Overview
Hepatitis B is an infection of the liver caused by the hepatitis B virus. Some people clear the virus within a few months, while in others it stays for years, which is called chronic hepatitis B.
Age at the time of infection matters more than anything else. Babies and young children who are infected almost always go on to carry the virus for life, while most healthy adults who catch it clear it. This is why vaccination at birth is so important.
Symptoms
Many people, including most infected as babies, have no symptoms at all and feel entirely well. When a new infection does cause illness, it may bring:
- Yellow eyes and skin, dark urine and pale stools
- Tiredness that does not lift
- Loss of appetite, nausea and vomiting
- Pain over the liver, on the upper right side of the tummy
- Fever and joint pains
- Itchy skin
Because chronic infection is usually silent, it is often found on a blood test taken for another reason, before donating blood, or in pregnancy.
When to see a doctor
See a doctor within a few days for yellow eyes, dark urine or lasting tiredness with loss of appetite, for a positive hepatitis B test that has had no follow-up, in pregnancy, or after contact with the blood of someone who has hepatitis B.
Causes
The virus spreads when blood, semen, vaginal fluid or another body fluid from an infected person enters the body of someone who is not protected. The common routes are:
- From mother to baby at birth or in early childhood
- Unsterile injections, or reused needles and syringes
- Sharing injecting equipment
- Tattooing, piercing or shaving with equipment that has not been sterilised
- Sex without a condom with an infected partner
- A needle-stick injury or blood splash at work
- Blood that has not been screened
Risk factors
- Being born to a mother with hepatitis B
- Living with or being the partner of someone who has it
- Health care and laboratory work
- , or having had many transfusions or blood products
- Injecting drugs
- Not having completed the course
Complications
A liver that has been inflamed for years can slowly scar. Chronic hepatitis B can lead to cirrhosis, in which the scarred liver works poorly, and to liver cancer, which can develop even without cirrhosis.
Because these can build up silently, people with chronic infection are asked to come for checks at regular intervals, even when they feel well.
Prevention
- The hepatitis B , with the first dose within 24 hours of birth and the rest of the course completed; it gives nearly complete protection that lasts for at least twenty years and probably for life
- Testing in pregnancy, so that the baby can be protected at birth
- Vaccination for household members and partners of anyone with hepatitis B
- A new needle and syringe for every injection, and no sharing of injecting equipment
- Sterile equipment for tattooing, piercing and shaving, and no shared razors, toothbrushes or nail cutters
- Condoms
- Screened blood for transfusion
Diagnosis
Hepatitis B is diagnosed with blood tests, because the symptoms alone cannot tell it apart from other causes of jaundice. The first test looks for the surface antigen of the virus, which shows that the infection is present.
Further blood tests show whether the infection is recent or long-standing, how much virus is in the blood and how the liver is coping. A scan of the liver, and sometimes a test of its stiffness, shows how much scarring there is.
Treatment
A new infection in an adult usually needs no specific medicine. Treatment is supportive, with rest, fluids, ordinary food and relief of symptoms, while the body clears the virus.
Chronic infection is treated with antiviral tablets when the tests show the virus is damaging the liver. They control the virus rather than cure it, and most people who start them stay on them for life. Not everyone needs them, and those who do not are followed up with regular tests instead.
Alcohol should be avoided, and any medicine, supplement or herbal preparation checked with the doctor first, because the liver has to deal with all of them. Treatment for cirrhosis or liver cancer is arranged by a liver specialist when needed.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Hepatitis B spreads by eating together or sitting close to someone who has it.”What is true?
Fact
It does not. Hepatitis B is not spread by sharing food or water, by sharing utensils, by kissing, hugging, coughing or sneezing, or by breastfeeding. It spreads when blood or other body fluids from an infected person enter someone else's body.
Myth“Someone with hepatitis B should be given separate plates and kept apart at home.”What is true?
Fact
Separating a family member is unnecessary and unkind, because ordinary household contact does not pass the virus on. What does help is that the household and partner are tested and vaccinated, and that razors, toothbrushes and nail cutters are not shared.
Myth“Only people who live carelessly get hepatitis B.”What is true?
Fact
In this part of the world most infections begin at birth or in early childhood, long before anyone had a choice about anything. Others follow an unsterile injection, a transfusion or a needle-stick injury at work. Carrying the virus says nothing about a person's character.
Myth“There is no point testing, because nothing can be done about it.”What is true?
Fact
Plenty can be done. Medicines can slow the damage to the liver, lower the risk of liver cancer and help people live longer, and regular checks catch problems early. A test also lets the family be protected by vaccination.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Can I pass it on to my family at home?
Not through everyday life together. Eating from the same plate, hugging, sharing a bathroom, coughing and sneezing do not pass hepatitis B on. Keep razors, toothbrushes and nail cutters to yourself, cover cuts, and ask a doctor to test and vaccinate your household and partner.
I have hepatitis B and I am pregnant. Will my baby get it?
The risk can be brought down a great deal. The baby is given the hepatitis B vaccine within 24 hours of birth along with the other protection the doctor advises, and some mothers are given an antiviral medicine in late pregnancy to lower the amount of virus in their blood. Tell the team looking after you early.
Is there a cure?
Chronic hepatitis B can be controlled but not usually cured. Antiviral medicines keep the virus in check, slow scarring of the liver and lower the risk of liver cancer. Regular monitoring matters just as much as the medicine, because it catches any change early.
I was vaccinated as a child. Do I need a booster?
Usually not. A completed course protects for at least twenty years and probably for life, and boosters are not routinely needed. Some people, such as those on dialysis or with low immunity, are checked and given extra doses, so ask your doctor if that applies to you.
