Hepatitis B is a virus that infects the liver. Most adults who get it have it for a short time and then get better. This is called acute hepatitis B.
Sometimes the virus causes a long-term infection, called chronic hepatitis B. Over time, it can damage your liver. Babies, young children, and people with weak immune systems who become infected with the virus are more likely to get chronic hepatitis B.
You can have hepatitis B and not know it. You may not have symptoms. If you do, they can make you feel like you have the flu. But as long as you have the virus, you can spread it to others.
It's caused by the hepatitis B virus. It is spread through contact with the blood and body fluids of an infected person.
You may get hepatitis B if you:
A mother who has the virus can pass it to her baby during delivery. Medical experts recommend that all pregnant women get tested for hepatitis B. If you have the virus, your baby can get shots to help prevent infection with the virus.
You cannot get hepatitis B from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drinks.
Many people with hepatitis B don't know they have it, because they don't have symptoms. If you do have symptoms, you may just feel like you have the flu. Symptoms include:
Most people with chronic hepatitis B have no symptoms.
A simple blood test can tell your doctor if you have the hepatitis B virus now or if you had it in the past. Your doctor also may be able to tell if you have had the vaccine to prevent the virus.
If your doctor thinks you may have liver damage from hepatitis B, he or she may use a needle to take a tiny sample of your liver for testing. This is called a liver biopsy.
In most cases, hepatitis B goes away on its own. You can relieve your symptoms at home by resting, eating healthy foods, drinking plenty of water, and avoiding alcohol and drugs. Also, find out from your doctor what medicines and herbal products to avoid, because some can make liver damage caused by hepatitis B worse.
Treatment for chronic hepatitis B depends on whether your infection is getting worse and whether you have liver damage. Most people with chronic hepatitis B can live active, full lives by taking good care of themselves and getting regular checkups. There are medicines for chronic hepatitis B, but they may not be right for everyone. Work with your doctor to decide if medicine is right for you.
Sometimes, chronic hepatitis B can lead to severe liver damage. If this happens, you may need a liver transplant.
The hepatitis B vaccine is the best way to prevent infection. The vaccine is a series of 3 or 4 shots. Check with your doctor or check your provincial immunization schedule to see if you or your child needs the hepatitis B vaccine.
A combination vaccine (Twinrix) that protects against both hepatitis B and hepatitis A also is available.
To avoid getting or spreading the virus to others:
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Hepatitis B is a liver disease caused by infection with the hepatitis B virus.
The virus is spread when blood, semen, or vaginal fluids (including menstrual blood) from an infected person enter another person's body. This usually happens through:
In the past, blood transfusions were a common way of spreading hepatitis B. Organ transplants could also spread the disease. Today, all donated blood and organs in Canada and the United States are screened for the virus. So it is extremely unlikely that you could become infected from a blood transfusion or an organ transplant.
Symptoms appear about 3 months after you have contact with the virus (incubation period). But they can appear as soon as 1 month to as late as 6 months after contact. Blood, semen, and vaginal fluids, whether fresh or dried, are highly contagious during this period and for several weeks after the start of symptoms.
If you have a short-term (acute) infection, in most cases you can't spread the virus after your body starts making a certain type of hepatitis B antibody. This generally takes several weeks. If you have a long-term (chronic) infection, you are able to spread the virus as long as you have an active infection.
Most people who have an acute hepatitis B infection don't have symptoms. But if you do have symptoms, they may include:
Most people who have chronic infection have no symptoms.
You may get infected without knowing it. You may not find out that you have an infection until you have a routine blood test or donate blood. Finding out that a family member or someone you live with is infected also may cause you to be tested. Some people never know they have hepatitis B until a doctor finds that they have cirrhosis or liver cancer.
Most people who have hepatitis B have an acute (short-term) infection.
If you stay infected with the virus for 6 months or longer, you have a chronic infection.
The risk of having chronic infection is related to the age at which you first become infected. The risk is highest for newborns infected at birth and children up to age 5.
Many people who have chronic hepatitis B won't develop complications. But about 15 to 25 out of 100 people who have chronic infection will die of cirrhosis or liver cancer.footnote 1 (This means that 75 to 85 people out of 100 who have a chronic infection won't die of these diseases.) Having a lot of virus in the body (a high viral load) increases the risk of getting cirrhosis and liver cancer.
Hepatitis D (delta) virus infection is a problem that can develop in relation to hepatitis B infection, but it's not common. It occurs only in those with hepatitis B. And it may make that infection more severe.
People who have hepatitis B who engage in high-risk behaviour (such as having multiple sex partners or injecting illegal drugs) are at increased risk for hepatitis C. They also are at higher risk of getting HIV, the virus that causes AIDS.
People who have certain behaviours or certain jobs are at high risk for becoming infected with hepatitis B.
Job risk factors include:
Lifestyle risk factors include:
Other factors include:
If you see a person with hepatitis B become unconscious, call 911 or other emergency services.
Call a doctor right away if you have been diagnosed with hepatitis B and you have severe dehydration or these signs of liver failure:
Call to make an appointment if:
Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Because of the need to prevent the spread of hepatitis B, watchful waiting isn't advised if you have symptoms of the virus or if you think you have come in contact with the virus.
Your family doctor, general practitioner, or pediatrician can usually diagnose a hepatitis B infection.
You may be referred to one of the following specialists who may work with your doctor to plan treatment:
Your doctor will diagnose hepatitis B based on a physical examination and blood tests. He or she also will ask about your medical history (including possible risks for the virus, such as your job and sexual activity).
Blood tests are done to help diagnose hepatitis B. They include:
Blood tests may be done to help find out if your liver has been damaged. They include:
Tests may be done if you have chronic hepatitis and are considering antiviral treatment. These tests also may be used to find out whether treatment has helped control liver damage. The tests include:
An alpha-fetoprotein (AFP) test may be done. If the AFP level is high, it may point to liver cancer.
If you have chronic infection, you will need to visit your doctor regularly. He or she will do blood tests to check your liver function and the activity of the virus in your body.
Some of the tests can tell your doctor if the virus is multiplying in your liver. This raises your risk for chronic hepatitis.
The Canadian National Advisory Committee on Immunization (NACI) recommends that all pregnant women have the hepatitis B surface antigen test. The test can show if a woman has a current hepatitis B infection. This test also may be repeated later in the pregnancy if a woman is at high risk for infection.
It is also recommended that you get tested if you:
You can be tested for hepatitis B before getting vaccinated.
Treatment of hepatitis B infection depends on how active the virus is and whether you are at risk for liver damage such as cirrhosis.
Treatment depends on whether you:
If you have not gotten a hepatitis B vaccine and think you may have been exposed to the virus, you should get a shot of hepatitis B immunoglobulin (HBIG) and the first of three shots of the hepatitis B vaccine. It is important to receive this treatment within 7 days after a needle stick and within 2 weeks after sexual contact that may have exposed you to the virus. The sooner you receive treatment after exposure, the better the treatment works.
If you have the symptoms of acute infection, treatment with antiviral medicine usually isn't needed. Home treatment—such as eating well, drinking plenty of fluids, and avoiding alcohol and drugs— usually will relieve your symptoms.
In some cases, you may be given medicine to treat an acute infection. But using medicine usually isn't done unless a person is very sick.
Treatment depends on how active the virus is in your body and your chance of liver damage. The goal of treatment is to stop liver damage by keeping the virus from multiplying.
Antiviral medicine is used if the virus is active and you are at risk for liver damage. Medicine slows the ability of the virus to multiply.
Antiviral treatment isn't given to everyone who has chronic hepatitis B.
Whether or not you take medicine, you will need to visit your doctor regularly. He or she will do blood tests to check your liver and the activity of the hepatitis B virus in your body.
Some of the tests can find out whether the virus is multiplying in your liver, which would increase your risk of liver damage.
If you develop advanced liver damage and your condition becomes life-threatening, you may need a liver transplant. But not everyone is a good candidate for a liver transplant.
You can protect yourself against hepatitis B infection by avoiding contact with the body fluids of someone whose health and sexual history aren't known to you. To prevent infection:
The hepatitis B vaccine is the most effective way to prevent infection. The vaccine is 95% to 100% effective against hepatitis B if you receive all the shots in the vaccination series (3 or 4 shots given at different times).footnote 2
The vaccine protects most people for life. Some people will need a blood test 1 to 6 months after finishing the vaccine series to make sure they are still protected. Talk to your health care professional about whether you will need a blood test after your vaccine. A combination vaccine for hepatitis A and B is also available.
Immunization schedules vary from province to province. Vaccination is generally recommended for:
Discuss vaccination with your doctor even if you aren't in one of the recommended groups. In the United States, about 15 out of 100 of those who become infected don't know how they got infected.footnote 4
In some cases, a doctor will order post-vaccination testing to make sure you have developed immunity to the virus. People who need this testing include those who have an impaired immune system or those who are health care workers or sex partners of people who have chronic infection.
If you are exposed to the virus before you have received all of the shots in the vaccination series, you may be given a dose of hepatitis B immunoglobulin (HBIG) soon afterward. In most cases, this will prevent infection until the vaccine takes effect.
If you have had sex with someone who has hepatitis B and you haven't received all doses of the hepatitis B vaccine, you should receive a shot of HBIG—in addition to continuing the vaccine series—within 14 days of being exposed to the virus.
If you are already infected, you can take steps to prevent spreading the virus to others. This includes not donating blood and not sharing razors or other toiletries.
For more information on prevention, see:
Home treatment can help relieve symptoms and prevent the spread of hepatitis B virus (HBV).
It is important to keep your body well-hydrated when you have hepatitis B, especially if you have been vomiting.
Hepatitis makes it hard for your liver to process drugs and alcohol. If you take drugs (prescription or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. They also can make liver damage worse.
People who have hepatitis sometimes have itchy skin. You can control itching by keeping cool and out of the sun, wearing cotton clothing, or using over-the-counter antihistamines such as a non-drowsy one like loratadine (Claritin) or one that may make you sleepy like diphenhydramine (Benadryl). Talk to your doctor before taking these medicines.
Treatment with medicine usually isn't recommended for people who have acute hepatitis B. Antiviral medicine may be used for chronic infection if the virus is multiplying. You also may take medicine if you have liver damage, such as cirrhosis, or could develop it.
Antiviral therapy may not help if you already have severe liver damage.
The Canadian Association for the Study of the Liver has made recommendations on who should receive antiviral treatment for chronic hepatitis B.
It's important to weigh the benefits of treatment against the risks. Treatment for chronic hepatitis B doesn't cure the disease, but it does suppress it.
There is no surgical treatment for hepatitis B.
If you have advanced liver damage because of hepatitis and your condition becomes life-threatening, you may need a liver transplant.
In rare cases, acute hepatitis B progresses rapidly to liver failure, a deadly condition called fulminant hepatitis. For people who develop this condition, a liver transplant is the only treatment choice.
Some people who have acute hepatitis B have severe nausea and dehydration. If this happens, you might need to stay in the hospital so you can receive fluids intravenously.
American Public Health Association (2015). Hepatitis B. In DL Heymann, ed., Control of Communicable Diseases, 20th ed., pp. 257–264. Washington, DC: American Public Health Association.
American Academy of Pediatrics (2015). Hepatitis B. In DW Kimberlin et al., eds., Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed., pp. 400–423. Elk Grove Village, IL: American Academy of Pediatrics.
World Health Organization (2015). Hepatitis B fact sheet. Available online: http://www.who.int/mediacentre/factsheets/fs204/en/index.html. Accessed May 7, 2015.
Perrillo R (2010). Hepatitis B and D. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1287–1312. Philadelphia: Saunders Elsevier.
Other Works Consulted
Centers for Disease Control and Prevention (CDC) (2012). Updated CDC recommendations for the management of hepatitis B virus–infected health-care providers and students. MMWR, 61(RR03): 1–12.
Janssen, H (2005). Pegylated interferon alfa-2b alone or in combination with lamivudine for HBeAg-positive chronic hepatitis B: A randomised trial. Lancet, 365(9454): 123–129.
Lok SFL, McMahon BJ (2009). Chronic Hepatitis B: Update 2009. Available online: http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Chronic_Hep_B_Update_2009%208_24_2009.pdf.
Papatheodoridis GV, et al. (2008). Current treatment indications and strategies in chronic hepatitis B virus infection. World Journal of Gastroenterology, 14(45): 6902–6910.
Sorrell MF, et al. (2009). National Institutes of Health consensus development conference statement: Management of hepatitis B. Annals of Internal Medicine, 150(2): 104–110.
U.S. Preventive Services Task Force (2009). Screening for hepatitis B virus infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine, 150(12): 869–874.
Weinbaum CM, et al. (2008). Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR, 57(RR-08): 1–20. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm.
Current as ofJuly 30, 2018
Author: Healthwise StaffMedical Review: Kathleen Romito, MD - Family MedicineDonald Sproule, MDCM, CCFP - Family MedicineE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineElizabeth T. Russo, MD - Internal MedicineW. Thomas London, MD - Internal Medicine, Hepatology
Current as of: July 30, 2018
Kathleen Romito, MD - Family Medicine & Donald Sproule, MDCM, CCFP - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Elizabeth T. Russo, MD - Internal Medicine & W. Thomas London, MD - Internal Medicine, Hepatology
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