Hepatitis B

Hepatitis means “inflammation of the liver”. Hepatitis B (also called hep B) is caused by the hepatitis B virus (HBV) and can lead to serious liver problems, such as liver cirrhosis and liver cancer. The virus is found in blood and, to a lesser degree, in body fluids such as semen and vaginal secretions.

You can get hepatitis B through unsafe sex, by sharing unsterile piercing or drug-injecting equipment, or through any activity in which the blood or body fluids of a person living with hepatitis B enter another person’s bloodstream. The virus may also be passed from a pregnant mother to her baby. In about 30 to 40% of cases, infections occur without a known cause.

Children who get hepatitis B are more likely to develop ongoing infection, and therefore more likely to develop liver disease or cancer later in life. Most adults who get hepatitis B recover completely (clear the virus) and do not need ongoing treatment. All children and adults at increased risk should be immunised.

Symptoms#

Most people have no symptoms when they are first infected. Some people who are newly infected, or who have lived with hepatitis B for a long time, may have mild, flu-like symptoms, while others do not become sick at all.

Many people with chronic hepatitis B (infection that persists for at least six months) may have had the virus since birth or early childhood. They often have no symptoms, or do not realise the symptoms they have are abnormal, as these can vary in severity over time. Other symptoms can include loss of appetite, nausea and vomiting, discomfort or pain in the liver area (under the right ribcage), fever, and pain in the joints. In more severe cases, hepatitis B can cause jaundice (yellowing of the eyes and skin).

Normally these symptoms disappear within a few weeks, but even when a person feels much better they may still be infectious. Most adults exposed to the virus recover completely and no longer carry it. Some people become very ill soon after exposure and need to go to hospital, and a small number may die.

A small proportion of people develop a long-term (chronic) infection. They may carry the virus in their bloodstream for most of their life without realising it, and may not notice any health problems until they develop liver problems such as scarring (cirrhosis) or liver cancer later in life. Treatment is important, because it is not possible to be a “healthy carrier” of the virus.

Chronic hepatitis B is more common in some communities, including people from parts of the world where the infection is more common, such as sub-Saharan Africa, parts of Asia, the Pacific, the Mediterranean, and other regions where hepatitis B is endemic.

How hepatitis B spreads#

Hepatitis B is transmitted through contact with infected blood, and through other body fluids. If infected blood or body fluids enter another person’s bloodstream, that person may become infected. The time from exposure to the appearance of illness (if symptoms occur) is 45 to 180 days.

Activities that can cause infection include:

• having unprotected sex (for example, without a condom), especially if blood is present
• sharing unsterile equipment for injecting drugs
• piercing the skin with equipment that has not been properly cleaned, disinfected and sterilised
• sharing razor blades or toothbrushes
• contact with infected blood through open cuts or the mucous membranes

Mothers who have hepatitis B can pass the virus to their babies at or after birth. If the newborn is vaccinated quickly, they can be protected from infection. In many countries, blood and blood products for medical use are carefully screened for hepatitis B and other blood-borne viruses, so the risk of infection from a transfusion is extremely low (approximately 1 in 764,000).

Reducing the risk#

Simple steps can help protect against hepatitis B:

• Get immunised – this is the best protection. Make sure you, your children, your partner and close contacts are immunised.
• Use condoms every time you have anal or vaginal sex with new partners until you both have a check-up. This also helps prevent other infections.
• It is unlikely you will get hepatitis B through oral sex unless blood is present, for example from ulcers or bleeding gums.
• Choose an experienced practitioner who follows good sterilisation and hygiene practices for any body piercing or tattooing.
• Wear single-use gloves if you give first aid or clean up blood or body fluids.
• Never share needles, syringes or other injecting equipment (such as spoons, swabs or water). Always use sterile needles and syringes, and always wash your hands before and after injecting.

If you have hepatitis B, take care so the virus does not pass to others in your home. Avoid sharing injecting equipment or personal items such as toothbrushes or razors, and completely cover any cut or wound with a waterproof dressing. You may wish to tell your healthcare professional about your condition before any medical or dental procedure, although there is no legal obligation to do so.

If you think you have been exposed to hepatitis B, see a doctor immediately. In some cases your doctor can give you treatment that greatly reduces the risk of becoming infected.

Diagnosis#

Blood tests can determine whether you are, or have been, infected with hepatitis B. It may take up to six months from the time of infection before a blood test can detect antibodies, so follow-up testing may be needed. During this period, until you know whether you are infected, take steps to prevent passing the virus to others.

Other tests can assess liver damage, including the liver function test, fibroscan, ultrasound and liver biopsy. It is recommended that all pregnant women are tested for hepatitis B. If you are living with chronic hepatitis B, your doctor can help reduce the risk of passing the virus to your newborn.

Check-ups and treatment#

Medicine for hepatitis B controls the amount of virus in the body but does not clear or cure the infection. People whose bodies naturally keep the virus at low levels and who have no sign of liver damage do not need medication. People who have high virus levels or some liver damage can have treatment that controls and reduces the virus, prevents liver damage and helps heal the liver.

Your body’s ability to control the virus can change, so you may need medication at some times and not at others. Talk to your doctor or specialist about whether you need treatment.

Although not everyone with long-term hepatitis B needs medication, everyone with the long-term infection needs regular check-ups every 6 to 12 months. If you have long-term hepatitis B, your doctor will monitor your condition and, if necessary, refer you to a specialist. You can also help keep your liver healthy by limiting alcohol, quitting smoking, eating a well-balanced low-fat diet, staying active and managing stress.

Immunisation#

Immunisation is the best protection against hepatitis B. A course of vaccination is recommended for all babies and for people in high-risk groups. It can be given as a hepatitis B vaccine alone, or as a combination vaccine. To be immunised, contact your doctor.

Vaccination is often recommended for high-risk groups, which may include:

• babies, with a dose at birth and combination doses in infancy
• children and young people having catch-up immunisation
• household contacts and sexual partners of people living with hepatitis B
• people who inject drugs or are on opioid substitution therapy
• people living with hepatitis C or HIV
• men who have sex with men
• people in custodial settings who do not have hepatitis B or immunity to it
• some populations and people from regions where hepatitis B is endemic
• healthcare or emergency workers, and members of the police force or armed forces
• workers who come into regular contact with blood, body fluids, tissue or used needles, such as funeral workers, embalmers and tattooists
• workers in the sex industry
• adults on haemodialysis, and people with severely impaired kidney function in whom dialysis is anticipated
• solid organ and stem cell transplant recipients
• immunocompromised adults
• people with a blood-clotting disorder or who require ongoing blood transfusions
• people with more than one sexual partner
• people with chronic liver disease or a liver transplant
• travellers to areas where hepatitis B is endemic, either long-term or for frequent short visits

Being immunised against hepatitis B does not protect you against HIV, hepatitis C or other diseases spread by blood or body fluids, so you still need to take precautions. Hepatitis B vaccine is not usually recommended during pregnancy or breastfeeding, but your doctor may recommend it if you are not immune and are at increased risk.

Key points#

• In about 30 to 40% of cases, infections occur without a known cause.
• Most adults who get hepatitis B recover completely (clear the virus) and do not need ongoing treatment.
• All children and adults at increased risk should be immunised against hepatitis B.
• Most people have no symptoms when they are first infected.
• In more severe cases, hepatitis B can cause jaundice (yellowing of the eyes and skin).

Where to get help#