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.

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.

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.

In 2007, there were an estimated 43,000 new hepatitis B virus infections in the United States. However, the official number of reported hepatitis B cases is much lower. Many people don’t know they are infected or may not have symptoms and therefore never seek the attention of medical or public health officials.

Has the number of people in the United States with acute hepatitis B been decreasing?

Yes, rates of acute hepatitis B in the United States have declined by approximately 82% since 1990. At that time, routine hepatitis B vaccination of children was implemented and has dramatically decreased the rates of the disease in the United States, particularly among children.

How common is chronic hepatitis B in the United States?

In the United States, an estimated 800,000 to 1.4 million persons have chronic hepatitis B virus infection.

How common is chronic hepatitis B outside the United States?

Globally, chronic hepatitis B affects approximately 350 million people and contributes to an estimated 620,000 deaths worldwide each year.

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.

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

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.

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.

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.

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

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 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.

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.

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.

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.

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.

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.

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)

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.

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

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

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.

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

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.

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.

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.

Hepatitis B Surface Antigen (HBsAg) is a protein on the surface of the hepatitis B virus. It can be detected in the blood during acute or chronic hepatitis B virus infection. The body normally produces antibodies to HBsAg as part of the normal immune response to infection.

A positive test means:

• A person has an acute or chronic hepatitis B virus infection and can pass the virus to others

A negative test means:

• A person does not have the hepatitis B virus in his or her blood

Hepatitis B Surface Antibody (anti-HBs) is an antibody that is produced by the body in response to the hepatitis B surface antigen.

A positive test means:

• A person is protected or immune from getting the hepatitis B virus for one of two reasons:
•
+ he or she was successfully vaccinated against hepatitis B
+ OR
+ he or she recovered from an acute infection (and can’t get hepatitis B again)

Total Hepatitis B Core Antibody (anti-HBc) is an antibody that is produced by the body in response to a part of the hepatitis B virus called the ”core antigen.” The meaning of this test often depends on the results of two other tests, anti-HBs and HBsAg.

A positive test means:

• A person is either currently infected with the hepatitis B virus or was infected in the past

IgM Antibody to Hepatitis B Core Antigen (IgM anti-HBc) is used to detect an acute infection.

A positive test means:

• A person was infected with hepatitis B virus within the last 6 months

Hepatitis B “e” Antigen (HBeAg) is a protein found in the blood when the hepatitis B virus is present during an active hepatitis B virus infection.

A positive test means:

• A person has high levels of virus in his or her blood and can easily spread the virus to others

This test is also used to monitor the effectiveness of treatment for chronic hepatitis B.

Hepatitis B e Antibody (HBeAb or anti-HBe) is an antibody that is produced by the body in response to the hepatitis B “e” antigen.

A positive test means:

• A person has chronic hepatitis B virus infection but is at lower risk of liver problems due to low levels of hepatitis B virus in his or her blood

Hepatitis B Viral DNA refers to a test to detect the presence of hepatitis B virus DNA in a person’s blood.

A positive test means:

• The virus is multiplying in a person’s body and he or she is highly contagious and can pass the virus to others
•If a person has a chronic hepatitis B virus infection, the presence of viral DNA means that a person is possibly at increased risk for liver damage

This test is also used to monitor the effectiveness of drug therapy for chronic hepatitis B virus infection.

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.

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.

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.

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.

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
• Healthcare 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
• Healthcare settings targeting services to injection drug users
• Healthcare 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

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/recs/schedules/default.htm.

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

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

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.

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.

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

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

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.

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.

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.

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

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

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.

Yes. When a pregnant woman comes in for prenatal care, she will be given a series of routine blood tests, including one that checks for the presence of hepatitis B virus infection. This test is important because women infected with this virus can pass hepatitis B to their babies during birth. But this can be prevented by giving the infant HBIG and the first hepatitis B vaccine at birth, and then completing the series.

If a pregnant woman has hepatitis B, she can pass the infection to her baby during birth. But this can be prevented through a series of vaccinations and HBIG for her baby beginning at birth. Without vaccination, babies born to women with hepatitis B virus infection can develop chronic infection, which can lead to serious health problems.

A baby can get hepatitis B from an infected mother during childbirth.

Yes, almost all cases of hepatitis B can be prevented if a baby born to an infected woman receives the necessary shots at the recommended times The infant should receive a shot called hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccine within 12 hours of birth. Two or 3 additional shots of vaccine are needed over the next 1–15 months to help prevent hepatitis B. The timing and total number of shots will be influenced by several factors, including the type of vaccine and the baby’s age and weight. In addition, experts recommend that the baby be tested after completion of the vaccine series to make sure he or she is protected from the disease. To best protect your baby, follow the advice of his or her doctor.

Most newborns who become infected with hepatitis B virus do not have symptoms, but they have a 90% chance of developing chronic hepatitis B. This can eventually lead to serious health problems, including liver damage, liver cancer, and even death.

Yes. The hepatitis B vaccine is recommended for all infants. CDC recommends that the infant get the first shot before leaving the hospital.

Hepatitis B vaccine is recommended for all babies so that they will be protected from a serious but preventable disease. Babies and young children are at much greater risk for developing a chronic infection if infected, but the vaccine can prevent this.