Hepatitis B is inflammation (irritation and swelling) of the liver due to the hepatitis B virus (HBV).
Causes, incidence, and risk factors:
The hepatitis B virus spreads through blood, semen, vaginal fluids, and other body fluids.
Infection can occur if you have:
- Blood transfusions
- Contact with blood in health care settings
- Had direct contact with the blood of an infected person by touching an open wound or being stuck with a needle
- Had unprotected sex with an infected person
- Received a tattoo or acupuncture with contaminated instruments
- Shared needles during drug use
- Shared personal items (such as toothbrushes, razors, and nail clippers) with an infected person
The hepatitis B virus can be passed to an infant during childbirth if the mother is infected.
Other risk factors for hepatitis B infection include:
- Being born, or having parents who were born in regions with high infection rates (including Asia, Africa, and the Caribbean)
- Having multiple sex partners
- Men having sex with men
- Being on hemodialysis
- Being infected with HIV
Hepatitis B infections may be acute or chronic.
- Acute hepatitis B is the 3 - 6 month period after becoming infected.
- Chronic hepatitis B is when the hepatitis B virus remains in a person's body. These people are considered to be carriers of hepatitis B, even if they do not have any symptoms.
Most of the damage from the hepatitis B virus is due to the body's response to the infection. When the body's immune system detects the infection, it sends out special cells to fight it off. However, these disease-fighting cells can lead to liver inflammation.
Many people who have chronic hepatitis B have few or no symptoms. They may not even look sick. As a result, they may not know they are infected. However, they can still spread the virus to other people.
Symptoms may not appear for up to 6 months after the time of infection. Early symptoms may include:
- Appetite loss
- Low-grade fever
- Muscle and joint aches
- Nausea and vomiting
- Yellow skin and dark urine due to jaundice
People with chronic hepatitis may have no symptoms, even though gradual liver damage may be occurring. They may have some or all of the symptoms of acute hepatitis.
Signs and tests:
The following tests are done to identify and monitor liver damage from hepatitis B:
The following tests are done to help diagnose hepatitis B:
- Hepatitis B surface antigen (HBsAg): positive result means you have active infection
- Antibody to hepatitis B core antigen (Anti-HBc): positive result means you had a recent infection or an infection in the past
- Antibody to HBsAg (Anti-HBs): positive result means you have either had hepatitis B in the past, or have received a hepatitis B vaccine
- Hepatitis E surface antigen (HBeAg): positive result means you are more contagious
Patients with chronic hepatitis may receive ongoing blood tests.
Acute hepatitis needs no treatment other than careful monitoring of liver function with tests. You should get plenty of bed rest, drink plenty of fluids, and eat healthy foods.
In the rare case that you develop liver failure, you will need a liver transplant. A liver transplant is the only cure in some cases of liver failure.
Some patients with chronic hepatitis may be treated with antiviral medications and a medication called peginterferon. Hepatitis B cannot be cured, but these medications may help lessen the infection. Liver transplantation is used to treat end-stage chronic hepatitis B liver disease.
Patients with chronic hepatitis should avoid alcohol and should always check with their doctor or nurse before taking any over-the-counter medications or herbal supplements. This even includes medications such as acetaminophen, aspirin, or ibuprofen.
See: Cirrhosis for information about treating more severe liver damage caused by hepatitis B.
The acute illness usually goes away after 2 - 3 weeks. The liver usually returns to normal within 4 - 6 months in almost all patients who are infected.
Some people develop chronic hepatitis.
- Most newborns and about 50% of children who become infected with hepatitis B develop chronic hepatitis. Only a few adults who are infected with the hepatitis B virus develop the chronic condition.
- Chronic hepatitis B infection increases the risk for liver damage, including cirrhosis and liver cancer.
- People who have chronic hepatitis B can transmit the infection. They are considered carriers of the disease, even if they do not have any symptoms.
Hepatitis B is fatal in approximately 1% of cases.
There is a higher rate of hepatocellular carcinoma in people who have chronic hepatitis B than in the general population.
Other complications may include:
- Fulminant hepatitis, which can lead to liver failure and possibly death
- Chronic persistent hepatitis
Calling your health care provider:
Call your health care provider if:
- You develop symptoms of hepatitis B
- Hepatitis B symptoms do not go away in 2 or 3 weeks, or new symptoms develop
- You belong to a high-risk group for hepatitis B and have not yet received the HBV vaccine .
All children should receive their first dose of the hepatitis B vaccine at birth, and complete the series of three shots by age 6 - 18 months. Children younger than age 19 who have not been vaccinated should receive "catch-up" doses.
People who are at high risk, including health care workers and those who live with someone who has hepatitis B should get the hepatitis B vaccine .
Infants born to mothers who either currently have acute hepatitis B, or who have had the infection should receive a special vaccination that includes hepatitis B immune globulin and a hepatitis B immunization within 12 hours of birth.
Screening of all donated blood has reduced the chance of getting hepatitis B from a blood transfusion. Mandatory reporting of the disease allows state health care workers to track people who have been exposed to the virus. The vaccine is given to those who have not yet developed the disease.
The hepatitis B vaccine or a hepatitis B immune globulin (HBIG) shot may help prevent hepatitis B infection if it is given within 24 hours of exposure.
Lifestyle measures for preventing transmission of hepatitis B:
- Avoid sexual contact with a person who has acute or chronic hepatitis B.
- Use a condom and practice safe sex.
- Avoid sharing personal items, such as razors or toothbrushes.
- Do not share drug needles or other drug paraphernalia (such as straws for snorting drugs).
- Clean blood spills with a solution containing 1 part household bleach to 10 parts water.
Hepatitis B (and hepatitis C) viruses cannot be spread by casual contact, such as holding hands, sharing eating utensils or drinking glasses, breast-feeding, kissing, hugging, coughing, or sneezing.
Sorrell MF, Belongia EA, Costa J, Gareen IF, Grem JL, Inadomi JM, et al. National Institutes of Health Consensus Development Conference Statement: Management of hepatitis B. Ann Intern Med. 2009;150:104-10.
Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008;359:1486-1500.