What is hepatitis B?
Hepatitis B (HB) is an infectious disease caused by the hepatitis B virus (HBV) that affects the liver. It can cause both acute and chronic infections. Many people have no symptoms during the initial infection. Some develop a rapid onset of sickness with vomiting, yellowish skin, tiredness, dark urine and abdominal pain.
Often these symptoms last a few weeks and rarely does the initial infection result in death. It may take 30 to 180 days for symptoms to begin. In those who get infected around the time of birth, 90% develop chronic hepatitis B while less than 10% of those infected after the age of five do.
Most of those with chronic disease have no symptoms; however, cirrhosis and liver cancer may eventually develop. Cirrhosis or liver cancer occurs in about 25% of those with chronic disease. The virus is transmitted by exposure to infectious blood or body fluids.
Infection around the time of birth or from contact with other people’s blood during childhood is the most frequent method by which hepatitis B is acquired in areas where the disease is common. In areas where the disease is rare, intravenous drug use and sexual intercourse are the most frequent routes of infection. Other risk factors include working in healthcare, blood transfusions, dialysis, living with an infected person, travel in countries where the infection rate is high, and living in an institution. Tattooing and acupuncture led to a significant number of cases in the 1980s; however, this has become less common with improved sterility. The hepatitis B viruses cannot be spread by holding hands, sharing eating utensils, kissing, hugging, coughing, sneezing, or breastfeeding. The infection can be diagnosed 30 to 60 days after exposure. The diagnosis is usually confirmed by testing the blood for parts of the virus and for antibodies against the virus. It is one of five main hepatitis viruses: A, B, C, D, and E.
What Are the Symptoms of Hepatitis B?
Many HBV infections occur during infancy or childhood. This is because a mother can pass HBV to her child during childbirth. However, doctors rarely diagnose HBV in childhood, as it causes few obvious symptoms.
Symptoms of a new HBV infection may not be apparent in children under 5 years of age or in adults with a suppressed immune system. Among those aged 5 years and over, around 30–50%Trusted Source will show initial signs and symptoms.
Acute symptoms appear around 60–150 days after exposure to the virus, and they can last from several weeks to 6 months.
A person with a chronic HBV infection may have ongoing episodes of abdominal pain, persistent fatigue, and aching joints.
Early symptoms
If HBV does cause symptoms early on, they may include:
- fever
- joint pain
- fatigue
- nausea
- vomiting
- loss of appetite
- abdominal pain
- dark urine
- clay colored stools
- jaundice, or yellowing of the skin and whites of the eyes
What Causes Hepatitis B?
It’s caused by the hepatitis B virus. The virus occurs in the blood and bodily fluids. HBV is transmissible via semen, vaginal fluids, and blood. It can also pass from a mother to a newborn child during delivery. Sharing needles and having sex without contraception both increase the risk.
People can also contract HBV when they visit a part of the world in which infection is more common.
A person can spread the virus without being aware, as it may not cause any symptoms.
How Do You Get Hepatitis B?
The most common ways to get hepatitis B include:
- Sex. You can get it if you have unprotected sex with someone who has it and your partner’s blood, saliva, semen, or vaginal secretions enter your body.
- Sharing needles. The virus spreads easily via needles and syringes contaminated with infected blood.
- Accidental needle sticks. Health care workers and anyone else who comes in contact with human blood can get it this way.
- Mother to child. Pregnant women with hepatitis B can pass it to their babies during childbirth. But there’s a vaccine to prevent newborns from becoming infected.
Health workers may be at risk through unsafe medical practices, such as reusing medical equipment, not using personal protection, or incorrectly disposing of sharps.
HBV cannot spread through:
- food or water
- shared eating utensils
- breastfeeding
- hugging
- kissing
- holding hands
- coughing
- sneezing
- insect bites
The virus can survive outside the body for at least 7 days. During this time, it can still cause infection if it enters the body of a person who has not received vaccination against it.
Is hepatitis B contagious?
Hepatitis B is highly contagious. It spreads through contact with infected blood and certain other bodily fluids. Although the virus can be found in saliva, it’s not spread through sharing utensils or kissing. It also doesn’t spread through sneezing, coughing, or breastfeeding. Symptoms of hepatitis B may not appear for 3 months after exposure and can last for 2–12 weeks. However, you are still contagious, even without symptomsTrusted Source. The virus can live outside the body trusted Source for up to seven days.
Possible methods of transmission include:
- direct contact with infected blood
- transfer from mother to baby during birth
- being pricked with a contaminated needle
- intimate contact with a person with HBV
- oral, vaginal, and anal sex
- using a razor or any other personal item with remnants of infected fluid
Who is at risk for hepatitis B?
Certain groups are at particularly high risk of HBV infection. These include:
- healthcare workers
- men who have sex with other men
- people who use IV drugs
- people with multiple sex partners
- people with chronic liver disease
- people with kidney disease
- people over the age of 60 with diabetes
- those traveling to countries with a high incidence of HBV infection
Diagnosis for Hepatitis B
Screening is available for people at higher risk of an HBV infection or complications due to an undiagnosed HBV infection. If a person has HBV, the doctor may assess their liver for damage.
Hepatitis B test
A blood test can help a doctor diagnose acute and chronic HBV infection.
If the test confirms the presence of HBV, the doctor may request follow-up blood tests to confirm:
- whether HBV infection is in its acute or chronic stage
- the person’s risk of liver damage
- whether or not treatment is necessary
A doctor will recommend regular testing for people with chronic HBV. Once the condition reaches a chronic stage, it can change over time.
Hepatitis has many different types. HBV and the hepatitis C virus (HCV) have both acute and chronic forms.
The main difference between HBV and HCV is how they spread from person to person. Although HCV is transmissible via sexual activity, this is rare. HCV usually spreads when blood that carries the virus comes into contact with blood that does not.
Here, learn more about the differences between HBV and HCV.
If a woman with HBV becomes pregnant, they may transmit the virus to their baby. Women should inform the doctor who delivers their baby that they have HBV.
The infant should receive an HBV vaccine and HBIG with 12–24 hours of birth. This significantly reduces the risk that they will develop HBV.
The HBV vaccine is safe to receive while pregnant.
Risk factors of Hepatitis B
People with a high risk of HBV include:
- the infants of mothers with HBV
- the sexual partners of people with HBV
- people who engage in sexual intercourse without contraception and those who have multiple sexual partners
- men who have sex with men
- people who inject illicit drugs
- those who share a household with a person who has a chronic HBV infection
- healthcare and public safety workers who are at risk of occupational exposure to blood or contaminated bodily fluids
- people receiving hemodialysis, which is a type of kidney treatment
- people taking medications that suppress the immune system, such as chemotherapy for cancer
- people with HIV
- those who come from a region with a high incidence of HBV
- all women during pregnancy
Prevention of Hepatitis B
People can prevent HBV infection by:
- wearing appropriate protective equipment when working in healthcare settings or dealing with medical emergencies
- not sharing needles
- following safe sexual practices
- cleaning any blood spills or dried blood with gloved hands using a 1:10 dilution of one part household bleach to 10 parts water
Vaccine of Hepatitis B
A vaccine against HBV has been available since 1982.
People who should receive this vaccine include:
- all infants, children, and adolescents without a previous vaccination
- all healthcare workers
- those who may have had exposure to blood and blood products through work or treatment
- people undergoing dialysis and the recipients of solid organ transplants
- residents and staff of correctional facilities, halfway houses, and community residences
- those who inject drugs
- people who share a household or engage in sexual intercourse with someone who has a chronic HBV infection
- those with multiple sexual partners
- people who travel to countries where HBV is common
Schedule
The HBV vaccine takes the form of three injections. A person can receive the first injection at any age, but babies should receive the first injection soon after birth. The second shot should occur at least 1 month after the first.
Adults can receive the third dose at least 8 weeks after the second dose and 16 weeks after the first. Infants should not receive the third dose before 24 weeks of age.
Learn more about the benefits of the hepatitis B vaccine for newborns here.
How long does it last?
According to the World Health Organization (WHO), “the complete vaccine series induces protective antibody levels” in over 95%Trusted Source of the infants, children, and adolescents who receive it.
Immune memory induced by the HBV vaccine can last for at least 30 yearsTrusted Source in healthy people. That said, studies into the duration of the protection that the vaccine offers are ongoing.
Side effects
Many people tolerate the HBV vaccine well.
According to the CDC, the most common side effects trusted Source of the HBV vaccine are fever and soreness at the injection site. A person may also experience swelling, redness, and hard skin in this area.
Very rarely, HBV vaccination can induce a serious type of allergic reaction called anaphylaxis.
Learn more about the possible effects of the HBV vaccine here.
Is it live?
The HBV vaccine contains no live virus. This makes it safe for women to receive during pregnancy and lactation.
Dangers
HBV infections can cause a range of life-threatening complications, including:
- Cirrhosis. This causes scarring on the liver and inhibits liver functions. It can lead to liver failure.
- Liver failure. Also known as end-stage liver disease, this can progress either rapidly or over a longer period. The liver cannot replace damaged cells or function.
- Liver cancer. Chronic HPV increases the risk of liver cancer.
Although HBV is a significant health concern around the world, for most people, the vaccine offers effective protection against the virus.
Frequently asked questions about Hepatitis B
What is hepatitis B?
Hepatitis B (also called hep B) is a virus that is found in blood and other body fluids including vaginal fluid, semen and breast milk. It is highly infectious and causes inflammation of the liver. Most adults, but not all, who become infected with hepatitis B are able to clear the virus without any problems. However, most babies and young children infected with hepatitis B are unable to clear the virus and will develop a chronic hepatitis infection.
Hepatitis B is one of the most common infectious diseases in the world and is a serious public health concern. Hepatitis B is a vaccine-preventable illness.
Who is at risk of getting hepatitis B?
There are around 165 000 people living with hepatitis B in Australia. The majority belong to one or more of the following groups:
- people who have migrated from countries where hepatitis B is endemic (especially North-East and South-East Asia, and sub-Saharan Africa)
- Aboriginal and Torres Strait Islander people
- people who inject drugs
- men who have sex with men.
How do you get hepatitis B?
Hepatitis B is most commonly spread by:
- at birth (from mother to child) or in early childhood (from family members or other close contacts)
- through sharing drug injecting equipment
- through vaginal, anal or oral sex without a condom/dental dam
- through unsterile tattooing or piercing.
There is also a chance that it can be spread through:
- blood-to-blood contact through open wounds
- needle stick injuries
- sharing personal items such as toothbrushes, razor blades or nail clippers
- blood transfusions/products (especially rare in Australia)
- unsterilized medical equipment (especially rare in Australia) (screening for hepatitis B in blood supply has been in place in Australia since 1971).
You cannot get hepatitis B from:
- hugging, kissing, another person’s tears or sneezes
- sharing cups, plates, clothes, food, drinks, showers or toilets
- eating food prepared by a person with hepatitis B
- mosquito bites.
What are the symptoms of hepatitis B?
Symptoms can take up to 6 months to appear and are likely to make you sick for between 1 and 3 months. If you do get symptoms, these are the most common:
- yellow skin or eyes (jaundice)
- feeling tired
- losing your appetite and weight loss
- aches and pains in muscles and joints
- dark urine and pale feces.
What is acute hepatitis B?
If someone has hepatitis B for less than 6 months it is called an acute infection. Most people who get hepatitis B as adults will only have an acute infection and recover from it. If you have acute hepatitis B, you might not experience any symptoms.
The older a person is when they become infected with hepatitis B, the better their chances of successfully fighting it off (‘clearing’ the virus). Around 95% of adults who contract hepatitis B will go on to have an acute infection and are then clear it naturally. On the other hand, up to 90% of babies and 30% of children who become infected will go on to have chronic hepatitis B.
What is chronic hepatitis B?
If the infection lasts for longer than 6 months it is called chronic hepatitis B. Most people with chronic hepatitis B contracted it as babies or young children. Many people with chronic hepatitis B have no symptoms, but if they appear they are similar to the symptoms of acute hepatitis B. Chronic hepatitis B is a lifelong illness.
What happens to people with chronic hepatitis B?
Chronic hepatitis B is a lifelong illness. Each person’s experience of the illness will be different and will depend on a number of factors like what stage his or her hepatitis B is currently in, lifestyle factors, and how long he or she has the virus.
However, we do know that 20 to 30% of people with chronic hepatitis B will develop the advanced liver disease if the virus is left untreated. Advanced liver disease can lead to complications including liver failure and liver cancer, and unfortunately, can lead to death. Treatment for hepatitis B aims to avoid these outcomes.
How is hepatitis B treated?
Treatment aims to stop or slow as much as possible, the increase in numbers of hepatitis B viruses. This decreases the risk of serious liver disease developing later in life and makes it possible for the liver to repair some of the damage and to work better.
Can a person spread hepatitis B and not know it?
Yes. Many people with acute hepatitis B have no symptoms and may not even know they have hepatitis B.
How long does the hepatitis B virus survive outside the body?
Hepatitis B virus can survive outside the body for at least 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.
What if I am exposed to hepatitis B, what should I do?
You should see your GP or local health center as soon as possible to discuss your options. You will need to have a blood test and in some cases, you may start treatment immediately to stop your body from becoming infected with Hepatitis B. Management may include hepatitis B immunoglobulin, an injection of plasma which contains high levels of antibodies to help prevent hepatitis B infection from developing in a person who has been exposed.
If I’ve had hepatitis B and cleared it, can I get it again?
If your body has naturally cleared the hepatitis B virus, then you will be immune. This means you cannot get hepatitis B again.
What tests are there for hepatitis B?
All of the tests used to diagnose hepatitis B are blood tests. Some indicate different stages of the illness or immunity. The following list shows the different tests available, and what a positive result indicates for each of them.
How can I protect myself until I am fully vaccinated?
- practice safer sex (use a condom)
- wash hands after touching blood or body fluids
- wear disposable gloves if giving someone first aid, or cleaning up blood or body fluids
- avoid sharing toothbrushes, razors, needles, syringes, personal hygiene items and grooming aids or any object that may come into contact with blood or body fluids
- use new and sterile injecting equipment for each injection
- cover all cuts and open sores with a waterproof dressing
- wipe up any blood spills and then clean the area with household
bleach - throw away personal items such as tissues, menstrual pads, tampons and bandages in a sealed plastic bag.