The hepatitis B vaccine is the best way to prevent infection. The vaccine is a series of 2, 3, or 4 shots. Adults may also need this shot when their job, travel, health condition, or lifestyle increases their risk of exposure.

To avoid getting or spreading the virus to others:

• Use a condom when you have sex.
• Don't share needles.
• Wear disposable gloves if you have to touch blood.
• Don't share toothbrushes or razors.
• Don't get a tattoo. Or, if you do, make sure that the needles used have been cleaned properly and are sterile.

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.

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Many people who have an acute hepatitis B infection don't have symptoms. But if you do have symptoms, they may include:

• Extreme tiredness (fatigue).
• Mild fever.
• Headache.
• Loss of appetite, nausea, and vomiting.
• Constant discomfort on the right side of the belly under the rib cage. (That's where the liver is located.)
• Tan-coloured bowel movements (stools).
• Dark urine.
• Jaundice. This means that the skin and whites of the eyes look yellow. Jaundice is a major sign of liver damage. It usually appears after other symptoms have started to go away.

Many people who have a chronic infection have no symptoms.

Most people who have hepatitis B have an acute (short-term) infection.

• They start to feel better after 2 to 3 weeks. They develop antibodies to hepatitis B. These antibodies give them lifelong protection against getting infected again.
• A small number of people have symptoms that last for months and sometimes years.
• The disease may be more severe in people who are older than 60.

If you stay infected with the virus for 6 months or longer, you have a chronic infection.

The risk of having a chronic infection is related to your age when you first become infected. The risk is highest for newborns infected at birth and children up to age 5.

A chronic hepatitis B infection can lead to cirrhosis. This can increase the risk of liver cancer.

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Call a doctor now if you have been diagnosed with hepatitis B and you have severe dehydration or these signs of liver failure:

• Extreme irritability.
• Trouble thinking clearly.
• Extreme sleepiness.
• Swelling of the arms, legs, hands, feet, belly, or face.
• Heavy bleeding from the nose, mouth, or rectum (including blood in the stool), or under the skin.
• Yellowing of the skin and the whites of the eyes.

Call to make an appointment if:

• You have risk factors for hepatitis B, such as handling blood or body fluids as a routine part of your job or having many sex partners.
• You have any symptoms of hepatitis B, such as a headache, feeling tired, or an upset stomach.
• Someone in your household has been diagnosed with hepatitis B.
• Your sex partner has been diagnosed with hepatitis B.
• You have been bitten by or exposed to the blood or body fluids (such as semen or vaginal fluids, including menstrual blood) of someone who has hepatitis B.

In most areas, public health units or sexual health clinics are able to diagnose and provide assessment and treatment of hepatitis B.

Watchful waiting

Watchful waiting is a wait-and-see approach. 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 doctor will diagnose hepatitis B based on a physical exam and blood tests. You will also be asked about your past health. This includes possible risks for the virus, such as your job and sexual activity.

Blood tests include:

• Hepatitis B antigens and antibodies. These tests help tell if you are or were infected with the virus. They also can show if you've been immunized and if you have long-term (chronic) infection. You also may get tested for the virus's genetic material (HBV DNA).
• Tests to see if the hepatitis A, hepatitis C, or Epstein-Barr viruses are causing your hepatitis.
• Tests to see if you also are infected with hepatitis D.

Blood tests may also be done to help find out if your liver has been damaged.

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Treatment of a hepatitis B infection depends on how active the virus is. It also depends on whether you are at risk for liver damage such as cirrhosis.

Treatment of short-term (acute) hepatitis B

If you haven't had a hepatitis B vaccine and think you may have been exposed to the virus, you should get a shot of hepatitis B immunoglobulin (HBIG). You should also get the first of three shots of the hepatitis B vaccine. Make sure to get this treatment within 7 days after a needle stick and within 2 weeks after sexual contact that may have exposed you to the virus.

In some cases, you may get medicine to treat an acute infection. But this usually isn't done unless you are very sick.

Treatment of long-term (chronic) hepatitis B

Antiviral medicines are used to stop or slow the growth of the hepatitis B virus and help prevent more serious liver damage. Whether your doctor will suggest treatment depends on how active the virus is and whether your liver is inflamed or damaged.

You may have choices about which medicine to take. The medicines differ in how long you need to take them and in what side effects you might have. Your doctor can help you choose.

• Reduce your activity to match your energy level.
• Avoid alcohol for as long as your doctor tells you to. This may be months. Alcohol can make liver problems worse.
• Make sure your doctor knows all the medicines you take. Some medicines, such as acetaminophen (Tylenol), can make liver problems worse. Do not take any new medicines unless your doctor says it is okay.
• If your doctor prescribes antiviral medicine, take it exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
• If you have nausea or vomiting, try to eat smaller meals and eat more often.
• Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• If you have itchy skin, keep cool, stay out of the sun, and wear cotton clothing. Talk to your doctor about medicines that can be used for itching. Read and follow the instructions on the label.

How to avoid spreading hepatitis B

• Tell the people you live with or have sex with about your illness as soon as possible. The Public Health Agency of Canada recommends that people in close contact with an infected person get the hepatitis B vaccine.
• Do not donate blood or blood products, organs, sperm, or eggs (ova).
• Stop all sexual activity or use latex condoms. Do this until your doctor tells you that you can no longer give hepatitis B to others. Avoid anal contact with a sex partner while you are infected.
• Do not share personal items that may have your blood on them. These include razors, toothbrushes, towels, and nail files.
• Use lotions or ointments to prevent chapped or broken skin. These skin problems can expose others to your blood.
• Tell your doctor, dentist, and anyone else who may come in contact with your blood about your illness.
• If you are pregnant, tell the doctor or midwife who will deliver your baby about your illness. Be sure your baby gets medicine to prevent infection. This should start right after birth.
• If you get blood on your clothing or other fabrics, clean them well.
• Be sure to carefully get rid of sanitary napkins and tampons or other disposable items that have your blood on them. Place them in sealed plastic bags before you throw them away.
• Use a solution of 1 part bleach to 10 parts water to clean surfaces that have your blood or any other body fluid (such as semen or menstrual blood) on them. These surfaces include toilet seats, countertops, and floors.
• If you have long-term hepatitis B, always use latex condoms during any sexual activity. You can infect others with the virus even if you do not have symptoms.

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