Hepatitis B
Hepatitis B is a liver infection caused by a virus that can spread through contact with infected blood or body fluids. While some people recover quickly, others develop a lifelong infection that can lead to serious liver damage if not properly monitored and managed.
Table of contents
- What is Hepatitis B
- Types of Infection
- Signs and Symptoms
- How It Spreads
- Who Is at Risk
- Diagnosis
- Prevention
- Treatment
- Living With Hepatitis B
- Possible Complications
- Global Impact
What is Hepatitis B
Hepatitis B is a viral infection that attacks the liver and causes inflammation. The infection is caused by the hepatitis B virus, also called HBV. This virus specifically targets liver cells and can cause both short-term and long-term illness.[1]
Hepatitis B is considered a serious global health problem. It is actually the most common liver infection in the world. About 254 million people worldwide are living with hepatitis B, and approximately 1.2 million new infections occur each year.[3]
Many people with hepatitis B do not know they are infected. In the United States, about 1 in 2 people with hepatitis B are unaware of their infection.[1] This happens because the infection often does not cause noticeable symptoms, especially in its early stages.
- Liver
Types of Infection
There are two main types of hepatitis B infection. The type you have depends on how long the virus stays in your body. A blood test can tell which type of infection you have.[1]
Acute Hepatitis B
Acute hepatitis B is a short-term illness that occurs within the first 6 months after you are exposed to the virus. Some people with acute hepatitis B have no symptoms or only mild illness that feels like the flu. For others, acute hepatitis B causes more severe symptoms that may require hospital care.[1]
The acute form can last for up to six months. During this entire time, you can spread the virus to others. Most adults who get hepatitis B are able to clear the infection on their own. About 95% of infected adults recover completely from acute infection and do not become chronically infected.[7]
Chronic Hepatitis B
Chronic hepatitis B is a lifelong infection that lasts more than six months. When acute hepatitis B does not go away, it becomes chronic. Left untreated, chronic hepatitis B can cause serious health problems including liver damage, cirrhosis (scarring of the liver), liver cancer, and even death.[1]
The likelihood of developing chronic hepatitis B is much higher for people who are infected at a younger age. About 90% of infants infected during or shortly after birth develop chronic hepatitis B, while less than 10% of those infected after the age of five develop chronic cases.[6]
Most people with chronic disease have no symptoms for many years. However, about 25% of those with chronic hepatitis B will eventually develop cirrhosis and liver cancer.[4] In 2022, hepatitis B resulted in an estimated 1.1 million deaths, mostly from cirrhosis and liver cancer.[3]
Signs and Symptoms
You can have hepatitis B even if you don’t have any symptoms. Many people infected with the virus won’t experience symptoms at all. This is why screening and testing are so important.[1]
When symptoms do occur during acute infection, they often begin about 90 days after exposure to the virus. However, you could notice symptoms as early as two weeks or as late as six months after infection.[2]
If symptoms appear, they may include:[1]
- Pain in your stomach area (abdomen)
- Feeling very tired
- Fever
- Joint pain
- Loss of appetite
- Nausea, stomach pain, and vomiting
- Weakness
- Dark-colored urine
- Light or clay-colored stools
- Yellowing of your skin and the whites of your eyes, called jaundice
Most people with chronic hepatitis B do not have symptoms until much later in life, often decades after exposure. When chronic infection does cause symptoms, they may be similar to those of acute infection.[1]
How It Spreads
Hepatitis B is contagious and spreads through contact with infected blood and body fluids. The virus can spread even in microscopic amounts of these fluids.[1]
You can get hepatitis B if blood, semen, or certain other body fluids from a person infected with the virus enter your body. Bodily fluids that can spread the virus include blood, semen, vaginal fluid, menstrual fluid, saliva, and amniotic fluid.[3]
Common ways hepatitis B spreads include:[4]
- From mother to child during pregnancy or birth
- Having unprotected sex with someone who has the virus
- Sharing needles or syringes with someone who has the virus
- Getting stuck with a contaminated medical instrument
In areas where hepatitis B is common, the virus is most often spread from mother to child at birth or through contact between children during the first 5 years of life. In areas where the disease is less common, sexual contact and injection drug use are the most frequent routes of infection.[3]
Other risk situations include sharing personal items that may have come into contact with blood, such as razors or toothbrushes, and getting tattoos or piercings with unsterilized equipment.[3]
The hepatitis B virus cannot be spread by holding hands, sharing eating utensils, kissing, hugging, coughing, sneezing, or breastfeeding.[6]
Who Is at Risk
Although anyone can get hepatitis B, some people are at higher risk of infection.[7]
People most commonly at risk include:[7]
- Infants born to people with hepatitis B
- People born in countries where hepatitis B is common
- People born in the United States who were not vaccinated as infants and whose parents were born in countries with high rates of hepatitis B
- People who inject drugs or share needles, syringes, and other drug equipment
- Sex partners of people who have hepatitis B
- Men who have sex with men
- People who live with someone who has hepatitis B
Certain medical conditions also increase risk:[7]
- People who have hepatitis C
- People who have sexually transmitted infections, including HIV
- People who are on dialysis
- People who have liver damage or inflammation
Healthcare and public safety workers who are exposed to blood on the job are also at higher risk, as are people who have been in jail or prison.[7]
Diagnosis
Healthcare providers diagnose hepatitis B through blood tests. These tests can detect the hepatitis B virus in your body and tell whether the infection is acute or chronic. A simple blood test can also find out if you’re immune to the condition from previous infection or vaccination.[2]
During diagnosis, your healthcare provider will give you a physical exam and look for symptoms of liver damage, such as yellowing skin and stomach pain.[9]
Additional tests may include:[9]
- Liver ultrasound: A special ultrasound can show the amount of liver damage
- Liver biopsy: Your healthcare provider might remove a small sample of your liver for testing to check for liver damage
Who Should Get Tested
All pregnant women need to get tested for hepatitis B at their first prenatal doctor visit for each pregnancy. Testing is important because the virus can be passed to the baby during pregnancy or birth.[9]
Healthcare professionals also recommend testing for people who:[9]
- Live with someone who has hepatitis B
- Have had many sexual partners
- Have had sex with someone who has hepatitis B
- Were born male and have sex with men
- Have a history of sexually transmitted infections
- Have HIV or hepatitis C
- Have liver test results that are irregular
- Receive kidney dialysis
- Take medicines that suppress the immune system
- Use injection drugs
Prevention
The best way to prevent hepatitis B is by getting vaccinated. The hepatitis B vaccine is safe and effective and is available for infants, children, and adults.[1]
Vaccination
The hepatitis B vaccine offers nearly 100% protection against the virus. The vaccine is usually given soon after birth with booster shots a few weeks later. You need to get all shots in the vaccination series to be fully protected.[3]
The Centers for Disease Control and Prevention (CDC) recommends hepatitis B vaccination for:[1]
- All babies at birth
- All children and adolescents younger than 19 years who were not vaccinated at birth
- Adults between ages 19 and 59 years who haven’t been vaccinated
- Adults age 60 years or older who are at higher risk for hepatitis B
It’s also important to make sure you’ve had the hepatitis B vaccine before you travel to countries where hepatitis B is common.[9]
Other Prevention Methods
If you have been exposed to hepatitis B virus, you should call your healthcare provider right away. A preventive treatment may lower your risk of infection if you receive it quickly, preferably within 24 hours of exposure.[2]
Additional steps to prevent infection include avoiding sharing needles, razors, toothbrushes, or other items that might have blood on them, and using protection during sexual activity.[3]
Treatment
Treatment for hepatitis B depends on whether you have acute or chronic infection.[10]
Treatment for Acute Hepatitis B
Currently, there’s no medicine available for acute hepatitis B. If you have mild symptoms, your doctor will recommend rest, good nutrition, and drinking plenty of fluids. If your symptoms are more severe, you may need to be hospitalized.[10]
Treatment for Chronic Hepatitis B
There are several medications approved to treat people who have chronic hepatitis B. These medications can help prevent severe liver disease. However, not every person with chronic hepatitis B needs medication, and the drugs may cause side effects in some people.[10]
Current treatments fall into two general categories:[11]
- Immune modulator drugs: These are interferon-type drugs that boost the immune system to help get rid of the hepatitis B virus. They are given as a shot over 6 months to 1 year.
- Antiviral drugs: These drugs stop or slow down the virus from reproducing, which reduces inflammation and damage to your liver. They are taken as a pill once a day for at least 1 year and usually longer.
People who start hepatitis B treatment may need to take medication for the rest of their lives because these medications do not lead to a complete cure. The medications help control the virus but don’t eliminate it.[10]
It’s important to know that not everyone with chronic hepatitis B needs to be treated right away. Your doctor will evaluate your condition through regular testing to determine if and when treatment should begin.[11]
Living With Hepatitis B
People with hepatitis B can live healthy and normal lives. If you are diagnosed with hepatitis B, it’s important to see a doctor regularly to optimize your care. Whether you need treatment or not, your doctor will want to see you every six months, or at minimum once every year.[10]
Staying Healthy
If you have hepatitis B, you should:[10]
- Eat a well-balanced diet with healthy foods
- Exercise regularly
- Limit or avoid alcohol consumption completely
- Avoid tobacco smoking
- Talk to your doctor before taking prescription drugs or nutritional supplements
- Get vaccinated against hepatitis A
- Get tested for hepatitis C, hepatitis D, and HIV
- Have your liver checked regularly (every 3 to 6 months)
Alcohol is particularly harmful because it can damage your liver, which is already being injured by the hepatitis B virus. You should eliminate all alcohol from your diet.[17]
Many over-the-counter drugs are processed through your liver, so check with your pharmacist before taking them to make sure they are safe. Be careful with vitamins and herbal supplements as well, since some could interfere with prescribed hepatitis B drugs or even damage your liver.[17]
Avoid inhaling fumes from paint, paint thinners, glue, household cleaning products, and other potentially toxic chemicals that could damage your liver.[17]
Protecting Your Loved Ones
If you have hepatitis B, you can take steps to protect others. Make sure your close family members and sexual partners get tested for hepatitis B and receive the vaccine if needed. The virus cannot spread through casual contact like hugging, holding hands, or sharing meals.[1]
You’re contagious as long as the virus is active in your body. Your healthcare provider can do blood tests to find out if you have an active or inactive virus.[4]
Possible Complications
Hepatitis B can cause serious health problems if not properly monitored and managed. Both acute and chronic hepatitis B may lead to complications.[4]
Possible complications include:[4]
- Acute liver failure: This is liver failure that happens very quickly. People with acute hepatitis B have an increased risk of this condition.
- Chronic liver failure: Chronic hepatitis B can lead to liver failure that happens over time.
- Cirrhosis: This happens when scar tissue builds up in your liver. Your liver makes scar tissue when it repairs damage. The more damage, the more scar tissue.
- Liver cancer: Chronic hepatitis B is the leading cause of liver cancer. About 25% of people with chronic hepatitis B will eventually develop cirrhosis and liver cancer.
- Hepatitis D: This is another type of viral hepatitis that you can only get if you have hepatitis B.
Because of these risks, people with chronic hepatitis B should have regular screening for liver cancer. One study found that more than one-third of people with chronic hepatitis B lived much longer if they had six-monthly screening, compared to no screening.[21]
Global Impact
Hepatitis B is a major global health problem. The World Health Organization (WHO) estimates that 254 million people were living with chronic hepatitis B infection in 2022, with 1.2 million new infections each year.[3]
The burden of infection varies greatly by region. The highest numbers are in the WHO Western Pacific Region and the WHO African Region, where 97 million and 65 million people, respectively, are chronically infected. Sixty-one million people are infected in the WHO South-East Asia Region, 15 million in the WHO Eastern Mediterranean Region, 11 million in the WHO European Region, and 5 million in the WHO Region of the Americas.[3]
In the United States, the CDC estimates that approximately 14,000 people have acute hepatitis B and about 640,000 adults have chronic hepatitis B.[4]
Globally, it is estimated that only 10% of persons chronically infected with hepatitis B have been diagnosed and only 5% of those who are eligible for treatment have received treatment.[16] This highlights the need for improved diagnosis and access to care worldwide.
In 2023, the rate of newly reported acute hepatitis B cases remained relatively stable in the United States. Rates were highest among non-Hispanic Black people and in states in or near the Appalachian region. The highest rate of chronic hepatitis B was in non-Hispanic Asian and Pacific Islander people.[1]
