What is Hep-B

What is the Hepatitis B (Hep-B) virus and how does it work?

Hepatitis B (Hep-B) is a virus which is very common in The Gambia (about 10% of adults >30 years are infected with the virus). Most are not even aware of it. This virus can be passed in blood, from mother to child at birth, or in early life from child to child with close contact. For the last 30 years, most children in Gambia have been vaccinated against HBV. However, adults over 30 years of age were born before the vaccine was introduced and may carry the virus. People with Hep-B who are carriers of this virus usually have no symptoms. When a person is infected the virus goes to the liver, where it lives in the liver cells.

Sometimes the body gets rid of the virus, or accepts the virus and there is no liver damage (Inactive low risk carriers which constitutes the majority, over 90%). In a small proportion of individuals (<10%) however, the virus remains active and causes the liver to become inflamed and eventually damaged, leading to cirrhosis (irreversible scarring) of the liver or even liver cancer. Liver cancer is the commonest cancer in Gambian men and third commonest in women, and is responsible for many premature deaths in young Gambians.

How do I know my status?

Visit the nearest health facility and get tested for Hep-B virus. It is a rapid test with only a finger-prick test that requires a single drop of blood.
What does a positive test result mean? The blood test confirms that you are infected with the Hep-B virus. However this does not show if the virus is active in your body, if it is causing damage to your liver or if treatment is required.

What is the next step?

Sometimes the body gets rid of the virus, or accepts the virus and there is no liver damage (Inactive low risk carriers which constitutes the majority, over 90%). In a small proportion of individuals (<10%) however, the virus remains active and causes the liver to become inflamed and eventually damaged, leading to cirrhosis (irreversible scarring) of the liver or even liver cancer. Liver cancer is the commonest cancer in Gambian men and third commonest in women, and is responsible for many premature deaths in young Gambians.

If you require treatment…

Available treatments include a once daily tablet called Tenofovir. In Gambia, this treatment is currently only available for those patients enrolled as part of the PROLIFICA project. The drug has few side-effects. Occasionally it can affect the kidneys but this is something we can pick up on blood tests. The Ministry of Health, in collaboration with WHO-IARC’s Gambia Hepatitis Intervention Study (GHIS) and other stakeholders, is in the active process of developing a whole country strategy and policies to tackle the problem of Hep-B virus in the country. Part of these plans include efforts to make this treatment available and affordable for those who need it in the not-too-distant future.

If you do not require treatment…

If this virus is not causing a problem in your liver, we will not offer you treatment. However we will see you once every year or two to make sure that the virus remains inactive in your liver.

How do we prevent infection with Hepatitis B virus?

  • Timely Hep-B vaccination for all babies at, or within 24 hours of birth.
  • Prevention of infected mothers passing the Hep-B virus to their babies at delivery by screening all pregnant women and ensuring their babies are
  • Vaccination of all high risk groups (e.g. health care workers) in addition to catch up vaccination for those who may have been missed as infants
  • Routine screening of all blood for Hep-B virus before transfusion
  • Proper infection control in all health facilities and continuous health education.
  • Proper sterilisation of instruments used in procedures that lead to contact with blood (scarification marks, gum and chin tattoos, ear-piercings, circumcision etc)
  • Avoid high risk sexual behaviours
  • Identify those who are actively infected with Hep-B virus in the community and offer them treatment to prevent them spreading the virus.