Summary: Hepatitis B is a serious global public health problem caused by the infection of the Hepatitis B virus (HBV), with severe consequences for chronic hepatitis, cirrhosis and liver cancer. The purpose of this paper is to provide a comprehensive picture of the viral characteristics, transmission routes, clinical performance, diagnostic methods, treatment strategies and preventive measures for hepatitis B in order to raise public awareness of the disease, promote early diagnosis, effective treatment and active prevention and reduce the incidence and burden of hepatitis B.
Introduction
Hepatitis B is an ancient and common infectious disease that has long plagued human health. According to estimates by the World Health Organization, around 296 million people globally are chronically infected with HBV, and about 820,000 people die every year from HBV-related diseases such as cirrhosis and liver cancer. In China, the prevention and control of viral hepatitis B is a major challenge, with a large number of people infected, placing an enormous economic and psychological burden on society and families. In-depth knowledge of hepatitis B is of great importance for its response.
II. Victorological characteristics
Hepatitis B virus is a hepatitis DNA virus, spherical, approximately 42nm in diameter. The viral particles consist of two parts of the membrane and the core, which contains a surface antigen (HBsAg) of hepatitis B, which induces the organism to produce protective antibodies. The core component contains Hepatitis B core antigens (HBcAg), Hepatitis B e antigens (HBAg) and viruses’ genomes DNA and DNA polymerase. The HBV genome, which is less than complete double-chained DNA, has a unique way of replicating it, i.e. through a retrogressive process, which allows the virus to persist in liver cells and is difficult to completely remove and is one of the major causes of the chronicization of hepatitis B.
III. Means of dissemination
1. Mother-to-child transmission
This is one of the most important means of transmission of viral hepatitis B, mainly intrauterine infections, delivery and post-partum transmission. Intrauterine infections refer to the transmission of HBV through the placenta of the foetus within the womb, which is difficult to prevent, although the incidence is relatively low. The most common transmission occurs at birth, where newborns are infected with mother blood, sheep water or vaginal secretions containing HBV. Post-natal transmission occurs mainly through breastfeeding and close contact between mother and child, but this mode of transmission is relatively rare and can be effectively avoided by taking appropriate preventive measures.
Blood transmission
– Blood transfusion and blood products: The importation of blood or blood products containing HBV can lead to infection, but this mode of transmission has been effectively controlled as modern blood screening techniques have been improved.
– Unsafe injection: HBV can be transmitted by blood, for example, by sharing syringes for drug use, injecting with medical devices that are not strictly sterile, acupuncture, tattoos, etc.
3. Sexual exposure transmission
Unprotected sexual contact with persons infected with Hepatitis B, HBV can enter a healthy person through broken mucous membranes or skin, especially among multiple sexual partners, homosexuals, etc., at higher risk of sexual transmission.
IV. Clinical performance
1. Acute viral hepatitis B
– The saloon type, where the disease is relatively slow, with symptoms such as fever, lack of strength, appetite, anorexia, nausea, vomiting, abdominal pain, diarrhoeal diseases, similar to cold or gastrointestinal diseases. As the condition progresses, the urine color is gradually increased as a tea sample, and the filaments and skins are yellow, with corrosive pains in the liver, hepatic swelling and concussion and crouper pain. Yellow stings generally peaked in 1-3 weeks, then gradually receded, and the entire pathology was about 2-4 months.
– Yellow-free: the symptoms are relatively light, and yellow-free, mainly manifested in weakness, appetite, abdominal swelling, pain in the liver, etc., are easily neglected or misdiagnosed, and generally shorter.
Chronic viral hepatitis B
Patients who have been infected with HBV have not recovered for more than six months and can develop into chronic viral hepatitis B. Most patients suffer from symptoms that are not visible, or that are characterized by mild insufficiency, appetite, liver disorders and repeated abnormality in the liver. Some patients can be accompanied by extra-hepatic manifestations, such as spider moles, liver palms, male breast development, which, as the disease progresses, can evolve into cirrhosis of the liver, serious complications such as abdominal water, abdominal dysentery fractures, liver cerebral disease, and even liver cancer.
V. Diagnosis
1. Serumology and virology
– Hepatitis B, two-and-a-half tests: HBsAg, anti-HBs, HBAg, anti-Hbe and anti-Hbe, are common screening indicators for the diagnosis of viral hepatitis B. The HBsAg positive indicates infection with HBV; the anti-HBs create protective antibodies for the organism, and the positive expression is immune; the HBAg positive virus is active and contagious; the anti-HB positive suggests to some extent that the replicability of the virus is decreasing; and the anti-HBc represents the core antibody of Hepatitis B, provided that the virus has been infected, whether or not the virus has been removed, and is usually positive for life.
– HBV DNA Quantification: The amount of HBV that can be detected in blood reflects the level of replicability of the virus, which is important for the diagnosis of the condition, the evaluation of the efficacy of the antiviral treatment and the prediction of the progress of the disease.
2. Inspection of liver function
Indicators such as diarrhea enzyme (ALT), diagrass enzyme (AST), total cholesterol, direct cholesterol, protein, ball protein, etc. can reflect the extent of hepatic inflammation, chromone metabolism and the synthesis function of the liver. Chronic type B viral hepatitis patients have chronic hepatitis abnormalities, as shown by the increase in the ALT, AST, cholesterol (in the case of yellow slurry patients), protein decline, ball protein rise, etc.
3. Liver video screening
– Ultrasound examination: the morphology, size and mass of the liver can be observed, with or without hepatic fibrosis, cirrhosis and liver cancer, as well as the detection of door veins, spleen vein diameter and blood flow, spleen size, etc., are commonly used as a method of visual screening for hepatitis B patients.
– CT and MRI: more accurate and detailed diagnosis of liver pathologies, especially of significant value in the detection of early liver cancers, but at relatively high cost, is generally used when ultrasounds reveal anomalies or conditions that require further assessment.
Treatment
1. Antiviral treatment
Antiviral treatment is the key to chronic viral hepatitis B treatment, which aims at inhibiting the replicability of the virus, reducing hepatitis and slowing the development of liver fibrosis, cirrhosis and liver cancer. The commonly used antiviral drugs are nucleotide analogues (e.g. Nteikave, Tinovellone, etc.) and interferostats (including general interferoferants and polyethylene interfluent). The nucleotide analogue has the advantage of being antiviral, less reactive and easy to use, and requires long-term administration; it not only inhibits the replicability of the virus, but also has immuno-regulating effects, which are relatively fixed, but have more adverse effects, such as heat, lack of strength, bone marrow inhibition, mental symptoms, etc., and some patients are unfit for use. Adaptation certificates, drug choices and treatments should be determined on the basis of such factors as the age of the patient, his or her condition, the volume of the virus, his or her liver function, and whether he or she has cirrhosis. During the treatment, serosy, viral and liver function indicators are regularly monitored, the effectiveness of the treatment is assessed and the treatment programme is adjusted in a timely manner.
Hepatotherapy
For patients with hepatic abnormalities, hepatopharmaceuticals such as glyceric acid formulations, hydroacthylene and bicyclic alcohol can be used to mitigate the response to hepatitis and to promote hepatocellular repair, but hepatopharmaceuticals are not a substitute for antiviral treatment, but only as part of a combination.
3. Treatment of symptoms
Treatment of the symptoms of the patient, such as cholesterol treatment, should be provided for patients with abdominal cirrhosis, sodium salt should be restricted for patients with abdominal cirrhosis, urethrin should be used to facilitate the discharge of the abdominal water, and, if necessary, abdominal puncture or other treatment for corral cirrhosis.
Prevention
Vaccination
Hepatitis B vaccination is the most effective measure against hepatitis B. Hepatitis B vaccine will require 3 doses of vaccine for the entire course, which will follow the 0, 1 and 6-month procedure. Neonatals should be vaccinated against hepatitis B as early as 24 hours after birth, while hepatitis B immunoglobins should be injected in different areas, which can significantly improve the impact of the disruption of mother-to-child transmission. People at high risk, such as medical personnel, people exposed to blood on a regular basis, family members of persons infected with hepatitis B virus, should also be vaccinated against hepatitis B, which can stimulate the body to produce anti-HBs and effectively prevent HBV infections.
2. Cutting out transmission channels
– Obstruction of mother-to-child transmission: in addition to neonatal vaccination against hepatitis B and hepatitis B immuno-protein, antiviral treatment is available for pregnant women infected with hepatitis B virus at the end of pregnancy, further reducing the risk of mother-to-child transmission. At the same time, natural childbirth is promoted in order to avoid the risk of mother-to-child transmission due to cervix and to encourage artificial feeding after the birth.
– Prevention of blood transmission: strengthening of blood management, rigorous screening of blood donors for HBV infections and ensuring safe use of blood. To promote the use of medical devices such as disposable syringes and infusions, acupuncture needles, tattoo needles, etc., should be strictly disinfected and medical transmission should be eliminated.
– Sexual contact transmission prevention: promotion of safe sex, correct use of condoms and effective reduction of the risk of sexual contact transmission of HBV. Hepatitis B vaccination should be provided in a timely manner to the sexual partner of the person infected with Hepatitis B.
Conclusions
Hepatitis B is an infectious disease that seriously endangers human health, and there is a long way to go to combat it. Increased public education, increased awareness of hepatitis B, universal vaccination, strict cut-off of transmission routes and regulated diagnosis, treatment and management of patients can effectively reduce the incidence and burden of hepatitis B and improve the quality of life and preparation of patients, leading to effective control and elimination of hepatitis B.
viral hepatitis
