Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV).
Most adults with hepatitis B recover fully, even if their symptoms are severe. Infants and children are more likely to develop a long-lasting hepatitis B infection. This is known as a chronic infection.
A vaccine can prevent hepatitis B, but there’s no cure if you have the condition. If you’re infected, taking certain precautions can help prevent spreading the virus to others.
WHAT IS HEPATITIS B?
Hepatitis B is a viral infection that affects your liver. It causes inflammation in your liver tissues, which is what “hepatitis” means. It begins as an acute infection that’s usually short-lived. But in some people, it turns into a chronic infection that never goes away.
Long-term inflammation does serious damage to your liver over time. It can lead to cirrhosis and liver failure. Like other chronic liver diseases, hepatitis B infection can do this damage without causing symptoms. Many people don’t realize they’re infected.
HOW COMMON IS HEPATITIS INFECTION?
Hepatitis B is the most common liver infection in the world. As many as 2 billion people (or 1 in 3) have been infected worldwide. Approximately 250 million people worldwide are living with chronic hepatitis B infection, many unaware.
WHAT ARE THE SYMPTOMS OF HEPATITIS B?
Not everyone has symptoms. If you do, they can range from mild to severe. You may have symptoms (or not) during the acute phase of infection, and you may also have them (or not) with chronic infection. You’re still contagious with or without symptoms.
Hepatitis B signs and symptoms may include:
- Abdominal pain
- Dark urine
- Joint pain
- Loss of appetite
- Nausea and vomiting
- Weakness and fatigue
- Yellowing of the skin and the whites of the eyes, also called jaundice
- Swelling with fluid in your belly or arms and legs.
With acute infection, symptoms of liver disease may indicate a more severe reaction than usual. Although many people clear the HBV virus without treatment, you should see a healthcare provider if you have symptoms of liver disease.
With chronic infection, you may have mild or vague symptoms on an ongoing basis, or you may not have symptoms at all for decades. When symptoms appear later, especially symptoms of liver disease, it may indicate your liver is beginning to fail.
WHAT ARE THE CAUSES?
Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from person to person through blood, semen or other body fluids. It does not spread by sneezing or coughing.
Common ways that HBV can spread are:
- Sexual contact. You may get hepatitis B if you have unprotected sex with someone who is infected. The virus can pass to you if the person’s blood, saliva, semen or vaginal secretions enter your body.
- Sharing of needles. HBV easily spreads through needles and syringes contaminated with infected blood. Sharing IV drug paraphernalia puts you at high risk of hepatitis B.
- Accidental needle sticks. Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood.
- Mother to child. Pregnant women infected with HBV can pass the virus to their babies during childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases. Talk to your provider about being tested for hepatitis B if you are pregnant or want to become pregnant.
Acute vs. chronic hepatitis B
Hepatitis B infection may be short-lived, also called acute. Or it might last a long time, also known as chronic.
- Acute hepatitis B infection lasts less than six months. Your immune system likely can clear acute hepatitis B from your body, and you should recover completely within a few months. Most people who get hepatitis B as adults have an acute infection, but it can lead to chronic infection.
- Chronic hepatitis B infection lasts six months or longer. It lingers because your immune system can’t fight off the infection. Chronic hepatitis B infection may last a lifetime, possibly leading to serious illnesses such as cirrhosis and liver cancer. Some people with chronic hepatitis B may have no symptoms at all. Some may have ongoing fatigue and mild symptoms of acute hepatitis.
The younger you are when you get hepatitis B — particularly newborns or children younger than 5 — the higher your risk of the infection becoming chronic. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease.
WHAT ARE THE RISK FACTORS?
Your risk of hepatitis B infection increases if you:
- Have unprotected sex with multiple sex partners or with someone who’s infected with HBV
- Share needles during IV drug use
- Are a man who has sex with other men
- Live with someone who has a chronic HBV infection
- Are an infant born to an infected mother
- Have a job that exposes you to human blood
- Travel to regions with high infection rates of HBV, such as Asia, the Pacific Islands, Africa and Eastern Europe
WHAT ARE THE COMPLICATIONS?
Having a chronic HBV infection can lead to serious complications, such as:
- Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B infection can lead to extensive liver scarring (cirrhosis), which may impair the liver’s ability to function.
- Liver cancer. People with chronic hepatitis B infection have an increased risk of liver cancer.
- Liver failure. Acute liver failure is a condition in which the vital functions of the liver shut down. When that occurs, a liver transplant is necessary to stay alive.
- Reactivation of the hepatitis B virus. People with chronic hepatitis B who have suppression of their immune system are prone to reactivation of the hepatitis B virus. This can lead to significant liver damage or even liver failure. This includes people on immunosuppressive medications, such as high-dose corticosteroids or chemotherapy. Before taking these medications, you should be tested for hepatitis B. If you test positive for hepatitis B, you should be seen by a liver specialist (hepatologist) before starting these therapies.
- Other conditions. People with chronic hepatitis B may develop kidney disease or inflammation of blood vessels.
Take precautions to avoid HBV
Other ways to reduce your risk of HBV include:
- Know the HBV status of any sexual partner. Don’t engage in unprotected sex unless you’re absolutely certain your partner isn’t infected with HBV or any other sexually transmitted infection.
- Use a new latex or polyurethane condom every time you have sex if you don’t know the health status of your partner. Remember that although condoms can reduce your risk of contracting HBV, they don’t eliminate the risk.
- Don’t use illegal drugs. If you use illicit drugs, get help to stop. If you can’t stop, use a sterile needle each time you inject illicit drugs. Never share needles.
- Be cautious about body piercing and tattooing. If you get a piercing or tattoo, look for a reputable shop. Ask about how the equipment is cleaned. Make sure the employees use sterile needles. If you can’t get answers, look for another shop.
- Ask about the hepatitis B vaccine before you travel. If you’re traveling to a region where hepatitis B is common, ask your provider about the hepatitis B vaccine in advance. It’s usually given in a series of three injections over a six-month period.
HOW DO WE DIAGNOSE HEPATITIS B IN OUR FACILITY?
We will examine you and look for signs of liver damage, such as yellowing skin or belly pain. Tests that can help diagnose hepatitis B or its complications are:
- Blood tests. Blood tests can detect signs of the hepatitis B virus in your body and tell your provider whether it’s acute or chronic. A simple blood test can also determine if you’re immune to the condition.
- Liver ultrasound. A special ultrasound called transient elastography can show the amount of liver damage.
- Liver biopsy. We might remove a small sample of your liver for testing to check for liver damage. This is called a liver biopsy. During this test, we inserts a thin needle through your skin and into your liver and removes a tissue sample for laboratory analysis.
WHAT ARE THE TREATMENT OPTIONS IN OUR FACILITY?
Treatment to prevent hepatitis B infection after exposure
It is important to know whether you have been vaccinated for hepatitis B. We will want to know when you were exposed and what kind of exposure you had.
We give injection of immunoglobulin (an antibody) within 24 hours of exposure to the virus to protect you from getting sick with hepatitis B. Because this treatment only provides short-term protection, you also should get the hepatitis B vaccine at the same time if you never received it.
Treatment for acute hepatitis B infection
If we feel your hepatitis B infection is acute — meaning it is short lived and will go away on its own — you may not need treatment. Instead, we might recommend rest, proper nutrition, plenty of fluids and close monitoring while your body fights the infection. In severe cases, antiviral drugs or a hospital stay is needed to prevent complications.
Treatment for chronic hepatitis B infection
Most people diagnosed with chronic hepatitis B infection need treatment for the rest of their lives. The decision to start treatment depends on many factors, including: if the virus is causing inflammation or scarring of the liver, also called cirrhosis; if you have other infections, such as hepatitis C or HIV; or if your immune system is suppressed by medicine or illness. Treatment helps reduce the risk of liver disease and prevents you from passing the infection to others.
Treatment for chronic hepatitis B may include:
- Antiviral medications. Several antiviral medicines — including entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir), adefovir (Hepsera) and telbivudine — can help fight the virus and slow its ability to damage your liver. These drugs are taken by mouth. Your provider may recommend combining two of these medications or taking one of these medications with interferon to improve treatment response.
- Interferon injections. Interferon alfa-2b (Intron A) is a man-made version of a substance produced by the body to fight infection. It’s used mainly for young people with hepatitis B who wish to avoid long-term treatment or women who might want to get pregnant within a few years, after completing a finite course of therapy. Women should use contraception during interferon treatment. Interferon should not be used during pregnancy. Side effects may include nausea, vomiting, difficulty breathing and depression.
- Liver transplant. If your liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.
WHAT ARE THE PREVENTIONS?
The hepatitis B vaccine is typically given as two injections separated by a month or three or four injections over six months, depending on which vaccine is given. You can’t get hepatitis B from the vaccine. The hepatitis B vaccine is recommended by the United States Advisory Committee on Immunization Practices for adults 19 to 59 years of age who do not have a contraindication to the vaccine.
The hepatitis B vaccine is also strongly recommended for:
- Children and adolescents not vaccinated at birth
- Those who work or live in a center for people who are developmentally disabled
- People who live with someone who has hepatitis B
- Health care workers, emergency workers and other people who come into contact with blood
- Anyone who has a sexually transmitted infection, including HIV
- Men who have sex with men
- People who have multiple sexual partners
- Sexual partners of someone who has hepatitis B
- People who inject illegal drugs or share needles and syringes
- People with chronic liver disease
- People with end-stage kidney disease
- Traveler’s planning to go to an area of the world with a high hepatitis B infection rate