Complexes with this research
Hospital complex Infectious screening for prevention and hospitalization 1,270 RUR Composition
Preparation for IVF for a man Examination to prepare a man for the IVF procedure 3,900 RUR Composition
Preparation for partner childbirth for a man Tests necessary to accompany a woman in labor RUB 2,470 Composition
IN OTHER COMPLEXES
- Expanded hospital complex 4,520 RUR
- Entry into IVF RUB 15,030
- Male infertility. Extended examination RUB 19,800
- Men's check-up No. 1 11,280 RUR
- Examination during pregnancy. 1st trimester 10,390 RUR
Contraindications
Despite the fact that vaccination can prevent the development of the disease and subsequent complications, in some cases it is contraindicated:
- in the presence of any diseases in the acute stage;
- if a serious allergic reaction occurs during a previously administered vaccination;
- with meningitis - an inflammatory disease that affects the meninges;
- if the previous vaccination led to dangerous consequences in the form of paralysis or a severe autoimmune progressive disease affecting the peripheral nervous system (Guillain-Barré syndrome);
- with existing diseases of the nervous system;
- in the presence of sensitivity to the auxiliary components of the vaccine.
When do you need to get tested for Hepatitis B, HBs Ag (quality)?
- Suspicion of infection with viral hepatitis B;
- Changes in liver biochemistry, indicating liver damage;
- Development of jaundice;
- Screening during pregnancy;
- Comprehensive examination before hospitalization;
- Pre-employment screening for specialists in certain professions (medical workers and others);
- Examination of people from groups at high risk of infection (receiving intravenous injections, undergoing hemodialysis, blood donors and others).
Specifics of vaccination against hepatitis during pregnancy
Since today vaccination against this disease is carried out in almost all countries, in the last few years the incidence of this disease has decreased several times.
Thanks to this, cirrhosis and liver cancer have become detected much less frequently. If several decades ago it was possible to be vaccinated against hepatitis only before the baby was conceived, today, thanks to developed pharmacology, such vaccinations are also given at the stage of gestation. More often, the need for vaccination arises if a pregnant woman is constantly receiving injections and other invasive procedures. This is usually done if the expectant mother suffers from a serious illness or doctors suspect the development of pathologies in the fetus.
Currently, private clinics and city hospitals use 6 different vaccines against hepatitis, which practically do not differ in the composition and dosage of active components. The effectiveness of these drugs has been confirmed by numerous clinical studies. Depending on the individual preferences and financial capabilities of the woman, vaccination can be done in a regular city hospital or in a private medical center.
Since the vaccines used contain only one component, 3 vaccinations are required to induce resistance of the immune system to the virus.
In most cases, their implementation is carried out according to the following scheme:
- the first time the drug is administered at any time convenient for the woman;
- the second time the drug is administered exactly one month later;
- The last time the drug is administered is 6 months after the first vaccination.
Regardless of which drug is used, it is always administered into the deltoid muscle. Since the vaccines used do not differ in composition, the first vaccination can be done with one means, and the remaining 2 with others.
Despite the fact that different drugs are allowed for vaccination, some doctors advise using only one drug. In any case, the doctor must make the decision.
Detailed description of the study
Hepatitis B virus is a potentially life-threatening infection that affects the liver. The pathogen is found in body fluids such as blood, semen and vaginal secretions.
The main mechanisms of transmission of hepatitis B infection are as follows:
- Horizontal transmission - through unprotected sexual intercourse or contact with the mucous membranes of saliva, vaginal secretions, semen and blood of an infected person$
- Vertical transmission - from mother to newborn.
The incubation period of the disease lasts on average from 30 to 180 days. The virus penetrates the liver, where it attaches to the surface of the hepatocyte (liver cell) using the HBs antigen (HBsAg). Next, the virus penetrates the cell itself and begins replication, that is, reproduction. The human immune system identifies infected hepatocytes and secretes appropriate antibodies to proteins on the membrane, which ultimately causes cell destruction.
People infected with hepatitis B virus may have acute symptomatic illness or asymptomatic infection. Initial symptoms are nonspecific and may include:
- Flu-like condition (weakness, fever, aches in joints and muscles);
- Nausea or vomiting;
- Discomfort and pain in the right hypochondrium;
- Lack of appetite.
Jaundice may then occur. An infected person notices darkening of urine, discoloration of stool, and yellowing of the whites of the eyes and skin. Recovery is the usual outcome for people with normal immunity (about 95% of cases), but in a small number of people (5% on average) the disease can develop into chronic hepatitis B, which is defined as the presence of HBsAg for more than six months.
With chronic infection, people can experience both asymptomatic carriage and chronic hepatitis with possible progression to liver cirrhosis, when hepatocytes die and are replaced by tissue that is unable to perform the necessary functions. As a result, liver failure develops. Its signs are:
- Increase in abdominal volume due to fluid accumulation (ascites);
- Constant bloating, indigestion;
- Nausea, vomiting;
- Swelling of the legs;
- Dysfunction of the central nervous system (CNS);
- Jaundice;
- Increased body temperature;
- Decreased or lack of appetite;
- Sarcopenia is a decrease in the muscles of the arms and legs;
- Tendency to bruise;
- Bleeding gums;
- A rash on the body that looks like spider veins;
- Redness of the palms.
In case of severe liver failure, jaundice, impaired consciousness (encephalopathy), and gastrointestinal bleeding may develop. People who have been infected with hepatitis B for a long time have an increased risk of hepatocellular carcinoma - liver cancer.
Diagnosis is based on blood tests in people with symptoms and associated risk factors for the disease. Detection of HBsAg serves as the basis for the primary diagnosis of viral hepatitis B. Its appearance in the blood is observed at the end of the incubation period of the disease and persists in the chronic form of the infection.
Hepatitis A and pregnancy
Perhaps this variant of hepatitis is one of the most easily tolerated, so infection during pregnancy is, of course, dangerous, but definitely not terrible. Viral hepatitis A (HAV) is classified as enteral - intestinal, because infection with the hepatitis A virus occurs from dirty hands that have come into contact with the pathogen, which is released into white light with the patient’s feces. One did not wash his hands after using the toilet, the other did not wash his hands before eating. The virus is also transmitted through dirty water that contains infected human feces. Pregnancy does not significantly aggravate the clinical picture of hepatitis A; in any case, indications of a moderate, and even more severe, form of hepatitis during pregnancy are not frequent in the scientific literature. It has been noted that infection with virus A can increase the duration of each period of the disease and the total duration of the disease as a whole to two months.
The incubation period is the time after the virus enters the body and the appearance of the first symptoms of the disease with HAV is not determined, on average 2–4 weeks, no shorter than 5 days and no longer than 50 days. Since it is not always possible to determine the source of infection, it is not known how the duration of incubation changes pregnancy. The prodromal period, when the virus multiplied in the intestines is massively released into the blood, is characterized by a clinical picture of a flu-like syndrome: fever, weakness, aches in the muscles and joints. There may be a picture of some kind of intestinal infection: nausea, vomiting, abdominal pain. Or severe weakness will develop without any other symptoms. Most often this is regarded as toxicosis, especially since the duration of “toxicosis” can be only a couple of weeks, which is not considered an important cause for concern.
The next stage is jaundice, which does not raise doubts about the presence of hepatitis, but only an examination will tell which one. Within a few days of skin coloring, feces will begin to lighten and urine will begin to darken; the apogee of changes in skin color and physiological functions will occur in the second week. During jaundice, health improves, some symptoms go away irrevocably, and a normal temperature is almost always noted.
Recovery will occur in a couple of months, perhaps later than without pregnancy, but no one knows for sure. Weakness stays the longest and is the most painful thing about CAA. The fulminant form of the course, which leads to hepatic coma with a high probability of death, is not typical for pregnancy.
Despite the fact that those suffering from mild hepatitis A are not hospitalized in an infectious diseases hospital - there is no need, hospital treatment is always indicated for pregnant women in any form. There are no specific antiviral drugs against HAV; therapy is aimed at reducing the manifestations of the disease and speedy recovery. The disease does not take a chronic form.
In order not to have troubles during such an anxious period of life, when planning a pregnancy, it is necessary to get vaccinated in advance if you have not been vaccinated before. The vaccine is high quality, and most importantly, highly effective. Even the first injection provides a large amount of antibodies to the virus, A, which can protect against infection. A full course of two injections with an interval of 6 months to 6 years can protect for two decades of life.
Pregnancy some time after hepatitis will not interfere with a normal life and the birth of a healthy child.
References
- Ivashkin, V.T., Mayevskaya, M.V., Pavlov, Ch.S. and others. Clinical recommendations of the Russian Society for the Study of the Liver and the Russian Gastroenterological Association for the treatment of complications of liver cirrhosis. - Russian Journal of Gastroenterology, Hepatology, Coloproctology, 2021. - V. 26(4). — P. 71-102.
- Schwarz, W., Heidi, M., Nancy, E. False positive hepatitis B surface antigen test caused by hepatitis B vaccine, The Pediatric Infectious Disease Journal, 2001. - Vol. 8(2). — P. 189-193.
- Tripathi, N., Mousa, O. Hepatitis B. - In: StatPearls, 2020.
- Anjum, Q. False positive Hepatitis B Surface Antigen due to recent vaccination. - IntJHealthSci (Qassim), 2014. - Vol. 8(2). — P. 189-193.
Principles of vaccination
Getting vaccinated against hepatitis B during pregnancy is usually necessary urgently. Vaccination is carried out no later than two days after infection. If a woman has never been vaccinated before or the concentration of antibodies in the blood is 10 mIU/ml or less, then a standard dose of the drug is administered. Along with it, immunoglobulin is injected, which reduces the risk of developing hepatitis B. The first revaccination for adults is carried out after a week, the second after 3, and the third after a year. The injection is placed intramuscularly in the shoulder area. Antibodies begin to be produced 7–10 days after the first injection.
Hepatitis B and pregnancy planning
When planning a pregnancy, a woman must consult with an infectious disease specialist; it is possible that the level of the virus in the blood will require antiviral therapy. In most cases, with the chronic form of hepatitis B, there are no exacerbations of the disease, but several publications have been devoted to a rare, nevertheless possible activation of the process with the development of fulminant liver failure. Exacerbation of the process after childbirth cannot be ruled out.
During the entire period of pregnancy, a woman should be monitored by an infectious disease specialist; if the viral load increases, antiviral therapy may be required, and the issue of preventing transmission of infection to the child during pregnancy and during childbirth must be addressed.
Preference is given to tenofovir, as it is the safest for the baby and least likely to cause the development of drug resistance. Interferon of any kind is contraindicated. For childbirth, a pregnant woman with chronic hepatitis is hospitalized in a special observational unit or maternity hospital.
Jaundice due to hepatitis B
The jaundice period, when the skin takes on an ocher color, lasts from two to six weeks, but in contrast to hepatitis A, with jaundice caused by virus B, health improves for a short time, which is replaced by a return of the symptoms of the disease, but with less intensity. An enlarged, inflamed liver responds with a feeling of heaviness in the right hypochondrium and nagging pain. Gradually, jaundice begins to fade, and urine and feces acquire their natural color. Recovery comes slowly - within several months, aggravated by prolonged weakness and lack of appetite, or hepatitis B becomes chronic. Severe forms of acute viral hepatitis during pregnancy are more common.
