................................................... 19
o Lifestyle changes ............................................................................ 20
o Surgery ........................................................................................... 20
o Prevention ....................................................................................... 21
o References: ..................................................................................... 22
 Overview
What is hepatitis B?

Hepatitis B is a viral infection that affects your liver. It causes

inflammation in your liver tissues, which is what “hepatitis”
means. It begins as an acute infection that’s usually short-lived.
But in some people, it turns into a chronic infection that never
goes away.

Long-term inflammation does serious damage to your liver over

time. It can lead to cirrhosis and liver failure. Like other chronic
liver diseases, hepatitis B infection can do this damage without
causing symptoms. Many people don’t realize they’re infected.

Why is it called “Hepatitis B”?

There are several different viruses that can infect your liver and
cause inflammation (hepatitis). They include hepatitis A, B, C,
D and E. Each is a little different in how they’re transmitted,
how they affect your body and how they’re treated (or
prevented).
What distinguishes hepatitis B from other hepatitis viruses?
Some distinguishing features of hepatitis B include:
 Hepatitis B has a safe and effective vaccine that makes it

preventable. The World Health Organization (WHO)

recommends vaccination for all children as soon as possible
after birth.
 Hepatitis B disproportionately affects children. Only 5% of
 adults who are infected go on to develop a chronic
infection, but 30% of children under the age of 6 do.
 As hepatitis B spreads through bodily fluids, birthing
parents can infect their babies at birth. Up to 90% of infants
infected with hepatitis B develop a chronic infection.
 Chronic hepatitis B is treatable, but not curable. Antiviral
medications can help control the infection, but you’ll have
to take special care of your liver for the rest of your life.

Epidemiology:

Hepatitis B is the most common liver infection in the world. As

many as 2 billion people (or 1 in 3) have been infected
worldwide. Approximately 250 million people worldwide are
living with chronic hepatitis B infection, many unaware.
It’s less common in the U.S. than in some other places, thanks to
the vaccine. The Centers for Disease Control and Prevention
(CDC) estimates approximately 20,000 new acute infections
occur in the U.S. each year. An estimated 862,000 people in the
U.S. are living with chronic hepatitis B.

In Pakistan, there are estimated 7-9 million carriers of hepatitis

B virus (HBV) with a carrier rate of 3-5%
 Symptoms and Causes

Typical symptoms of infection include:

 Fever.

 Loss of appetite.

 Nausea and vomiting.

 Abdominal pain.

 Weakness

and fatigue.
 Joint pain.

 Jaundice (yellowing

of your skin and the

whites of your eyes).
 Dark-colored urine.

 Light or clay-colored

poop.
 Swelling with fluid in your belly or arms and legs.

With acute infection, symptoms of liver disease may indicate a

more severe reaction than usual. Although many people clear the
HBV virus without treatment, you should see a healthcare
provider if you have symptoms of liver disease.
With chronic infection, you may have mild or vague symptoms
on an ongoing basis, or you may not have symptoms at all for
decades. When symptoms appear later, especially symptoms of
liver disease, it may indicate your liver is beginning to fail.
 How do you get hepatitis B?
Spread of Hepatitis B

Hepatitis B infection comes from the hepatitis B virus (HBV).

The virus spreads through bodily fluids. Transmission occurs
when fluids from the body of a person who’s infected enter the
body of a person who’s uninfected. This might happen through:
 Childbirth.

 Sexual contact.

 Contact with an

open wound.
 Sharing needles or

syringes.
 Sharing a

toothbrush or
razor.
 Accidental stick

from an infected
sharp instrument.

Besides blood, HBV also lives in other bodily fluids, including

saliva. But unlike some viruses, hepatitis B isn’t easily
transmitted through saliva. That means you aren’t likely to get it
from sharing food or eating utensils or from someone coughing
or sneezing on you.
 Susceptible to get hepatitis B?

Communities with higher rates of infection include:

 People with HIV. As much as 7.5% of people with HIV

also have chronic hepatitis B.

 People who use intravenous drugs. Rates of hepatitis B

infection have risen steeply in states recently affected by

the opioid crisis.
 People of African, Asian or Pacific Island descent.

Infection rates in these countries range between 2% and

8%. In the U.S., these peoples make up more than half of
those with chronic hepatitis B infection.

How do you get chronic hepatitis B?

Chronic hepatitis B develops when your immune system fails to

fight off the virus. Most people successfully fight it off during
the acute phase of the infection. The acute phase is when your
immune system recognizes the virus and launches its attack.
When you have symptoms of illness after an infection, such as
fever, nausea and vomiting, those symptoms are part of your
immune response. Your immune system is trying to get rid of
the virus by purging and burning it out. That’s the acute phase.

Sometimes, some people’s immune systems don’t succeed in

clearing the HBV virus during the acute phase. For various
reasons, their immune response is weaker than necessary. The
acute phase only happens once. If the virus survives, there isn’t
another one.
A person might have a weaker immune response to the virus if
they:
 Are a young child whose immune system is still

developing.
 Have another infection at the same time.

 Have a chronic medical condition that compromises their

immune system.
 Receive immunosuppressant therapy or chemotherapy.

What is reactivated hepatitis B?

Sometimes after overcoming an acute hepatitis B infection,

something causes your immune system to weaken against the
virus later in life. Maybe your immune system was strong at the
time of infection, but now you have a condition that weakens it.
When this happens, the once-defeated virus can become active
in your body again. Reactivated hepatitis B can be temporary or
lasting. But because it tends to occur in immune-suppressed
people, it may be especially severe and even cause acute liver
failure.
 How long are you contagious with
hepatitis B?
You’re contagious as long as the virus is active in your body. If
you have an acute infection, it may last from a few weeks to six
months, and you’re contagious that whole time. If you have a
chronic infection, you’re contagious as long as it lasts, which is
usually for life.

Possible Complications Of Hepatitis B

Infection
Most complications come from chronic infection, but some
people may have complications with acute infection. Though it’s
not common, some people experience acute liver failure with
acute hepatitis B infection, which is a life-threatening
emergency.
Complications of chronic hepatitis B can include:
 Hepatitis D. Hepatitis D, or delta virus, is another viral

hepatitis infection that only affects people with hepatitis B.

If you have chronic hepatitis B, you can get both viruses.
This is called superinfection. It doubles the stress on your
liver and can lead to acute liver failure.
 Cirrhosis. Chronic liver inflammation leads to cirrhosis in

some people. It takes a long time and depends on many

factors, such as the overall health of your liver and other
conditions that might affect it. Cirrhosis happens when
injured liver tissues are gradually replaced with scar tissue.
The scar tissue stops your liver from functioning, which
leads to chronic liver failure.
 Chronic liver failure. Chronic liver failure is a gradual
process where your liver loses its ability to function over
time. It usually follows cirrhosis. Even though it happens
slowly, chronic liver failure is life-threatening. You can’t
live without a functioning liver. Liver failure can also cause
life-threatening side effects as it progresses. The only cure
is a liver transplant.
 Liver cancer. For reasons that aren’t entirely clear, people
with chronic hepatitis are more likely to develop primary
liver cancer. In fact, healthcare providers consider chronic
hepatitis B to be the leading cause of liver cancer. Liver
cancer itself is one of the leading causes of death in people
with chronic hepatitis B.
 Diagnosis and Tests
How is hepatitis B diagnosed?

Hepatitis B is diagnosed through various methods that help in

detecting the presence of the hepatitis B virus (HBV) or its
components in the body. Here are the primary diagnostic methods
used:
Blood Tests:
Hepatitis B Surface Antigen (HBsAg) Test: This test detects the
presence of the HBV surface antigen, which is a protein on the
surface of the virus. A positive result indicates an active infection.
Hepatitis B Core Antibody (anti-HBc) Test: This test looks for
antibodies produced by the body in response to the virus. It helps
in determining whether a person has had a past or current
infection.
Hepatitis B Surface Antibody (anti-HBs) Test: It checks for
antibodies that develop after HBV infection or after receiving the
hepatitis B vaccine.

Liver Function Tests (LFTs):

LFTs measure the levels of various enzymes and proteins in the
blood that indicate how well the liver is functioning. Elevated
levels may suggest liver damage or hepatitis.

Viral DNA or PCR Tests:

Polymerase Chain Reaction (PCR) tests detect the genetic
material (DNA) of the hepatitis B virus. This test can identify the
presence of the virus even when levels are very low, and it helps
monitor the viral load in chronic cases.
 Liver Biopsy:
In some cases, a liver biopsy might be recommended to assess the
extent of liver damage caused by the virus. A small sample of
liver tissue is taken and examined under a microscope.

Nursing Diagnosis:
Nursing diagnoses for a patient with Hepatitis B can vary based
on the patient's symptoms, complications, and individualized care
needs. Here are some potential nursing diagnoses that a nurse
might identify:

Risk for Infection related to Hepatitis B virus exposure:

This diagnosis is applicable for patients who have been exposed
to the Hepatitis B virus, either through direct contact or other
means. Nurses need to focus on preventing the spread of infection
to others and implementing appropriate isolation precautions.

Fatigue related to liver inflammation and systemic effects:

Hepatitis B can cause significant fatigue due to the body's
immune response and the impact on the liver. Nurses should
assess the level of fatigue and plan interventions to conserve the
patient's energy, prioritize activities, and encourage rest.

Imbalanced Nutrition: Less than Body Requirements related to

anorexia, nausea, and malabsorption: Patients with Hepatitis B
may experience reduced appetite, nausea, and difficulty
absorbing nutrients due to liver inflammation. Nurses can
collaborate with dietitians to develop a nutritional plan that
includes small, frequent meals, easy-to-digest foods, and
adequate hydration to meet the patient's nutritional needs.
Impaired Skin Integrity related to pruritus (itching) and
jaundice:
Hepatitis B can cause jaundice and itching due to the buildup of
bilirubin in the blood. Nurses should assess the skin for signs of
breakdown and implement measures to relieve itching, such as
using emollients and advising the patient to avoid scratching.

Anxiety related to diagnosis, prognosis, and potential

complications: A diagnosis of Hepatitis B can cause anxiety
about the future, treatment, and potential complications. Nurses
can provide emotional support, education about the disease, and
information about available treatments to alleviate anxiety.

Knowledge Deficit related to Hepatitis B transmission,

prevention, and management:
Patients and their families may lack sufficient knowledge about
Hepatitis B, its transmission, prevention measures, and
management. Nurses can provide education, resources, and
clarification to improve understanding and promote adherence to
treatment and preventive measures.
 Management and Treatment

A healthcare provider may offer you different treatment options

based on the status of the infection.
Prophylactic Treatment
If you have reason to believe you or your child has recently been
exposed to the virus, a healthcare provider might suggest
prophylactic treatments to help prevent the infection from taking
hold. These treatments include:
 Vaccination. Healthcare providers recommend an

immediate dose of the hepatitis B vaccine if you haven’t

had it yet, preferably within 24 hours of exposure. You’ll
need two more doses over the next six months to become
fully vaccinated against the virus.
 Hepatitis B immune globulin (HBIG). HBIG is a

substance made from human blood containing naturally-

produced antibodies to the hepatitis B virus. It’s given as a
shot to help prevent infection in people who’ve recently
been exposed to the virus.
These treatments are very effective in preventing babies born to
parents with chronic hepatitis B from becoming infected. Infants
who receive these treatments shortly after birth have a good
prognosis, and they can safely breastfeed (chestfeed).
 Acute Treatment
There’s no specific medication to treat an acute hepatitis B
infection, and many people won’t need any treatment. But if
you’re having severe symptoms, a healthcare provider might
monitor you for complications and offer supportive care, such
as:
 IV fluids.

 IV nutrition.

 Pain relief.

Treatment For Chronic Infection

Several medications are available to treat chronic hepatitis B,
but they may not be appropriate for everyone. A healthcare
provider will recommend treatment based on your condition and
risk factors. Your treatment plan may include:
Surveillance
A healthcare provider treating you for chronic hepatitis B will
monitor your liver health through regular checkups and testing,
ideally every six months. They’ll look for signs of active liver
disease that may be affecting your liver’s functioning.
Tests may include:
 Blood tests.

 Imaging tests.

 Elastography (organ stiffness scan).

 Medication
Healthcare providers have found that current medications for
hepatitis B are most effective for people who show signs of
active liver disease. This may be only 25% of people diagnosed
with chronic hepatitis B, according to the World Health
Organization (WHO).
Current medications help boost your immune system and slow
down the rate at which the virus reproduces itself. They don’t
kill the virus completely, but they can help keep your liver as
healthy as possible for as long as possible. They include:
 Immune modulator drugs. Immune modulators, also

known as interferons, include peginterferon alfa-

2a and interferon apfa-2b. These are synthetic versions of
the antibodies our bodies produce to fight infections.
They’re given by injection for a course of six to 12 months.
They’re prescribed for some adults and as a first-line
treatment for children.

 Oral antiviral medications. Antivirals taken by mouth are

the most potent medications for suppressing HBV. Your
provider might recommend one or several based on who
you are and how you respond. First-line antivirals
include tenofovir disoproxil or tenofovir
alafenamide and entecavir. Most people who begin these
medications will continue them for life.
 Lifestyle changes
Whether or not you’re taking medication for hepatitis B, you’ll
need to take steps to protect your liver from further harm
throughout your life. Healthcare providers particularly
recommend that you avoid alcohol and maintain a healthy,
balanced diet.
Alcohol use and metabolic factors such as a high BMI and high
triglycerides are two of the leading causes of liver inflammation
outside of infection. When you already have chronic hepatitis,
it’s best to limit alcohol, sugar and fat intake to minimize
inflammation.

Surgery

If chronic hepatitis leads to complications such as cirrhosis and

liver failure or liver cancer, you might need to have surgery to
remove part or all of your liver. Your liver can regenerate itself
after a partial resection, as long as enough healthy tissue
remains.
If too much of your liver is diseased or failing, however, you’ll
need a liver transplant to replace it. Most donated livers come
from recently deceased people, and there’s a long waiting list for
these. But you can skip the wait if you’re able to find a living
liver donor.
 Prevention
The best way to prevent infection is vaccination. If you’re
vaccinated against the virus, you won’t have to worry about
accidental exposure in your day-to-day life. However, it does
take about six months to complete the three doses of the
hepatitis B vaccine.
In the short-term, you can reduce your risk by:

 Practicing safe sex.

If you don’t know
whether your partner
is infected, use a
latex or polyurethane
condom.
 Not sharing personal

items that might be

exposed to blood,
such as toothbrushes,
razors, medical
equipment or
needles.
 Planning ahead for
travel abroad.
If you plan to travel to regions where the rate of infection is
relatively high, schedule your vaccinations for before you go.
 Prophylactic treatment. If you think you may have recently
been exposed, you can reduce your risk of infection by
receiving a dose of vaccine and hepatitis B immune globulin
within 24 hours.
 References:
https://www.healthline.com/health/hepatitis-b#treatments
https://www.who.int/news-room/fact-
sheets/detail/hepatitis-b?gclid=Cj0KCQiAj_CrBhD-
ARIsAIiMxT-dWZpfPEhZf0GWJLcqaurDPBx-
KFheOdnan6sQm5495BdrCfqaVVUaAutlEALw_wcB
https://www.mayoclinic.org/diseases-conditions/hepatitis-
b/symptoms-causes/syc-20366802
https://emedicine.medscape.com/article/177632-overview
https://www.healthdirect.gov.au/hepatitis-b
https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/
https://www.hepatitisb.org.au/hepatitis-b-virus-testing-and-
interpreting-test-results/
https://britishlivertrust.org.uk/information-and-
support/liver-conditions/hepatitis-b/tests/