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Health Information

Hepatitis B 

Summary/Definition

The causative agent of this acute infectious disease, which belongs to the infectious diseases of the 3rd class, is the hepatitis B virus.

Ways of spreading

Hepatitis B virus is transmitted through contact with infected blood, sexual contact with an infected person, as well as through infected tools, such as needles, razors, etc., which can cause injury when used. There is a particularly high probability of transmission of the virus from mother to child during childbirth, including both natural childbirth and cesarean section. 

Poor risk group 

High-risk groups for hepatitis B infection include family members infected with hepatitis B virus, patients who often require blood transfusions, patients undergoing hemodialysis, people who inject drugs, medical workers, prisoners and prison staff. 

World statistics

It is estimated that in 2015, 257 million people worldwide were chronically infected with hepatitis B, and 887,000 people died from hepatitis B, with the majority of deaths associated with cirrhosis of the liver and hepatocellular carcinoma. 

The situation of morbidity within the country

In the Republic of Korea in the 1970s and early 1980s, before the introduction of hepatitis B vaccination, there was a high level of positive results for hepatitis B surface antigen. It was about 7-8% among the general population, 5% among women of childbearing age and 4.8% among schoolchildren. However, after the introduction of the hepatitis B vaccine in the Republic of Korea in 1983 and the launch of the national vaccination program in 1995 (when routine vaccination of newborns began), the incidence began to gradually decrease. Since 2010, a system of monitoring infected people has been implemented in the country, within the framework of which there has been a gradual transition from selective surveillance to universal monitoring. Since 2016, less than 400 new cases of infection have been registered annually. Since the vaccination rate against hepatitis B among newborns in the Republic of Korea exceeds 99%, the most important route of infection in the country is perinatal infection, and most cases of infection occur during childbirth. According to the results of the 2018 National Health and Nutrition Examination, the hepatitis B surface antigen positivity index in men and women was 2.9% and 1.9%, respectively. 

< Table: Hepatitis B incidence status within the country > 

Year 2010 year 2011 year 2012 year 2013 year 2014 year 2015 year 2016 year 2017 year 2018 year 2019 year 
Number of messages (Integrated monitoring system) – 462 cases 289 cases 117 cases 173 cases 155 cases 359 cases 391 cases 392 cases 389 cases 

* Hepatitis B: 2000 (infectious diseases of the 2nd class/selective control) → 2010 (infectious diseases of the 2nd class/general control) → 2020 (infectious diseases of the 3rd class/ general control) 
* In accordance with the revised notification on standards for the diagnosis of infectious diseases, the report included changes have been made, according to which, from January 7, 2016, only acute hepatitis B will be reported. 
* Source: Korea Agency for Disease Control and Prevention (2020). Portal of infectious Diseases 

Symptoms 

Incubation period

Clinical symptoms appear after the end of the incubation period, which ranges from 45 to 160 days, on average 120 days after infection. 

Clinical symptoms

1) Acute hepatitis B 

The acute manifestation of the disease includes symptoms such as jaundice, darkening of urine, loss of appetite, nausea, muscle pain, severe fatigue and pain in the right upper abdomen. However, an asymptomatic course of infection is also possible. Usually, the clinical symptoms and functional parameters of the liver are restored, and the virus disappears within 6 months. However, if the virus persists in the body for more than 6 months, and the hepatitis B surface antigen remains positive, chronic hepatitis is diagnosed. 

2) Chronic hepatitis B 

The chronic form of the disease can be either asymptomatic or accompanied by chronic debilitating symptoms, for example, fatigue, general weakness, persistent or periodic jaundice, loss of appetite, as well as end-stage liver failure.

Diagnostics 

If hepatitis B surface antigen (HBsAg) and hepatitis B-specific antibodies (IgM anti-HBc) are detected in the blood sample, a new case of the disease is diagnosed. 

Treatment and course of the disease

Acute hepatitis B

Among adults infected with acute hepatitis B, most recover independently without the need for special treatment. However, the recovery process can be accelerated by following a rest regime and eating protein-rich foods. 

Chronic hepatitis B

Patients who have developed a chronic form of hepatitis B may be prescribed interferon injections and oral antiviral drugs to reduce the degree of liver damage and prevent the development of liver cirrhosis. Before starting treatment, you should consult with your doctor, evaluate the indications for treatment, determine the genotype of the virus, choose the appropriate drug, take into account possible side effects, the potential occurrence of resistance, as well as evaluate the cost and other important aspects of treatment. 

Prevention and vaccination 

Vaccination period and schedule

Newborns are vaccinated at the ages of 0, 1 and 6 months, while children and adults are recommended to have 3 vaccinations at intervals of 0, 1 and 6 months.

Dosage of the vaccine

For children under 10 years of age, a dose of 0.5 ml is used, and for children over 11 years of age – 1.0 ml. 

Method of administration of the vaccine

Infants are injected intramuscularly into the anterior-lateral part of the thigh, and older children and adults are injected into the deltoid muscle. 

Purpose of vaccination

Vaccination is recommended for all infants and adults who have no signs of immunity. 

* Signs of immunity include: a diagnosis of hepatitis B, a positive reaction to antibodies or a previous vaccination against hepatitis B.

Groups at increased risk of hepatitis B infection include

Patients with chronic liver diseases. 

Patients undergoing hemodialysis. 

People infected with HIV. 

Patients who regularly receive blood preparations. 

Medical staff. 

Prisoners in pre-trial detention facilities, including disabled persons and detainees, as well as staff serving them. 

Persons with disabilities living in groups and staff providing their care. 

Family members of hepatitis B virus carriers. 

Injection addicts. 

Groups with a high risk of contracting sexually transmitted diseases.

Complications

In rare cases, acute hepatitis B can progress to fulminant hepatitis, and its main complication is the transition to a chronic form of the disease. Chronic hepatitis B is accompanied by serious complications, including varicose bleeding, hepatic coma, blood clotting disorders, splenomegaly, cirrhosis of the liver with the development of ascites and hepatocellular carcinoma. 

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