Hepatitis B

“Hepatitis” means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viral infections that affect the liver; the most common types are Hepatitis A, Hepatitis B, and Hepatitis C.

What is the difference between Hepatitis A, Hepatitis B, and Hepatitis C?

Hepatitis A, Hepatitis B, and Hepatitis C are diseases caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. People with Hepatitis A usually improve without treatment. Hepatitis B and Hepatitis C can also begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent Hepatitis A and B; however, there is not one for Hepatitis C. If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.

What is Hepatitis B?

Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. It results from infection with the Hepatitis B virus. Hepatitis B can be either “acute” or “chronic.”
Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection can — but does not always — lead to chronic infection.
Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body.

Transmission / Exposure

How likely is it that acute Hepatitis B will become chronic?

The likelihood depends upon the age at which someone becomes infected. The younger a person is when infected with Hepatitis B virus, the greater his or her chance of developing chronic Hepatitis B. Approximately 90% of infected infants will develop chronic infection. The risk goes down as a child gets older. Approximately 25%–50% of children infected between the ages of 1 and 5 years will develop chronic hepatitis. The risk drops to 6%–10% when a person is infected over 5 years of age. Worldwide, most people with chronic Hepatitis B were infected at birth or during early childhood.

How is Hepatitis B spread?

Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus during activities such as:

• Birth (spread from an infected mother to her baby during birth)
• Sex with an infected partner
• Sharing needles, syringes, or other drug-injection equipment
• Sharing items such as razors or toothbrushes with an infected person
• Direct contact with the blood or open sores of an infected person
• Exposure to blood from needlesticks or other sharp instruments

Can a person spread Hepatitis B and not know it?

Yes. Many people with chronic Hepatitis B virus infection do not know they are infected since they do not feel or look sick. However, they still can spread the virus to others and are at risk of serious health problems themselves.

Can Hepatitis B be spread through sex?

Yes. Among adults in the United States, Hepatitis B is most commonly spread through sexual contact and accounts for nearly two-thirds of acute Hepatitis B cases. In fact, Hepatitis B is 50–100 times more infectious than HIV and can be passed through the exchange of body fluids, such as semen, vaginal fluids, and blood.

Can Hepatitis B be spread through food?

Unlike Hepatitis A, it is not spread routinely through food or water. However, there have been instances in which Hepatitis B has been spread to babies when they have received food pre-chewed by an infected person.

What are ways Hepatitis B is not spread?

Hepatitis B virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing.

Who is at risk for Hepatitis B?

Although anyone can get Hepatitis B, some people are at greater risk, such as those who:

• Have sex with an infected person
• Have multiple sex partners
• Have a sexually transmitted disease
• Are men who have sexual contact with other men
• Inject drugs or share needles, syringes, or other drug equipment
• Live with a person who has chronic Hepatitis B
• Are infants born to infected mothers
• Are exposed to blood on the job
• Are hemodialysis patients
• Travel to countries with moderate to high rates of Hepatitis B

If I think I have been exposed to the Hepatitis B virus, what should I do?

If you are concerned that you might have been exposed to the Hepatitis B virus, call your health professional or your health department. If a person who has been exposed to Hepatitis B virus gets the Hepatitis B vaccine and/or a shot called “HBIG” (Hepatitis B immune globulin) within 24 hours, Hepatitis B infection may be prevented.

How long does the Hepatitis B virus survive outside the body?

Hepatitis B virus can survive outside the body 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.

How should blood spills be cleaned from surfaces to make sure that Hepatitis B virus is gone?

All blood spills — including those that have already dried — should be cleaned and disinfected with a mixture of bleach and water (one part household bleach to 10 parts water). Gloves should always be used when cleaning up any blood spills. Even dried blood can present a risk to others.

If I had Hepatitis B in the past, can I get it again?

No, once you recover from Hepatitis B, you develop antibodies that protect you from the virus for life. An antibody is a substance found in the blood that the body produces in response to a virus. Antibodies protect the body from disease by attaching to the virus and destroying it. However, some people, especially those infected during early childhood, remain infected for life because they never clear the virus from their bodies.

Can I donate blood, organs, or semen if I have Hepatitis B?

No, if you have ever tested positive for the Hepatitis B virus, experts recommend that you not donate blood, organs, or semen because this can put the recipient at great risk for getting hepatitis.

Symptoms

Does acute Hepatitis B cause symptoms?

Sometimes. Although a majority of adults develop symptoms from acute Hepatitis B virus infection, many young children do not. Adults and children over the age of 5 years are more likely to have symptoms. Seventy percent of adults will develop symptoms from the infection.

What are the symptoms of acute Hepatitis B?

Symptoms of acute Hepatitis B, if they appear, can include:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellow color in the skin or the eyes)

How soon after exposure to Hepatitis B will symptoms appear?

On average, symptoms appear 90 days (or 3 months) after exposure, but they can appear any time between 6 weeks and 6 months after exposure.

How long do acute Hepatitis B symptoms last?

Symptoms usually last a few weeks, but some people can be ill for as long as 6 months.

Can a person spread Hepatitis B without having symptoms?

Yes. Many people with Hepatitis B have no symptoms, but these people can still spread the virus.

What are the symptoms of chronic Hepatitis B?

Some people have ongoing symptoms similar to acute Hepatitis B, but most individuals with chronic Hepatitis B remain symptom free for as long as 20 or 30 years. About 15%–25% of people with chronic Hepatitis B develop serious liver conditions, such as cirrhosis (scarring of the liver) or liver cancer. Even as the liver becomes diseased, some people still do not have symptoms, although certain blood tests for liver function might begin to show some abnormalities.

How will I know if I have Hepatitis B?

Talk to your health professional. Since many people with Hepatitis B do not have symptoms, doctors diagnose the disease by one or more blood tests. These tests look for the presence of antibodies or antigens and can help determine whether you:

• have acute or chronic infection
• have recovered from infection
• are immune to Hepatitis B
• could benefit from vaccination

How serious is chronic Hepatitis B?

Chronic Hepatitis B is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. Approximately 2,000–4,000 people die every year from Hepatitis B-related liver disease.

Tests For Hep B

What are antigens and antibodies?

An antigen is a substance on the surface of a virus that causes a person’s immune system to recognize and respond to it. When the body is exposed to an antigen, the body views it as foreign material and takes steps to neutralize the antigen by producing antibodies. An antibody is a substance found in the blood that the body produces in response to a virus. Antibodies protect the body from disease by attaching to the virus and destroying it.

What are the common blood tests available to diagnose Hepatitis B?

There are many different blood tests available to diagnose Hepatitis B. They can be ordered as an individual test or as a series of tests. Ask your health professional to explain what he or she hopes to learn from the tests and when you will get the results. Below are some of the common tests and their meanings. But remember: only your doctor can interpret your individual test results.

Treatment

How is acute Hepatitis B treated?

There is no medication available to treat acute Hepatitis B. During this short-term infection, doctors usually recommend rest, adequate nutrition, and fluids, although some people may need to be hospitalized.

How is chronic Hepatitis B treated?

It depends. People with chronic Hepatitis B virus infection should seek the care or consultation of a doctor with experience treating Hepatitis B. This can include some internists or family medicine practitioners, as well as specialists such as infectious disease physicians, gastroenterologists, or hepatologists (liver specialists). People with chronic Hepatitis B should be monitored regularly for signs of liver disease and evaluated for possible treatment. Several medications have been approved for Hepatitis B treatment, and new drugs are in development. However, not every person with chronic Hepatitis B needs to be on medication, and the drugs may cause side effects in some patients.

What can people with chronic Hepatitis B do to take care of their liver?

People with chronic Hepatitis B should be monitored regularly by a doctor experienced in caring for people with Hepatitis B. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver.

Prevention / Vaccination

Can Hepatitis B be prevented?

Yes. The best way to prevent Hepatitis B is by getting the Hepatitis B vaccine. The Hepatitis B vaccine is safe and effective and is usually given as 3-4 shots over a 6-month period.

What is the Hepatitis B vaccine series?

The Hepatitis B vaccine series is a sequence of shots that stimulate a person’s natural immune system to protect against HBV. After the vaccine is given, the body makes antibodies that protect a person against the virus. An antibody is a substance found in the blood that is produced in response to a virus invading the body. These antibodies are then stored in the body and will fight off the infection if a person is exposed to the Hepatitis B virus in the future.

Who should get vaccinated against Hepatitis B?

Hepatitis B vaccination is recommended for:

• All infants, starting with the first dose of Hepatitis B vaccine at birth
• All children and adolescents younger than 19 years of age who have not been vaccinated
• People whose sex partners have Hepatitis B
• Sexually active persons who are not in a long-term, mutually monogamous relationship.
• Persons seeking evaluation or treatment for a sexually transmitted disease
• Men who have sexual contact with other men
• People who share needles, syringes, or other drug-injection equipment
• People who have close household contact with someone infected with the Hepatitis B virus
• Health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job
• People with end-stage renal disease, including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
• Residents and staff of facilities for developmentally disabled persons
• Travelers to regions with moderate or high rates of Hepatitis B
• People with chronic liver disease
• People with HIV infection
• Anyone who wishes to be protected from Hepatitis B virus infection

In order to reach individuals at risk for Hepatitis B, vaccination is also recommended for anyone in or seeking treatment from the following:

• Sexually transmitted disease treatment facilities
• HIV testing and treatment facilities
• Facilities providing drug-abuse treatment and prevention services
• Health care settings targeting services to injection drug users
• Health care settings targeting services to men who have sex with men
• Chronic hemodialysis facilities and end-stage renal disease programs
• Correctional facilities
• Institutions and nonresidential day care facilities for developmentally disabled persons

When should a person get the Hepatitis B vaccine series?

Children and Adolescents

• All children should get their first dose of Hepatitis B vaccine at birth and complete the vaccine series by 6–18 months of age.
• All children and adolescents younger than 19 years of age who have not yet gotten the vaccine should also be vaccinated. “Catch-up” vaccination is recommended for children and adolescents who were never vaccinated or who did not get the entire vaccine series.

Adults:

• Any adult who is at risk for Hepatitis B virus infection or who wants to be vaccinated should talk to a health professional about getting the vaccine series.

For more information about Hepatitis B and other vaccines, see http://www.cdc.gov/vaccines/schedules/index.html.

Is the Hepatitis B vaccine recommended before international travel?

The risk for Hepatitis B virus infection in international travelers is generally low, although people traveling to certain countries are at risk. Travelers toregions with moderate or high rates of Hepatitis B should get the Hepatitis B vaccine.

How is the Hepatitis B vaccine series given?

The Hepatitis B vaccine is usually given as a series of 3 or 4 shots over a 6-month period.

Is the Hepatitis B vaccine series effective?

Yes, the Hepatitis B vaccine is very effective at preventing Hepatitis B virus infection. After receiving all three doses, Hepatitis B vaccine provides greater than 90% protection to infants, children, and adults immunized before being exposed to the virus.

Is the Hepatitis B vaccine safe?

Yes, the Hepatitis B vaccine is safe. Soreness at the injection site is the most common side effect reported. As with any medicine, there are very small risks that a serious problem could occur after getting the vaccine. However, the potential risks associated with Hepatitis B are much greater than the risks the vaccine poses. Since the vaccine became available in 1982, more than 100 million people have received Hepatitis B vaccine in the United States and no serious side effects have been reported.

Is it harmful to have an extra dose of Hepatitis B vaccine or to repeat the entire Hepatitis B vaccine series?

No, getting extra doses of Hepatitis B vaccine is not harmful.

What should be done if Hepatitis B vaccine series was not completed?

Talk to your health professional to resume the vaccine series as soon as possible. The series does not need to be restarted.

Who should not receive the Hepatitis B vaccine?

The Hepatitis B vaccine is not recommended for people who have had serious allergic reactions to a prior dose of Hepatitis B vaccine or to any part of the vaccine. Also, it not recommended for anyone who is allergic to yeast because yeast is used when making the vaccine. Tell your doctor if you have any severe allergies.

Are booster doses of Hepatitis B vaccine necessary?

It depends. A “booster” dose of Hepatitis B vaccine is a dose that increases or extends the effectiveness of the vaccine. Booster doses are recommended only for hemodialysis patients and can be considered for other people with a weakened immune system. Booster doses are not recommended for persons with normal immune status who have been fully vaccinated.

Is there a vaccine that will protect me from both Hepatitis A and Hepatitis B?

Yes, there is a combination vaccine that protects people from both Hepatitis A and Hepatitis B. The combined Hepatitis A and B vaccine is usually given as three separate doses over a 6-month period.

Can I get the Hepatitis B vaccine at the same time as other vaccines?

Yes. Getting two different vaccines at the same time has not been shown to be harmful.

Where can I get the Hepatitis B vaccine?

Talk to your doctor or health professional or call your health department. Some clinics offer free or low-cost vaccines.

What is Hepatitis B immune globulin (HBIG)?

Hepatitis B immune globulin is a substance made from human blood samples that contains antibodies against the Hepatitis B virus. It is given as a shot and can provide short-term protection (approximately 3 months) against Hepatitis B.