Hepatitis B

hepatitis B

Hepatitis B is a contagious disease caused by the hepatitis B virus (HBV). Illness can be either acute or chronic.

Acute hepatitis B virus infection is a short-term illness that occurs within the first six months after someone is exposed to the hepatitis B virus. Acute infection can, but does not always, lead to chronic infection. The infection can range in severity from a mild illness, with few or no symptoms, to a serious condition requiring hospitalization. Some people, especially adults, are able to clear, or get rid of, the virus without treatment. People who clear the virus become immune and cannot get infected with the hepatitis B virus again.

Chronic hepatitis B virus infection is a long-term illness that occurs when the hepatitis B virus remains in a person’s body. Risk for chronic infection is related to age at infection: approximately 90% of infected infants become chronically infected, compared with 2%–6% of adults. Chronic hepatitis B can lead to serious health issues, like cirrhosis (scarring of the liver), liver cancer, or even death.

Symptoms

Not everyone with hepatitis B infection has symptoms. If symptoms develop, they usually appear 90 days (three months) after exposure, but they can appear any time between six weeks and six months after exposure. 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)

Symptoms are more likely to occur in adults than in children. They usually last a few weeks, but some people can be ill as long as six months. You can spread HBV without having symptoms.

Most individuals with chronic hepatitis B remain symptom free for as long as 20 or 30 years. About 15% to 25% of people with chronic hepatitis B develop serious liver conditions, such as cirrhosis 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 abnormalities.

Hepatitis B is diagnosed with a blood test. The presence of hepatitis B antibodies can tell a healthcare professional if you have been exposed to hepatitis B, if you have a chronic infection, or if you have previously received the hepatitis B vaccine.

Transmission

The hepatitis B virus is spread when blood, semen, or other body fluids from an infected person enters the body of someone who is not infected. Activities that can expose someone to hepatitis B include:

  • Having sex with someone who has hepatitis B
  • Sharing needles, syringes or drug preparation equipment
  • Contact with blood or skin wounds and sores of an infected person
  • Sharing household items (razors, toothbrushes, nail clippers, and tweezers)
  • Being born to a hepatitis B positive mother
  • Exposure to infected blood in any situation can be a risk for transmission

The 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.

Hepatitis B is not spread through breastfeeding, sharing eating utensils, hugging, kissing, holding hands, coughing, or sneezing. Unlike some forms of hepatitis, hepatitis B is also not spread by contaminated food or water.

Vaccination

The best way to prevent hepatitis B is by getting vaccinated. The hepatitis B vaccine is safe and effective and is usually given as 3-4 shots over a 6-month period. All children should get their first dose of hepatitis B vaccine at birth and complete the vaccine series by 6 to 18 months of age. 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
  • Health care 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
Treatment

For those with acute hepatitis B, doctors usually recommend rest, adequate nutrition, fluids, and close medical monitoring. Some people may need to be hospitalized.

People living with chronic hepatitis B should be evaluated for liver problems and monitored on a regular basis. They should avoid alcohol and check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver.

Vaccination to protect against hepatitis A is also recommended. Getting more than one type of hepatitis at once can increase the chance of liver damage and liver cancer.

Hepatitis B and Pregnancy

If a pregnant woman has hepatitis B, she can pass the infection to her baby during birth. For this reason, all pregnant women should be tested for hepatitis B infection during their prenatal care.

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 one to six 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 birth weight. In addition, experts recommend that the baby get an antibody test one to two months after completion of the vaccine series at age 9-12 months to make sure he or she is protected from the disease.

The Vermont Department of Health’s Perinatal Hepatitis B Prevention Program works to identify the hepatitis B status of pregnant women, communicate with those at high risk for transmitting hepatitis B infection to their infants, and ensure access to hepatitis B immune globulin and hepatitis B vaccine. Hepatitis B vaccine is available free of charge to hospitals participating in the Vaccines for Children Program from the Vermont Department of Health Immunization Program.

The hepatitis B vaccine is recommended for all infants, not just infants born to infected women. The CDC recommends that infants get their first shot before leaving the hospital.

For more information on the Health Department’s Perinatal Hepatitis B Prevention Program, vaccine recommendations, and access to free vaccines through the Vaccines for Children Program, visit the Vermont Department of Health Immunization Program web pages

Vermont Immunization Registry Hepatitis B Birth Dose Data Brief

CDC resources for health care providers