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Hepatitis B is a virus carried in your blood and body fluids which infects and damages your liver.
Hepatitis B is an inflammation (swelling) of your liver and is caused by infection with the hepatitis B virus.
Hepatitis B is relatively uncommon in the UK. Areas where it’s more common include South Asia, East Asia, sub-Saharan Africa, the Middle East, the Far East and Southern Europe.
Hepatitis B can be acute or chronic. When describing an illness, the terms ‘acute’ and ‘chronic’ refer to how long a person has it, not to how serious a condition is. Acute hepatitis B is typically over within three months. Chronic hepatitis B is a long-term illness that can sometimes last for the rest of the affected person’s life. Up to one adult in 10 who gets infected with the hepatitis B virus develops a chronic infection.
Hepatitis B has an incubation period of about five to 22 weeks. The incubation period is the time from when you’re exposed to the virus to the start of your symptoms. However, some people have mild symptoms or don’t have any at all. These people are still infectious and can unknowingly pass on the disease to others.
If you do have symptoms, they may be similar to those of flu and include:
- a mild fever
- aching limbs and/or joint pains
- loss of appetite
- feeling sick and vomiting
- a reluctance to drink alcohol or smoke
You may also develop jaundice, which makes your skin and the whites of your eyes yellow. This is caused by a yellow-coloured substance in your blood called bilirubin. Bilirubin is usually broken down by your liver, but this doesn't happen if your liver is affected by hepatitis. Jaundice can also cause your urine to darken and your skin to itch.
These symptoms aren't always caused by hepatitis B but if you have them, see your GP.
The younger you are when you become infected with hepatitis B, the more likely you are to develop a chronic infection. The hepatitis B virus infects the cells in your liver, causing inflammation (swelling and tenderness) and fibrosis (scar tissue). If you have hepatitis B for a long time, inflammation and fibrosis continue to spread. Over time, usually after many years, this can lead to cirrhosis (scarring of the liver). If you have cirrhosis, you’re at risk of developing liver failure or liver cancer.
A rare complication of acute hepatitis B is liver failure (known as fulminant hepatitis). This can be fatal. However, if caught early enough, it can be treated with a liver transplant.
Hepatitis B is caused by the hepatitis B virus. It can spread between people by contact with an infected person’s blood or other body fluids, for example, semen or vaginal fluid.
The virus can survive outside your body for up to seven days. During that time, the virus can still cause infection if it enters the body of a person who isn’t immune.
The hepatitis B virus can be spread:
- from mother to baby (usually during childbirth)
- through sharing contaminated needles and syringes to inject drugs
- through sharing razors or toothbrushes that are contaminated with small amounts of infected blood
- through an open wound
- from contaminated tattooing equipment that isn't sterilised properly
- by receiving blood from an infected donor in countries where blood isn't tested
- by having unprotected sex
Hepatitis B can also be spread from accidental needle stick injuries, so if you’re a healthcare worker it’s important to take precautions.
If you think you have been exposed to the hepatitis B virus, contact your GP. He or she will ask about your symptoms and examine you. He or she may also ask you about your medical history. Hepatitis B can be detected by a blood test. A sample of your blood will be sent to a laboratory for testing to find out if you're infected with the hepatitis B virus. A blood test can detect parts of the virus and measure the activity of the virus and how many viruses are present in your blood. The blood test can also determine if you have been recently infected (acute hepatitis B).
If results show that you're infected with hepatitis B, your GP will refer you to a hepatologist (a doctor who specialises in identifying and treating conditions that affect the liver) to have additional tests. For example, a liver function blood test can measure substances in your blood that indicate any liver damage. You may need to have a liver ultrasound scan so that your doctor can look at an image of your liver. You may also need to have a liver biopsy (small sample of tissue taken) to determine how severe the inflammation is and whether any scarring or cirrhosis has developed if you have chronic hepatitis B.
Most people with acute hepatitis B recover without treatment, within about four to 12 weeks. It's important not to spread it to others. Cover any cuts with a dressing and don’t:
- have unprotected sex
- donate blood
- share any needles, syringes, razors or toothbrushes as they may be contaminated with small amounts of infected blood
As your liver won't be working properly, it's important not to drink any alcohol until your liver has fully recovered.
If you have chronic hepatitis B, your doctor will aim to prevent your condition progressing to cirrhosis and end-stage liver disease. You may not need treatment straight away if there are low levels of the hepatitis B virus in your blood and little liver damage. Your doctor will monitor you and start treatment if there are signs of the disease progressing.
There are two types of medicines to treat chronic hepatitis B:
- interferon medicines
- antiviral medicines
Interferon is a protein that is naturally produced by your body when you’re infected with a virus. It prevents the virus multiplying inside your cells. Treatment with interferon can prevent the hepatitis B virus causing more liver damage. The most common interferon medicine is peginterferon alfa-2a. This is an injection that you have once a week for 48 weeks.
Antiviral medicines also stop the hepatitis B virus from multiplying in your body. Your doctor may prescribe medicines on their own or in combination.
- Entecavir – given as a tablet once a day.
- Enofovir disoproxil fumarate – given as a tablet once a day.
- Amivudine – given as a tablet or as an oral solution once a day for at least a year.
- Adefovir dipivoxil – given as a tablet once a day.
- Telbivudine – given as a tablet once a day.
These medicines aren't suitable for everyone. Your doctor or specialist nurse will advise you on which treatment is best for you. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
These medicines don’t cure chronic hepatitis B, but help to suppress the virus and allow your liver to recover. You will usually need to take medicines long term.
Hepatitis B vaccine
If you think you're at risk of getting hepatitis B, for example if you’re going on holiday to a high-risk area, contact your GP or a travel clinic to discuss whether you should have a vaccination against the disease. If you're at risk of getting hepatitis B at work, speak to your employer about getting vaccinated.
It can take up to six months to get full protection and you will receive a course of three injections.
If you’re pregnant and have hepatitis B, your baby should have the hepatitis B vaccine soon after he or she is born. The first dose will be given within 24 hours of you giving birth and two more doses will be given at one and two months, with a booster dose at 12 months.
Hepatitis B immunoglobulin
Hepatitis B immunoglobulin (HBIG) is an injection of antibodies against the hepatitis B virus. If you have been exposed to the hepatitis B virus, your doctor may advise you to have an immunoglobulin injection as well as the vaccine. It's more effective the sooner it's given after exposure to the virus, usually within 48 hours.
Hepatitis B immunoglobulin can also provide short-term protection for newborn babies who are at risk of getting hepatitis B from their mother during childbirth.
1. I have tested positively for hepatitis B. What does that mean?
There are various blood tests to check for hepatitis B. Different tests indicate if you have an acute or chronic infection, if you're immune to further infection, and if you might pass the disease on to others. If you test positive for hepatitis B, your doctor will also carry out further tests to see if the virus is affecting or damaging your liver.
Hepatitis B infection is detected by the hepatitis B surface antigen (HBsAg) test, which is a blood test that looks for the virus in your bloodstream.
A positive test result means that you have hepatitis B, but you will need further tests to find out if you have been recently infected (acute hepatitis B) or if you have chronic hepatitis B.
You will need additional tests to find out how active the virus is and how infectious you are. It's possible to do a test that counts how many viruses are present in each millilitre of your blood (the hepatitis B virus DNA test, also known as the viral load test). Other tests can tell if you're immune to hepatitis B. This might be because you had hepatitis B in the past and recovered from it or because you had a vaccination.
If you test positive for active hepatitis B infection, your doctor may ask you for another blood sample to carry out a liver function test, although this may have been routinely done during your initial hepatitis B test. This test measures certain enzymes and proteins in your blood and allows your doctor to monitor the progress of the disease; for example, whether you have a damaged or inflamed liver.
Your doctor may also discuss the possibility of referring you for a liver ultrasound scan or biopsy, where a small sample of liver tissue will be taken and checked in a laboratory for any liver damage.
2. How does hepatitis B differ from hepatitis A, C, D and E?
Hepatitis is a general term meaning inflammation (swelling) of your liver. There are five types of hepatitis virus – A, B, C, D and E. Hepatitis B, C and D may develop into chronic infections lasting for more than six months, resulting in long-term liver problems.
Hepatitis A, B, C, D and E are all viruses that attack and damage your liver. The hepatitis A and E virus is usually found in the faeces of an infected person. You usually get hepatitis A and E infections from close personal contact with an infected person or by eating or drinking contaminated food or water. Certain types of shellfish (eg mussels, oysters and clams), and food that has been washed in water contaminated by sewage can contain the virus.
Hepatitis B, C and D are spread when an infected person's blood enters your bloodstream. Hepatitis B can also be spread through contact with an infected person’s semen or other bodily fluid. Hepatitis D is an incomplete virus, which means you must already have the hepatitis B infection for it to survive in your body. Only around one in 20 people with hepatitis B also have hepatitis D.
Hepatitis B, C and D infections can cause long-term liver problems, but hepatitis A and E infections are short-lived and usually get better without treatment. There are vaccines available that can protect you from hepatitis A and hepatitis B infection, but there is currently no vaccine to protect you from hepatitis C, D or E.
Because hepatitis B, C and D can cause long-term damage to your liver, it's important that you see a hepatologist (a doctor who specialises in liver diseases) as you may need to take medicines to treat these infections.
3. If I have hepatitis B, how long will I remain infectious?
If you have hepatitis B, you will remain infectious for as long as the virus can be detected in your bloodstream. This will vary from person to person. It may only be a few weeks in someone who has acute hepatitis B and makes a full recovery, to a lifelong infection in someone with chronic hepatitis B.
Hepatitis B is an infectious disease and is easily passed to other people through body fluids, such as blood, semen and vaginal fluid.If you have chronic hepatitis B, you may be a carrier of the virus for life.
If you're infected with hepatitis B, it’s important to try and minimise the risk of infecting other people.
- Don’t have unprotected sex (always use a condom).
- Don’t donate blood.
- Don’t share needles, syringes, razors or toothbrushes (as they may be contaminated with infected blood). The hepatitis B virus can survive outside your body for up to seven days, so dispose of anything that could be contaminated with your blood.
- Cover any cuts with a waterproof dressing.
Hepatitis B isn't spread by casual contact such as touching hands and kissing, or sharing towels and eating utensils.
If you have chronic hepatitis B infection, ensure that your partner and close contacts are vaccinated to protect them from getting the disease.
Your GP will monitor your condition and, if necessary, refer you to an infection specialist or a hepatologist (a doctor who specialises in liver diseases) for blood tests. A positive result for hepatitis B surface antigen indicates that you have hepatitis B, but further tests are required to find out how active the virus is and how infectious you are.
- British Liver Trust
0800 652 7330
- Hepatitis B Foundation UK
0800 434 6476
- Hepatitis B. British Liver Trust. www.britishlivertrust.org.uk, published 2011
- Hepatitis B. PubMed Health. www.ncbi.nlm.nih.gov, published 23 November 2010
- Hepatitis B. NICE Clinical Knowledge Summaries. www.cks.nice.org.uk, published August 2010
- Hepatitis B. Health Protection Agency. www.hpa.org.uk, published 6 November 2009
- Hepatitis B. National Travel Health Network and Centre. www.nathnac.org, published January 2011
- Hepatitis B: How to protect your baby. Department of Health. www.dh.gov.uk, accessed 12 November 2012
- Hepatitis B. Lab Tests Online UK. www.labtestsonline.org, published 11 October 2012
- Hepatitis Centers for Disease Control and Prevention. www.cdc.gov, published 1 April 2008
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