What is hepatitis B?
Hepatitis B (formerly known as serum hepatitis) is a liver disease caused by a virus. The disease is fairly common.
Who gets hepatitis B?
Anyone can get hepatitis B, but those at greater risk include:
How is the virus spread?
Hepatitis B virus can be found in the blood and, to a lesser extent, saliva, semen and other body fluids of an infected person. It is spread by direct contact with infected body fluids, usually by needle stick injury or sexual contact. Hepatitis B virus is not spread by casual contact.
What are the symptoms of hepatitis B?
The symptoms of hepatitis B include tiredness, poor appetite, fever, vomiting and occasionally joint pain, hives or rash. Urine may become darker in color, and then jaundice (a yellowing of the skin and whites of the eyes) may appear. Some individuals may experience few or no symptoms.
How soon do symptoms appear?
The symptoms may appear 1� to six months after exposure, but usually within three months.
How long is a person able to spread the virus?
The virus can be found in blood and other body fluids several weeks before symptoms appear and generally persists for several months afterward. Approximately 6 to 10 percent of infected adults become long-term carriers of the virus; this percentage is much higher (70-90%) for children infected very early in life.
What is the treatment for hepatitis B?
No special medicines or antibiotics are usually prescribed to treat a person once the symptoms appear. Generally, bed rest is all that is needed for uncomplicated cases.
What precautions should hepatitis B carriers take?
Hepatitis B carriers should follow good hygienic practices to ensure that close contacts are not directly contaminated by their blood or other body fluids. Carriers must not share razors, toothbrushes or any other object that may become contaminated with blood. In addition, susceptible household members, particularly sexual partners, should be immunized with hepatitis B vaccine. It is important for carriers to inform their dentist and health care providers about their carrier status.
How can hepatitis B be prevented?
A vaccine to prevent hepatitis B has been available for several years. The vaccine is safe and effective. It is given to all babies when they are born and also is recommended for people in high-risk settings who have not already been infected. A special hepatitis B immune globulin is also available for people who have been exposed to the virus. It may help prevent the disease if it is given within two weeks of exposure. In the event of exposure to hepatitis B, consult a doctor or the local health department.
Hepatitis B is inflammation of the liver caused by infection with the hepatitis B virus (HBV). Viruses are extremely small articles that cannot be seen by the naked eye. The hepatitis B virus belongs to the viral family known as Hepadnaviridae. It was isolated in the laboratory for the first time in 1965 by Dr. Baruch Blumberg. Dr. Blumberg won the Nobel Prize for his discovery and for the invention of the hepatitis B vaccine which became available in 1982.
There is a chronic (lifelong) state of hepatitis B viral infection. This chronic state of hepatitis B kills 5,000 Americans each year.
Anyone who is not immune to HBV can become infected after exposure to the virus. People who are already immune--either from previous infection or because they have been vaccinated against HBV--will not become infected.
Only 3-5% of adults in the United States are immune to HBV because of previous exposure to HBV or vaccination against HBV. But because of aggressive vaccination programs, 90% of those 2 and under are immune from HBV. Hepatitis B continues to be one of the most frequently reported vaccine-preventable diseases in the United States.
HBV is transmitted very differently from the hepatitis A virus (HAV), which you may have read about. HBV is not found in the stool, but in body fluids like blood and semen. Not all body fluids of HBV-infected individuals have the same concentration of the virus. For instance, blood possesses much greater amounts of HBV than does saliva or tears. In general, the main ways of becoming infected with HBV are:
Other body fluids, such as saliva and tears, are very rarely a source of infection. Hepatitis B virus is not spread by contaminated food or water, and cannot be spread casually in the workplace
Globally, most HBV infections occur from infected mother to child, from child to child contact in household settings, and from reuse of unsterilized needles and syringes. In some developing countries, almost everyone has been HBV infected by the time they are adults.
The reason these groups below are higher-risk groups for the transmission of HBV is that they are more likely to have direct contact with HBV-infected body fluids.
Injection drug users
The most efficient way to become infected with HBV is to shoot drugs with a needle
previously used by someone with HBV, because there is direct transmission of the
hepatitis B viral particles into the bloodstream. For instance, 40% of injection drug users
become infected with hepatitis B after only 1 year of drug use, and 80% of injection users
become infected after 10 years of use.
Persons with multiple sex partners or diagnosis of a sexually transmitted disease
People who have sex with multiple sex partners generally do so with those who also have
multiple sex partners. Therefore, there is a greater chance that one or both of those
people will have a sexually transmitted infection (STI). Many STIs such as herpes, when
in the active state, result in open sores around the genitals. These sores can be very small
or even invisible, but still allow for HBV-infected sexual fluids to more easily enter the
body, if one of the sex partners has HBV. Additionally, people with multiple sex partners
tend to partake in riskier—and sometimes unhealthy—behaviors which may put them at
risk for coming into contact with someone else’s blood or body fluids.
Men who have sex with men (MSM)
MSM are at greater risk for HBV infection because they may be more likely to have anal
sex. This type of sex can cause small tears or rips around the lining of the anus. This
could allow for HBV-infected semen to more easily enter the body.
Sex contacts of HBV-infected persons
Since all kinds of sex can result in an exchange of body fluids which may be HBV
infected, anyone who has sex with someone who is an HBV carrier--whether short-term
or chronically--can become HBV infected.
Health care workers
Health care workers will likely come into contact with body fluids. Occasionally they
experience needle stick injuries (an accidental needle puncture of the skin during patient
care). If the needle has not been used yet, a needle stick injury poses little threat.
However, if the needle was just used to draw the blood of someone with HBV then there
is a 30% chance of infection if that healthcare worker is not already immune to HBV.
Patients who have kidney problems and undergo routine dialysis
The kidneys filter our blood of many impurities. When they are unable to do so,
undergoing blood dialysis on a regular basis is necessary to clear out impurities. This
process involves circulating a patient’s blood through a complex system of filters.
Occasionally, an HBV-infected patient’s blood is not thoroughly removed from the
dialysis machine. Other patients whose blood circulates through the HBV-infected
dialysis machine can then pick up the hepatitis B viral particles and become infected.
Household contacts of chronically infected persons
Unfortunately, living in close quarters for a long time with someone who is HBV-positive
puts those around him or her at risk. Over the years, small/unrecognized exchanges of
blood or other body fluids may occur from the HBV-positive person to HBV-negative
persons. In addition, the hepatitis B virus can live on environmental surfaces for up to
seven days. While the chances of infection from those surfaces are small, it is possible.
Infants born to infected mothers
During the delivery process, exchanges of blood can occur from mother to child. Even a
small transfer of blood can start an infection. At least 10 % of babies born to HBVinfected
mothers will become HBV-infected without post-exposure prophylaxis. The
number one predictor of mother-child HBV transmission is the mother’s viral load at the
time of delivery. If the ‘e’ antigen is present in the mother, the viral load is usually very
high.
Infants/children of immigrants from areas with high rates of HBV infection
The younger the age that infection occurs, the more likely the HBV infection will become
chronic. Because prevention, testing and treatment for HBV in some parts of the world
have not been a significant part of public health, many people have acquired HBV, most
at a very early age. Therefore, there are many chronic carriers of HBV in other parts of
the world.
Those regions of the world which have the highest rates of hepatitis B include China, most of Africa, and southeast Asia.
About half of those adults acutely infected with HBV have no signs or symptoms. However, the other half does have signs and symptoms.Signs are clues to a patient’s condition which can be observed by a nurse or doctor, and they include:
Symptoms are clues to a patient’s condition which the patient feels, but which cannot be observed by a nurse or a doctor, and they include:
Three things to remember about the signs and symptoms of hepatitis B:
If you are reading this web page and think you might have Hepatitis B right now,
consult your primary healthcare provider for diagnosis and treatment options.
It can take from 6 weeks to 6 months for a newly infected person to show signs and symptoms. In most cases people recover from the HBV illness within 2-8 weeks. Some people, however, may feel weak and fatigued for months after the other signs and symptoms disappear.
Many chronic carriers of HBV have no signs or symptoms for 10-20 years as they
advance into serious HBV liver disease without knowing it.
A blood sample is all that is needed in order to perform the necessary tests for HBV.
Among adults, only 6% of those who are infected with HBV become chronic carriers. The other 94% resolve the infection completely, and can never again become ill from re-infection.
Most people require simple bed rest and fluids and food as tolerated in order to recover. A small percentage of acutely infected HBV patients require a short stay in the hospital to treat dehydration and general malaise or fatigue. For the 6% of HBV-infected adults who do not recover and become chronic carriers of the hepatitis B virus, there are currently four treatments available in the United States.
For more information please see the ‘Treatment Referral Guide for Virginians with
Chronic Hepatitis B and Hepatitis C’ link on our main Viral Hepatitis page.
You can become ill with acute hepatitis B only ONCE in your lifetime unless you become a chronic carrier of the virus. After you are infected for the first time—whether you become ill or not--your body makes hepatitis B antibodies. These antibodies circulate in your blood for the rest of your life and will fight off the hepatitis B virus if you are ever again infected.
If you are ever infected with HAV you do not need the two-shot vaccination series to prevent HAV. The HAV antibodies left behind from previous infection will protect you from becoming re-infected.
Yes. There is a lifelong--or chronic--state of Hepatitis B. This occurs in:
Therefore, the younger a person is when he or she is infected with HBV, the more likely that person is to become a chronic carrier of HBV.
As we mentioned at the beginning of this web page, in the United States HBV is responsible for the deaths of around 5,000 people per year. The risk of death from HBVrelated liver cancer or cirrhosis is approximately 15-25% for persons who become longterm carriers during childhood. By comparison, the yearly number of deaths from HIV is around 15,000; the number of yearly deaths from Hepatitis C is between 10,000 and 12,000.
To minimize the risk of serious illness and death from chronic HBV, and infected person should:
If you are a chronic carrier of HBV, you should absolutely be tested for the hepatitis A virus (HAV) and the hepatitis C virus (HCV). You should be vaccinated against HAV if you have never been exposed to HAV. It is very important to avoid becoming ill with two or more types of viral hepatitis. There is no vaccine against HCV.
The best way to avoid infection from HBV is to complete the three-shot vaccination series against HBV (see HAV and HBV Vaccine Fact Sheet Link).
If you are having sex, but not with one steady partner, use latex condoms correctly and every time you have sex. The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission;
If you have ever been exposed to HBV, even if you resolved the infection spontaneously or through treatment, you should not donate blood, organs, semen or other body tissues.
There is an injectable substance called Hepatitis B Immune Globulin (HBIG) (see HAV and HBV Vaccine Fact Sheet Link.) Treatment with HBIG requires only one injection. It is like the vaccine only instead of getting it before you are exposed to HBV, you would get it after you have been exposed to HBV.
So, if you recently had sexual contact with someone who you find out was ill with HBV at the time you had sex, you could consult a nurse or a doctor and explain to them your specific situation. At that time they would decide whether or not you should receive the HBIG.
If more than two weeks have passed since the time you think you might have been exposed to the hepatitis B virus, HBIG will very likely not work. At that point it is best to continue to be on the alert for signs and symptoms which may or may not develop.
ALL pregnant women should be tested for hepatitis B! Testing is especially important for women who fall into high-risk groups such as health care workers, women from ethnic communities where hepatitis B is common, spouses or partners living with an infected person, etc. If you are pregnant, be sure your doctor tests you for hepatitis B before your baby is born. HBV testing is important because if you test positive for hepatitis B and are pregnant, the virus can be passed on to your newborn baby during delivery. If your doctor is aware that you have hepatitis B, he or she can make arrangements to have the proper medications in the delivery room to prevent your baby from being infected. If the proper procedures are not followed, your baby has a 90% chance of developing chronic hepatitis B if he or she does in fact become infected during delivery. If you test positive for hepatitis B, then your newborn must be given the following two shots within twelve hours after delivery to ensure that a newborn has more than a 90% chance of being protected against a lifelong hepatitis B infection:
You must also make sure that your baby receives the second and third dose of the hepatitis B vaccine at one and six months of age to ensure complete protection. There is no second chance to protect your newborn baby. If you are infected with hepatitis B during pregnancy, the infection should not cause any problems for you or your unborn baby. Again, it is important for your doctor to be aware of your hepatitis B infection so that he or she can monitor your health and so your baby can be protected from an infection right after it is born.
The Centers for Disease Control and Prevention (CDC) recommends that all women with hepatitis B should be encouraged to breastfeed their newborns. The benefits of breastfeeding outweigh the potential risk of infection, which is minimal, especially since all infants should be vaccinated against hepatitis B at birth.
90 % of those who are HBV-infected during delivery will become chronic HBV
carriers without post-exposure prophylaxis.
You can also take the Hepatitis B Interactive Quiz
