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Hepatitis B

Definition
Hepatitis B is inflammation (irritation and swelling) of the liver due to the hepatitis B virus (HBV).

Key facts

* Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
* The virus is transmitted through contact with the blood or other body fluids of an infected person - not through casual contact.
* About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B.
* About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.
* The hepatitis B virus is 50 to 100 times more infectious than HIV.
* Hepatitis B virus is an important occupational hazard for health workers.
* Hepatitis B is preventable with a safe and effective vaccine.

Causes:

The hepatitis B virus spreads through blood and other body fluids. Infection can occur if you have:

* Blood transfusions
* Contact with blood in healthcare settings
* Received a tattoo or acupuncture with contaminated instruments
* Shared needles during drug use
* Unsafe sex with an infected person

The hepatitis B virus can be passed to an infant during childbirth or shortly thereafter if the mother is infected.

The risk of becoming chronically infected depends on your age at the time of infection. Most newborns and about 50% of children infected with hepatitis B develop chronic hepatitis. Only a few adults infected with HBV develop the chronic condition.

Most of the damage from hepatitis B virus is due to by the body's response to the infection. When the body's immune system detects the infection, it sends out special cells to fight it off. However, these disease-fighting cells can lead to liver inflammation. The liver damage also interferes with the body's ability to get rid of bilirubin, a breakdown product of old red blood cells). This leads to jaundice (yellow discoloration of the eyes and body) and dark urine.

Symptoms

It takes about 1-6 months from the time of infection until symptoms of acute hepatitis appear. Early symptoms may include:

* Appetite loss
* Fatigue
* Low-grade fever
* Muscle and joint aches
* Nausea and vomiting
* Yellow skin and dark urine due to jaundice

Treatment
There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Chronic hepatitis B can be treated with drugs, including interferon and anti-viral agents, which can help some patients. Treatment can cost thousands of dollars per year and is not available to most patients in developing countries.

Liver cancer is almost always fatal, and often develops in people at an age when they are most productive and have family responsibilities. In developing countries, most people with liver cancer die within months of diagnosis. In higher income countries, surgery and chemotherapy can prolong life for up to a few years in some patients.

Patients with cirrhosis are sometimes given liver transplants, with varying success.

Ayurvedic Treatment:
In Ayurveda many antiviral drugs are being used as the treatment of Hepatitis B along with the medicine of common hepatitis and some immunomodulaters.
phyllanthus amarus and phyllanthus niruri are the major antiviral herbs that used in hepatitis B. Three therapeutically active substances of phyllanthus amarus show activity against the hepatitis virus, improve the body's immune system and protect the liver. Immunomodulator like Guduchi, Aswagandha and Amala are also used in Ayurveda.

-Bhoomyaamlaki (phyllanthus niruri), a small herb with numerous leaves, is commonly used in the treatment of all types of jaundice. One teaspoonful of the juice of the plant or fresh root in the form of paste can be taken thrice daily mixed with honey.
-the leaves of Guduchi (Gurjo In Nepali) or Tinospora cordifolia made into a paste with whey, may be used in 5gm dose with whey, or milk with dry ginger powder or turmeric reduced to pulv should be taken in the morning.
-the decoction of the three myrobalans or triphala, Guduchi (Gurjo In Nepali) or Tinospora cordifolia, Berberis asiatica or Chutro and the expressed juice of the bark of Melia Azadirachta (Bakaino in Nepali) mixed with honey may also be taken every morning.
Punarnava mandoor 2 tablet thrice daily should be taken for 2 to 3 weeks. Navaayas Loha taken in the dose of 125 mg thrice daily is an effective remedy for jaundice.
Other useful medicines are
- Rohitakyadi churna
-Phalatrikadi Kada
-Kumaryasava
- Kamalari vati
- Punarnavadi Mandura
- Arogyavardhini Vati
- Sheeta Rasa
- lohaasava and punarnavaasava.

Patent Drug for Liver Disorder
MV Liv (Gorkha Ayurved company)
Dose:  Adult : 2 tablets three times a day.  Children: 1 tablet three times a day.  To be taken orally with water on empty stomach.

Prevention
All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis B prevention.

The vaccine can be given as either three or four separate doses, as part of existing routine immunization schedules. In areas where mother-to-infant spread of HBV is common, the first dose of vaccine should be given as soon as possible after birth (i.e. within 24 hours).

The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. After age 40, protection following the primary vaccination series drops below 90%. At 60 years old, protective antibody levels are achieved in only 65 to 75% of those vaccinated. Protection lasts at least 20 years and should be lifelong.

All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. People in high risk groups should also be vaccinated, including:

* persons with high-risk sexual behaviour;
* partners and household contacts of HBV infected persons;
* injecting drug users;
* persons who frequently require blood or blood products;
* recipients of solid organ transplantation;
* those at occupational risk of HBV infection, including health care workers; and
* international travellers to countries with high rates of HBV.

The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.

As of December 2006, 164 countries vaccinate infants against hepatitis B during national immunization programmes - a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.

Compiled by: Dr Raja Ram Dhungana





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