Hepatitis B
·
Hepatitis is
an inflammation of the liver, most commonly caused by a viral infection. There
are five main hepatitis viruses, referred to as types A, B, C, D and E, but it
can also be caused due to toxins (notably alcohol, certain medications, some
industrial organic solvents and plants), other infections and autoimmune
diseases.
·
Hepatitis A and E are typically caused by ingestion of
contaminated food or water. Hepatitis B, C and D usually occur as a result of
parenteral contact with infected body fluids. Common modes of transmission for
these viruses include receipt of contaminated blood or blood products, invasive
medical procedures using contaminated equipment and for hepatitis B
transmission from mother to baby at birth, from family member to child, and
also by sexual contact.
·
The clinical presentation of infectious hepatitis varies with the
individual, as well as with the specific causative virus. Some patients may be
entirely asymptomatic or only mildly symptomatic at presentation. Others may
present with rapid onset of fulminant hepatic failure (FHF). The classic
presentation of infectious hepatitis involves 4 phases, as follows:
Ø Phase 1 (viral replication phase)
– Patients are asymptomatic during this phase; laboratory studies
demonstrate serologic and enzyme markers of hepatitis
Ø Phase 2 (prodromal phase) – Patients
experience anorexia, nausea, vomiting, alterations in taste, arthralgias,
malaise, fatigue, urticaria, and pruritus, and some develop an aversion to
cigarette smoke; when seen by a health care provider during this phase,
patients are often diagnosed as having gastroenteritis or a viral syndrome
Ø Phase 3 (icteric phase) – Patients
may note dark urine, followed by pale-colored stools; in addition to the
predominant gastrointestinal (GI) symptoms and malaise, patients become icteric
and may develop right upper quadrant pain with hepatomegaly
Ø Phase 4 (convalescent phase) – Symptoms
and icterus resolve, and liver enzymes return to normal
ü Initial features are of nonspecific
flu-like symptoms, common to almost all acute viral infections and may include
malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and
headache. More specific symptoms, which can be present in acute
hepatitis from any cause, are: profound loss of appetite, aversion to smoking
among smokers, dark urine, yellowing
of the eyes and skin (i.e., jaundice) and abdominal discomfort.
Physical findings are usually minimal, apart from jaundice in a third and
tender hepatomegaly (swelling of the liver) in about 10%. Some exhibit
lymphadenopathy (enlarged lymph nodes, in 5%) or splenomegaly (enlargement of
the spleen, in 5%).
ü Acute viral hepatitis is more likely to be asymptomatic in younger
people. Symptomatic individuals may
present after convalescent stage of 7 to 10 days, with the total illness
lasting 2 to 6 weeks.
ü A small proportion of people with acute hepatitis progress to acute liver failure, in which the liver is unable to clear harmful substances from the circulation (leading to confusion and coma due to hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding). This may become life-threatening and occasionally requires a liver transplan
v
ü Chronic hepatitis often
leads to nonspecific symptoms such as
malaise, tiredness and weakness, and often leads to no symptoms at all.
It is commonly identified on blood tests performed either for screening or to
evaluate nonspecific symptoms. The occurrence of jaundice indicates advanced
liver damage. On physical examination there may be enlargement of the liver. WHO estimates that in 2015, 257
million people were living with chronic hepatitis B infection (defined as hepatitis
B surface antigen positive).
ü Extensive damage and scarring of liver (i.e. cirrhosis) leads to
weight loss, easy bruising and bleeding tendencies, peripheral edema (swelling
of the legs) and accumulation of ascites (fluid in the abdominal cavity). Eventually, cirrhosis may
lead to various complications: esophageal varices (enlarged veins in the wall
of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney
dysfunction).
§ Acne, abnormal menstruation, lung scarring,
inflammation of the thyroid gland and kidneys may be present in women with
autoimmune hepatitis.
v Geographical
distribution:
ü Hepatitis B prevalence
is highest in the WHO Western Pacific Region and the WHO African Region, where
6.2% and 6.1% of the adult population is infected respectively. In the WHO
Eastern Mediterranean Region, the WHO South-East Asia Region and the WHO
European Region, an estimated 3.3%, 2.0% and 1.6% of the general population is
infected, respectively. And in the WHO Region of the Americas, 0.7% of the
population is infected.
v Lack of Knowledge About Hepatitis B Disadvantages Black Communities:
ü Hepatitis B is known to affect Black people to a greater extent
than whites in the United States. Only Asians have a higher rate. Both African
American and Haitian Black communities have poor knowledge about the disease,
which might limit prevention, diagnosis and treatment, researchers reported in
a study published in Cancer Causes
& Control.
ü These findings highlight the need for
community-level, culture-specific programs that include Black communities
and guide them toward earlier screening and treatment for hep B.
ü “Essentially, if you don’t know that you have HBV, you cannot
seek treatment for it, and if you develop cancer, you will likely
present when the cancer is advanced and there are fewer options for
treatment,” Patricia Jones, MD, of the University of
Miami’s Sylvester Comprehensive Cancer Center, said in a press release. “We want to interrupt that cycle by better understanding the
perspectives of the populations most affected and creating programs that
address those specific needs.”
ü
Of the estimated 1.4
million people with chronic hep B in the United States, only 26% are aware they
carry the virus. In an earlier study, the researchers had found that despite
being heavily affected by hep B, Blacks were likely to be unaware of their
infection until they were diagnosed with hepatocellular carcinoma. Further,
when diagnosed, African Americans were younger and further along in their disease
progression than their white, Latino and Asian
counterparts.
ü
“When we studied
patients with liver cancer in South Florida, we found that 8% of white liver
cancer patients had long-term HBV infections, compared to 21% of
African-American Black and 30% of Haitian liver cancer patients,” Jones
said.
ü
In South Florida,
Jones and her colleagues recruited Black participants through email, social
media, local radio, word of mouth or a hepatology clinic. Between February 2017
and February 2018, they conducted focus groups in Haitian Creole or English to
determine these communities’ understanding of hep B, hepatocellular carcinoma
and availability of screening.
ü
They included Black
men and women born in the United States or Haiti and excluded any individuals
who had been diagnosed with hepatitis C or who already had cirrhosis or liver
cancer. Of the 55 participants, 15 (27%) had chronic HBV infection.
ü
Among the Haitian
Blacks, only 42% knew about hep B. Comparatively, 78% of African Americans knew
about the virus. People with chronic hep B were more knowledgeable about the
virus than individuals without hep B.
ü
There was little
knowledge about liver cancer within the African-American community, with most
believing it to be uncommon. On the other hand, cirrhosis was reported as being
common, with most participants having some understanding of its causes and
symptoms.
ü
All participants in
this group knew of at least one individual with cirrhosis and considered it to
be related to heavy alcohol and drug use. This group was less aware of hep B,
including its transmission route, and hepatocellular carcinoma. Many
participants were under the impression that hep B was somehow related to
HIV.
ü
In comparison to
African Americans, Haitian Blacks were better informed about cirrhosis and hep
B. They knew about its symptoms and preventive vaccines. But many individuals
were unaware of its transmission route and connection to hepatocellular
carcinoma. Participants from this group also talked about “supernatural” causes
leading to sickness—even though most acknowledged their disbelief in these
long-held and firmly rooted beliefs in the community. While this group knew
that hep B and HIV were different, stigma was associated with both. Those
living with hep B were unlikely to reveal the information to anybody
else.
ü
“In two communities
disproportionately affected by HBV, misconceptions about disease transmission,
stigma, low health literacy and decreased access to care may limit detection
for HBV,” wrote the researchers.
ü
Both communities were
of the opinion that distrust of medical facilities, stigma and fear might
prevent members from accessing health care. Economic disadvantage and lack of
education were held responsible for the higher likelihood of late-stage
diagnosis of hepatocellular carcinoma among Black individuals.
ü
Overall, both groups
believed that a lack of access to opportunities and health care was a result of
the low economic status of their communities. Moreover, these communities
concurred that they are less likely to have access to the care afforded white
people. Census data reaffirmed that white people are more likely to be insured
in comparison with Latinos and Blacks.
ü Further, people who had been diagnosed with hep B reported
having to educate themselves about the viral infection because information from
their providers was lacking. “It’s critical that we, as physicians, ask
how much patients understand and that we assess their understanding,” Jones
said.
ü Through the focus group, it became apparent that more awareness
of hepatitis and cirrhosis is needed across Black communities. Public service
announcements via social media or more traditional institutions, educational
town hall meetings and even Haitian radio would be suitable routes for hep B
education. Getting community leaders involved in the dissemination of this
information would help engage the community. Home-based screening or
using a confidential mobile testing service would also aid in increasing
access.
ü “The key is to understand how to work best with communities and
get people to engage in education, screenings, medical care and research,”
Jones said.
ü In conclusion, the reseachers wrote, “Culturally
relevant community-based interventions are needed to increase HBV detection.”
v Transmission:
ü
In highly endemic areas, hepatitis B is most commonly spread
from mother to child at birth (perinatal transmission), or through horizontal
transmission (exposure to infected blood), especially from an infected child to
an uninfected child during the first 5 years of life. The development of chronic infection is very common in infants
infected from their mothers or before the age of 5 years.
§ As of 2016, 27 million
people (10.5% of all people estimated to be living with hepatitis B) were aware
of their infection, while 4.5 million (16.7%) of the people diagnosed were on
treatment. According to latest WHO estimates, the proportion of children under
five years of age chronically infected with HBV dropped to just under 1% in
2019 down from around 5% in the pre-vaccine era ranging from the 1980s to the
early 2000s.
ü Hepatitis
B is also spread by needlestick injury, tattooing, piercing and exposure to
infected blood and body fluids, such as saliva and, menstrual, vaginal, and
seminal fluids.
ü Sexual transmission of hepatitis
B may occur, particularly in unvaccinated men who have sex with men and
heterosexual persons with multiple sex partners or contact with sex workers.
Infection in adulthood leads to chronic hepatitis in less than 5% of cases,
whereas infection in infancy and early childhood leads to chronic hepatitis in
about 95% of cases.
v Who is
at risk of chronic disease?
ü The
likelihood that infection becomes chronic depends on the age at which a person
becomes infected. Children less than 6 years of age who become infected with
the hepatitis B virus are the most likely to develop chronic infections.
ü In
infants and children:
§ 80–90% of infants
infected during the first year of life develop chronic infections; and
§ 30–50% of children
infected before the age of 6 years develop chronic infections.
ü In
adults:
§ less than 5% of
otherwise healthy persons who are infected as adults will develop chronic
infections; and 20–30% of adults who are chronically infected will develop
cirrhosis and/or liver cancer.
v
About
Virus:
ü The
hepatitis B virus can survive outside the body for at least 7 days. During this
time, the virus can still cause infection if it enters the body of a person who
is not protected by the vaccine. The incubation period of the hepatitis B virus
is 75 days on average, but can vary from 30 to 180 days. The virus may be
detected within 30 to 60 days after infection and can persist and develop into
chronic hepatitis B.
Diagnosis:
ü It is not possible, on clinical
grounds, to differentiate hepatitis B from hepatitis caused by other viral
agents, hence, laboratory confirmation of the diagnosis is essential. A number
of blood tests are available to diagnose and monitor people with hepatitis B.
They can be used to distinguish acute and chronic infections.
There are several laboratory tests that may be used in cases of known or
suspected hepatitis, including:
§
Abdominal ultrasound
§
Autoimmune blood markers
§
Hepatitis virus
serologies
§
Liver function tests
§
Liver biopsy to check
for liver damage
§
Paracentesis (if fluid
is in your abdomen)
§
Detection of immunoglobulin
M (IgM) for hepatitis A virus (HAV) is the standard for diagnosing acute
infection with HAV.
§
Detection of IgM for
hepatitis B core antigen (HBcAg) in serum is required to make the diagnosis of
acute hepatitis B virus (HBV) infection. Hepatitis B surface antigen (HBsAg)
may be present in acute infection or in patients who are chronic carriers. Its
presence in patients with symptoms of acute hepatitis strongly suggests acute
HBV infection but does not rule out chronic HBV with acute superinfection by
another hepatitis virus. The presence of HBsAg in the serum for 6 months or
longer indicates chronic infection.
§
Hepatitis C virus (HCV)
infection can be confirmed with serologic assays to detect antibody to HCV
(anti-HCV) or with molecular tests for the presence of viral particles.
Third-generation assays for anti-HCV are sensitive and specific and can detect
such antibodies within 4-10 weeks of infection. A rapid antibody test strip has
now been approved. Qualitative polymerase chain reaction (PCR) assay for
presence of viral particles is the most specific test of HCV infection and may
be helpful in diagnosing acute HCV infection before antibodies have developed.
§
Assays to detect IgM
antibody to hepatitis D virus (HDV) do not need to be routinely performed in
all patients with suspected hepatitis.
v Treatment:
ü There
is no specific treatment for acute hepatitis
B. Therefore, care is aimed at maintaining comfort and adequate nutritional
balance, including replacement of fluids lost from vomiting and diarrhoea.
Most important is the avoidance of unnecessary medications . Acetaminophen/Paracetamol and medication
against vomiting should not be given.
You’ll have to give up things that can hurt your liver, like alcohol and acetaminophen. Check
with your doctor before taking any other drugs, herbal treatments, or supplements.
ü Chronic hepatitis
B infection can be treated with medicines, including oral antiviral agents.
Treatment can slow the progression of cirrhosis, reduce incidence of liver
cancer and improve long term survival. Only a proportion (estimates vary from
10% to 40% depending on setting and eligibility criteria) of people with
chronic hepatitis B infection will require treatment.
ü WHO
recommends the use of oral treatments - tenofovir or entecavir- as the most
potent drugs to suppress hepatitis B virus. They rarely lead to
drug resistance compared with other drugs, are simple to take (1 pill a day),
and have few side effects, so require only limited monitoring.
§ Entecavir
(Baraclude). This is the newest drug for hepatitis B. You can
take it as a liquid or tablet.is off-patent. In 2017, all low- and
middle-income countries could legally procure generic entecavir, but the costs
and availability varied widely.
§ Tenofovir (Viread). This drug comes as a powder or tablet. If you take
it, your doctor will check often to make sure it doesn’t hurt your kidneys.This drug is no
longer protected by a patent anywhere in the world. The median price of
WHO-prequalified generic tenofovir on the international market fell from US$
208 per year to US$ 32 per year in 2016.
§
Lamivudine (3tc, Epivir A/F, Epivir HBV,
Heptovir). It
comes as a liquid or tablet you take once a day. Most people don’t have a
problem with it. But if you take it for a long time, the virus might stop responding
to the drug.
§
Adefovir dipivoxil
(Hepsera). This drug, which you
take as a tablet, works well for people who don’t respond to lamivudine. High
doses can cause kidney problems.
§ Interferon alfa (Intron A, Roferon A, Sylatron). This medicine boosts your immune system. You take it as a shot for at least 6 months. It doesn’t cure the disease. It treats liver inflammation. Long-acting interferon, peginterferon alfa2a (Pegasys, Pegasys Proclick), can also help. But this drug can make you feel bad all over or depressed, and it can and zap your appetite. It also lowers your white blood cell count, which makes it harder to fight off infection.
§ Telbivudine (Tyzeka) is an antiviral medication. Resistance to this medication is common.
ü In most
people, however, the treatment does not cure hepatitis B infection, but only
suppresses the replication of the virus. Therefore, most people who start hepatitis B treatment must continue it for life.
ü There
is still limited access to diagnosis and treatment of hepatitis B in many
resource-constrained settings. In 2016, of the more than 250 million people
living with HBV infection, 10.5% (27 million) were aware of their infection. Of
those diagnosed, the global treatment coverage is 16.7% (4.5 million). Many
people are diagnosed only when they already have advanced liver disease.
ü Among
the long-term complications of HBV infections, cirrhosis and hepatocellular
carcinoma cause a large disease burden. Liver cancer progresses rapidly, and
since treatment options are limited, the outcome is generally poor. In
low-income settings, most people with liver cancer die within months of
diagnosis. In high-income countries, surgery and chemotherapy can prolong life
for up to a few years. Liver transplantation is sometimes used in people with
cirrhosis in high income countries, with varying success.
v Ayurveda
Perspective & Management of Hepatitis:
ü
In Ayurveda, the liver is called Yakrit. Pitta is the predominant humor of the liver.
Most liver disorders are aggravated conditions of Pitta.
ü
Excessive bile production or a blockage in the flow of bile
usually indicates high pitta, which in turn affects the agni or enzyme
activities responsible for absorption, digestion and metabolism.
ü
Aggravation of the Pitta causes the liver diseases such as
hepatitis, cirrhosis and fatty liver.
ü
Kaamala is the
term mentioned in Ayurveda to describe the wide range of liver diseases
including Hepatitis. Kaamala is
a disease of the Raktavaha srotas (a system which includes liver, spleen, blood
vessels, and reticuloendothelial tissue) and dominant of pitta dosha. Kaamala is caused due to impairment of pitta dosha and rakta dhatu.
ü
Ayurveda describes various types of kaamala (hepatitis
or jaundice) based on the stage or depth of the symptoms. They are:
§
Shakhasrita – is caused by the aggravation of all the doshas (Vata, Pitta and
Kapha), and is a kind of obstructive jaundice.
§
Koshta shakhsrita – results from very high pitta derangement and considered as
severe jaundice or hepatitis, difficult to cure.
§
Kumbha kamala – is a neglected or untreated stage of jaundice or
hepatitis. It can become incurable if not attended immediately. It can be
compared with Cirrhosis of liver.
§
Haleemaka – is an advanced or neglected stage of Paandu roga that occurs
when both the vata and pitta are out of level.
§
Various herbal centre are
providing highly effective treatment for various type or Hepatitis including
hepatitis B & hepatitis C. Their treatment is useful in controlling the
infection & replication of the virus, preventing further damage to liver.
Hepatitis B patients show better response than Hepatitis C.
ü
Their treatment involves
Shodana chikitsa (detoxification through Panchakarma procedures), Shamana
chikitsa (Palliative researched Ayurvedic medicines) and Kayakalpa
(rejuvenation).
ü
Diet restrictions, life style modifications and de-addiction are
also the essential factors practiced for the best possible results.
v Prevention:
ü The hepatitis B vaccine is the
mainstay of hepatitis B prevention. WHO recommends that all
infants receive the hepatitis B vaccine as soon as possible after birth,
preferably within 24 hours – followed by two or three doses of hepatitis B
vaccine at least four weeks apart to complete the series. Timely birth dose is
an effective measure to reduce transmission from mother-to-child.
ü This
marks the achievement of one of the milestone targets to eliminate viral
hepatitis in the Sustainable Development Goals ─ to reach under 1% prevalence
of HBV infections in children under five years of age by 2020.
ü
The scale-up of hepatitis B vaccine worldwide over the last two
decades has been a great public health success story and contributed to the
decrease in HBV infections among children
ü In
2019, coverage of 3 doses of the vaccine reached 85% worldwide compared to
around 30% in 2000. However, coverage of the hepatitis B vaccine birth dose
remains uneven. Global coverage of the HBV birth dose, for example, is 43%,
while coverage in the WHO African Region is only 6%. .
ü The
complete vaccine series induces protective antibody levels in more than 95% of
infants, children and young adults. Protection lasts at least 20 years and is
probably lifelong. Thus, WHO does not recommend booster vaccinations for
persons who have completed the 3-dose vaccination schedule.
ü All
children and adolescents younger than 18 years and not previously vaccinated
should receive the vaccine if they live in countries where there is low or
intermediate endemicity. In those settings it is possible that more people in
high-risk groups may acquire the infection and they should also be vaccinated.
This includes:
§ people who frequently
require blood or blood products, dialysis patients and recipients of solid
organ transplantations;
§ people in prisons;
§ people who inject drugs;
§ household and sexual
contacts of people with chronic HBV infection;
§ people with multiple
sexual partners;
§ healthcare workers and
others who may be exposed to blood and blood products through their work; and
§ travellers who have not
completed their HBV series, who should be offered the vaccine before leaving
for endemic areas.
ü The
vaccine has an excellent record of safety and effectiveness and the
proportion of children under five years of age chronically infected with HBV
dropped to just under 1% in 2019 down from around 5% in the pre-vaccine era
ranging from the 1980s to the early 2000s.
ü In addition to infant
vaccination, including a timely birth dose, WHO recommends the use of antiviral
prophylaxis for the prevention of hepatitis B transmission from mother-to-child.
Pregnant women with high levels of HBV DNA (viral load) and/or the presence of
HBeAG have an elevated risk of transmitting the virus to their child, even
among infants who receive the timely birth dose and the complete hepatitis B
vaccine series. As such, pregnant women with high HBV DNA levels may be
eligible for antiviral prophylaxis during pregnancy to prevent perinatal HBV
infection and protect their infants from contracting the disease.
ü In
addition to infant vaccination and prevention of mother-to-child-transmission,
implementation of blood safety strategies, including quality-assured screening
of all donated blood and blood components used for transfusion, can prevent
transmission of HBV. Furthermore, safer sex practices, including minimizing the
number of partners and using barrier protective measures (condoms), also
protect against transmission.
v WHO
response :
ü In May
2016, the World Health Assembly adopted the first "Global health sector strategy on
viral hepatitis, 2016-2020". The strategy highlights the
critical role of universal health coverage and sets targets that align with
those of the Sustainable Development Goals.
ü The
strategy has a vision to eliminate viral hepatitis as a public health problem.
This is encapsulated in the global targets to reduce new viral hepatitis
infections by 90% and reduce deaths due to viral hepatitis by 65% by 2030.
Actions to be taken by countries and the WHO Secretariat to reach these targets
are outlined in the strategy.
ü To
support countries in achieving the global hepatitis elimination targets under
the Sustainable Development Agenda 2030, WHO is working to:
§ raise awareness, promote
partnerships and mobilize resources;
§ formulate evidence-based
policy and data for action;
§ increase health equities
within the hepatitis response
§ prevent transmission;
and
§ scale up screening, care
and treatment services.
ü In
March 2015, WHO launched its first "Guidelines
for the prevention, care and treatment of persons living with chronic hepatitis
B infection".
ü The
recommendations include:
§ promote the use of
simple, non-invasive diagnostic tests to assess the stage of liver disease and
eligibility for treatment;
§ prioritize treatment for
those with the most advanced liver disease and at greatest risk of mortality;
and
§ recommend the preferred
use of the nucleos(t)ide analogues with a high barrier to drug resistance
(tenofovir and entecavir, and entecavir in children aged 2–11 years) for first-
and second-line treatment.
ü These
guidelines also recommend lifelong treatment for those with cirrhosis and those
with high HBV DNA and evidence of liver inflammation, and regular monitoring
for those on treatment, as well as those not yet on treatment for disease
progression, indications for treatment and early detection of liver cancer.
ü In July
2020 WHO published additional guidance on “Prevention of mother-to-child
transmission of hepatitis B virus: Guidelines on antiviral prophylaxis in
pregnancy”.
ü In
addition to the series of hepatitis B vaccinations (including a first dose
within 24 hours of birth), WHO now recommends that pregnant women testing
positive for HBV infection (HBsAg positive) with an HBV DNA equal to or greater
200,000 IU/ml receive tenofovir prophylaxis; the preventive
therapy should be provided from the 28th week of pregnancy
until at least birth.
ü Some
settings have poor access to tests that quantify an individual’s HBV viral load
and determine whether a pregnant woman would be eligible for preventative
treatment or prophylaxis. This is especially the case in low income settings or
rural areas where many antenatal care visits take place. In settings where
antenatal HBV DNA testing is not available, WHO now recommends the use of HBeAg
testing as an alternative to determine eligibility for tenofovir prophylaxis
for the prevention of mother-to-child transmission of HBV.
ü The
hepatitis B testing and treatment of eligible pregnant women can be integrated
with the prevention of mother-to-child transmission of HIV and congenital
syphilis with antenatal care service. This approach is often referred to as
‘Triple elimination’ – an initiative that promotes the elimination of
mother-to-child transmission of three infections: HIV, syphilis and hepatitis B
virus.
ü In
addition, WHO recently published the “Progress report on HIV, viral hepatitis
and sexually transmitted infections, 2019”, outlining its progress towards
elimination. The report sets out global statistics on viral hepatitis B and C,
the rates of new infections, the prevalence of chronic infections and mortality
caused by these 2 high-burden viruses, and coverage of key interventions, all
current as at the end of 2016 and 2017.
ü Moreover,
since 2011, together with national governments, partners and civil society, WHO
has organized annual World Hepatitis Day campaigns (as 1 of its 9 flagship
annual health campaigns) to increase awareness and understanding of viral
hepatitis. The date of 28 July was chosen because it is the birthday of
Nobel-prize winning scientist Dr Baruch Bloomberg, who discovered the hepatitis
B virus and developed a diagnostic test and vaccine for it.
ü
For World Hepatitis Day 2020, WHO is focusing on the theme
“Hepatitis-Free Future” to highlight the importance of addressing the
prevention of mother-to-child transmission of HBV, launch new guidance,
and to call for increased domestic and international programming and
funding to prevent hepatitis B mother-to-child transmission and
expand access to hepatitis prevention, testing and treatment services, with a
view to achieving the 2030 elimination targets
0 Comments