Acute Hepatitis B (HBV)

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Infection occurs through blood contact, sexual contact and transmission from mother to child (vertical transmission). The incubation period is 8 to 24 weeks. The diagnosis is made by a very strong increase in transaminases, which may or may not be accompanied by an increase in bilirubin. The hepatitis B surface antigen becomes positive, as does the hepatitis B DNA. 

The course of the disease is determined by the age at which you come into contact with the virus. In newborns, the infection is usually subclinical, but leads to chronicity in 90% of babies. In children, the chance of chronicity is 20% and in the elderly less than 10%. Acute hepatitis B is a rare cause of acute liver failure (ALF).

Mother-to-child transmission is virtually universal. Transmission occurs during childbirth and therefore a caesarean section* is of no benefit. All children of a hepatitis B surface antigen-positive mother should be vaccinated and given immunoglobulins immediately after delivery. Mothers with very high viraemia (> 200,000 IU/ml) are best treated with a polymerase inhibitor in the third trimester of pregnancy.

Acute hepatitis B should not be treated with antiviral therapy unless after several weeks it appears that the serum hepatitis B DNA is still strongly positive. In that case, antiviral therapy can be considered.

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