Is hepatitis B transmitted through saliva: true or false?

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Extract from the article: In developing countries, hepatitis, particularly hepatitis B and C, is a major public health issue, causing many deaths each year. While it is well known that hepatitis B is transmitted through sexual contact, blood and perinatal transmission, ...

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In developing countries, hepatitis, particularly hepatitis B and C, is a major public health issue, causing many deaths each year. While it is well known that hepatitis B is transmitted through sexual contact, blood and perinatal transmission, saliva is sometimes mentioned as a means of infection. Myth or reality? Answers with Kponou Tobossi, Specialist in Dietetics, Phytotherapy and Hepatology (Lomé).

Infections such as hepatitis are among the leading causes of death worldwide, after tuberculosis. They represent a major public health challenge, particularly in developing countries.

The World Health Organisation (WHO) estimates that 70% of hepatitis B cases occur in Africa, where more than 91 million people are infected with the most serious forms of the virus: hepatitis B and hepatitis C. According to data from the Togolese Ministry of Health, the prevalence of hepatitis is 16% for the B virus and 10% for the C virus among people aged 18 to 35, an alarming statistic for health professionals.

Transmission routes

Hepatitis B is mainly transmitted in three ways: ‘sexually, through blood (from one person to another outside of birth: horizontal transmission) and perinatally (from mother to child: vertical transmission); at any age, through contact with infected fluids,’ says Kponou Tobossi, Specialist in Dietetics, Phytotherapy and Hepatology (Lomé).

However, saliva is sometimes mentioned as a possible route of transmission. Although saliva is sometimes mentioned as a route of transmission in theory, this remains less likely in practice.

"The hepatitis B virus is detectable in several biological fluids: semen, vaginal secretions, saliva. Although the hepatitis B virus (HBV) is detectable in saliva, its viral concentration is much lower than in blood, but the risk is not zero. The mechanisms by which the risk arises are as follows: contact of saliva with a damaged mucous membrane or wound, sharing of contaminated toothbrushes (a recognised risk among children living together), human bites (rare, but documented), and deep kissing (if there are mouth lesions or bleeding gums)," emphasises Kponou Tobossi. In specific cases such as the following, it is also possible : sharing objects such as spoons, toothbrushes, toys, small bites or scratches.

The specialist in dietetics, phytotherapy and hepatology reiterates that "to contract the virus via saliva, you have to consume an enormous amount of infected saliva. This route of transmission is therefore not a major concern compared to other routes of contamination, but the risk is plausible.

In the six months following initial infection, the specialist points out, acute hepatitis B may be asymptomatic or cause symptoms such as abdominal pain, vomiting and skin rashes. In some cases, acute hepatitis can develop into a fulminant form, which is often fatal. Chronic hepatitis B, on the other hand, persists for more than six months. In most cases (80 to 90%), patients have no symptoms, but in 10 to 20% of cases, signs such as fatigue, jaundice, digestive problems and joint pain may occur. It should be noted that these symptoms are not specific to hepatitis B.

‘The disease can progress to cirrhosis and liver cancer if left untreated, leading to severe abdominal pain, enlargement of the liver and sometimes oedema of the lower limbs,’ says Kponou Tobossi.

What should be done?

Several measures are effective in preventing hepatitis, including "universal vaccination (from birth) or as soon as screening is carried out in adulthood, strict hygiene (not sharing toothbrushes, razors, cutlery, etc.). ‘Oral-blood contact with carriers should be avoided,’ he recommends.

Specialists emphasise the importance of early screening and health education in order to slow the silent spread of these viral diseases among the population.

William O.