Hepatitis B is one of the most common causes of viral hepatitis worldwide. The world health organization (WHO) estimates that around 257 million people in the world are living with chronic Hepatitis B virus (HBV) infection.
Dr Nor Hayati Bte Shaharuddin
Consultant Internal Medicine/Infectious Disease
BMBS (Flinders), M.MED. INT MED (UKM), Fellowship in Infectious Disease Medicine (KKM)
Pantai Hospital Ayer Keroh
In 2015, WHO reported that HBV has resulted in more than 800 000 deaths. Most of it was due to its late complications such as liver failure, liver chirrosis and hepatocellular carcinoma. Hepatitis B is endemic in the South East Asia region. It is estimated that 2.0% of the general population in SEA is infected.
However, despite it being a common infection, there are quite a number of common myths and misunderstanding about this common disease:
Myth #1. Hepatitis B can be transmitted easily through casual contact such as touching, hugging, kissing, eating together, using public toilet, swimming in the public swimming pool as well as eating seafood.
Fact: Hepatitis B can only spread from an infected person to another person via blood or other bodily fluids such as semen, vaginal fluid. Hence, the virus can transmit through unprotected sex, sharing needles or syringes among intravenous drug users, exposure to contaminated equipments at barber shops or while doing tattoo but not through casual contacts. Additionally, pregnant women can also spread the virus to their babies during childbirth.
Therefore, hepatitis B patients do not have to avoid close contact with people and other people also do not have to discriminate against someone known to have hepatitis B. They do not have to eat separately or use separate bathrooms. They should avoid sharing personal hygiene items such as a toothbrush, razor and nail clipper as these products could be contaminated with their infected blood. They should also not donate blood.
Hepatitis B does not spread by consumption of seafood. Among the different types of viral hepatitis, only hepatitis A and E are transmitted through contaminated food and water (i.e. oral-fecal route).
Myth #2: Hepatitis B infection is due to poor hygiene, and therefore occurs only in developing countries.
Fact: No. Hepatitis B infection is not related to the standards of hygiene. It is not transmitted by direct contact. Hepatitis B is not just endemic in Asia and Africa but it is also a prevalent disease in many parts of the world inclusive the affluent region of Asia and Australia.
Myth#3: I have always been healthy. If I have hepatitis B, I would have symptoms.
Fact: Hepatitis B patients usually do not have any noticeable signs and symptoms. A person who has been infected with the virus for many years may not feel any difference from anyone else. They may only experience symptoms when they have more advanced disease and their liver cannot function normally. Hence, not having any symptoms does not mean that you are not infected. The only sure way to find out whether you have been infected or not is by doing a hepatitis B blood test.
Myth #4: HBV infection is only an acute infection and it will never become chronic. Once infected by the virus, the person’s body will have its own system to clear the virus and make the person clear of the infection. Hence, HBV infection will never cause chronic liver disease/liver chirrosis or liver cancer.
Fact: This is not true. HBV infection can both be acute or chronic. Only about 90 percent of patients who are acutely infected with HBV, especially those who are older than 5 years will recover from the infection and develop immunity against the virus. Another 10 Percent of the infected patients will continue to have a chronic HBV infection, which could lead to serious liver diseases and complications. However, if the infection occurs at age less than 5 years, 60-90 percent of these children will become chronic carriers of HBV. HBV infection is one of the main causes of liver cancer.
Myth #5: Herbal medications are effective as treatment for HBV infection and its complications such as liver cirrhosis and liver cancer.
Fact: At present, there has been no scientific research showing any herbal drugs as effective treatment for HBV infection, liver cirrhosis and liver cancer. On the other hand, the ministry of health and the pharmaceutical bureau has reported that a number of herbal preparations can cause acute hepatitis and jaundice. Therefore, one should consult with physician before taking any herbal preparations.
Myth #6: Hepatitis B patients have to be on a special diet that excludes fatty and fried foods, eggs, cold foods such as ice creams etc.
Fact: They do not have to be on any special diet. They can eat a normal and well balanced diet without having to exclude cold foods, eggs, meats or fatty foods. However, if the patients are overweight or have high cholesterol, they should lose weight and be on a diet to control their cholesterol since fat is “toxic” to liver. Patients with chronic HBV infection should also be avoid consumption of alcohol as this can only worsen their liver function.
Myth #7: Healthy carriers of HBV and chronic HBV infection are two different entities. A healthy carrier of HBV is healthy and has no liver damage. A person with chronic HBV infection has a progressive disease and bound to develop liver chirrosis and liver cancer.
Fact: No. That’s not true. There is no such condition known as a healthy carrier. All patients with HBV infection and have not managed to clear the virus from their body are regarded as chronic hepatitis patients. The chronically infected patient needs lifelong monitoring even though they are well and healthy. The state of the infected liver can change without notice and the disease may progress leading to liver damage.
Myth #8: Hepatitis B infection is a rare infection and mainly occurs in people with blood group B.
Fact: No. That’s not true. Hepatitis B is one of the most common infectious diseases in the world and it can happen to anyone. It has got nothing to do with the person’s blood group.
Myth #9: Hepatitis B vaccines will prevent people with HBV infection from getting sicker.
Fact: No. That’s not true. The Hepatitis B vaccine is only effective for people who have not been infected with the HBV. HBV vaccine prevents infection. It is not meant to hasten the disease process once a person has been infected with HBV. People who have been infected need to consult their medical professionals about the best treatments for controlling the virus.
Myth #10: I have been diagnosed as having a chronic HBV infection. This means that I will sure die of a liver disease or liver cancer one day and I can’t have a child of my own as when I have an unprotected sex with my husband, I will transmit the HBV infection to him and when I give birth to a child, I will also transmit the HBV to my baby.
Fact: No. That’s not true. People with chronic HBV infection can lead a normal life, get married and have own children without having to transmit the HBV to their spouse and their offspring. HBV infection can be prevented with vaccination. The vaccine is safe. It is also extremely effective provided you complete all 3 doses. Please consult your physician regarding how to prevent and to treat HBV infection.