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Hepatitis B

Published by Bupa's health information team, March 2009.

This factsheet is for people who have hepatitis B, or who would like information about it.

Hepatitis B is a disease that damages the liver. It's caused by infection with the hepatitis B virus (also known as HBV). Hepatitis B can be prevented with the use of a vaccine.

• About hepatitis B
• Symptoms of hepatitis B
• Causes of hepatitis B
• Diagnosis of hepatitis B
• Treatment of hepatitis B
• Prevention of hepatitis B
• Further information
• Questions and answers
• Related topics
• Sources

About hepatitis B

Hepatitis means inflammation of the liver and can have many causes, the most common of which is an infection with a hepatitis virus.

Hepatitis B is relatively uncommon in the UK. High-risk areas for hepatitis B include South-East Asia, Africa, the Middle East, the Far East and southern and eastern Europe.

Hepatitis B is highly contagious, which means it can be passed from person to person very easily. It's 50 to 100 times more contagious than HIV (human immunodeficiency virus). The virus is present in body fluids such as blood, saliva, semen and vaginal fluid.

Hepatitis B can be acute or chronic. An acute illness is typically over quite quickly. The term acute refers to the length of time a person has had it, not how serious a condition is. Chronic hepatitis B lasts for more than six months, sometimes for the rest of a person's life. The term chronic refers to time, not how serious a condition is. Babies and young children who become infected with hepatitis B have a very high chance of becoming carriers, which means they are infectious. Only between two and 10 adults out of 100 infected with hepatitis B will develop a chronic infection.

Symptoms of hepatitis B

Acute hepatitis B

Hepatitis B has an incubation period of about six to 23 weeks - the time from exposure to the virus to the start of symptoms. Some people with hepatitis B never have any symptoms. They are known as asymptomatic carriers as they are still infectious and can unknowingly pass on the disease to others.

If you have hepatitis B you may have symptoms similar to those of flu. They can include:

• mild fever
• tiredness
• aching limbs
• loss of appetite
• feeling sick and vomiting
• stomach ache and/or diarrhoea

You may also develop jaundice, which makes your skin and the whites of your eyes go 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 due to hepatitis B but if you have them, you should visit your GP.

Less than three out of 100 people who have acute hepatitis B develop liver failure (known as fulminant hepatitis) as a complication of acute disease and may need a liver transplant.

Fulminant hepatitis can be fatal.

Chronic hepatitis B

The younger you are when you become infected with hepatitis B, the more likely you are to develop a chronic infection. If you develop chronic hepatitis, you can get the following.

• Cirrhosis (scarring of the liver) - this develops slowly, over five to 20 years or more after infection. Fifteen to 20 out of 100 people with chronic hepatitis B will develop cirrhosis.
• Liver cancer (also known as HCC, or hepatocellular cancer). Up to nine out of 100 people with chronic hepatitis B may develop liver cancer.

Causes of hepatitis B

The hepatitis B virus can be transferred from mother to baby and this usually happens during childbirth ('perinatal' or 'vertical' transmission). This is the most common way that hepatitis B is spread worldwide. However, in developed countries, hepatitis B is usually spread by illegal drug use or sexual contact.

You can get hepatitis B from infected blood:

• by using contaminated needles to inject illegal drugs
• through an open wound
• from contaminated medical or dental equipment that isn't sterilised properly
• from contaminated tattooing equipment that isn't sterilised properly
• by receiving blood from an infected donor in countries where blood isn't tested (in the UK all blood donations are tested for hepatitis B)

Hepatitis B is also an important complication of accidental needle stick injuries and therefore a risk factor for unvaccinated healthcare workers.

As hepatitis B can be spread by sexual contact, body fluids such as semen and vaginal fluid should be considered as potentially infectious.

Diagnosis of hepatitis B

If you think you have been exposed to the hepatitis B virus, you should contact your GP for testing. Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. He or she will ask you a number of questions including, for example, whether you have recently been abroad and if so, which country or region you have visited. Your GP may also need to take your sexual history to establish possible contacts.

Your GP may ask you for a blood sample. This will be sent to a laboratory for testing to find out if you're infected with the hepatitis B virus. The most important test is called the hepatitis B surface antigen test (HBsAg). If this is positive, you have hepatitis B. A range of further laboratory tests can be done to find out if you have been recently infected (acute hepatitis B) or to measure the activity of the virus and how many viruses are present in your blood.

If results show that you're infected with hepatitis B, you may have additional tests. For example, a liver function blood test can measure substances in your blood that indicate any liver damage. If you're at risk, your doctor may want to test you for other viruses that can be transmitted in the same way as hepatitis B, such as hepatitis C and HIV, and for other sexually transmitted diseases.

Treatment of hepatitis B

Most people with acute hepatitis B recover without treatment. The disease generally lasts from one to six weeks but it may last longer than this. Your GP will aim to prevent progression of the disease to cirrhosis and end-stage liver disease, and will generally advise you to rest. As your liver won't be working properly, it's best not to drink any alcohol until your liver is fully recovered.

If you have chronic hepatitis B, your GP may refer you to an infection specialist or hepatologist (a doctor specialising in liver diseases).

Medicines

If you have chronic hepatitis B, your doctor may prescribe the following types of medicines.

• Peginterferon alfa (eg Pegasys, Viraferon-Peg) - given by injection once weekly for 48 weeks.
• Lamivudine (eg Epivir) - given as a tablet or as an oral solution once a day.
• Adefovir dipivoxil - given as a tablet once daily.
• Tenofovir - given as a tablet once daily.
• Telbivudine - given as a tablet once daily.
• Entecavir - given as a tablet once daily.

These medicines aren't suitable for everyone. Your doctor or specialist nurse will give you advice about whether they are the best treatment for you.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Prevention of hepatitis B

If you think you're at risk of getting hepatitis B, contact your GP immediately to discuss whether or not you should have a vaccination against the disease.

If you're infected with hepatitis B, it's important not to spread it to others. Cover any cuts with a dressing and:

• don't have unprotected sex
• don't donate blood
• don't share any needles, syringes, razors or toothbrushes as they may be contaminated with blood

Transmission of hepatitis B to your baby can be prevented by vaccinating him/her at birth.

Hepatitis B vaccine

Immunisation can give protection from hepatitis B but takes six months to give full protection. You will receive a course of three injections and you may also have your blood tested to confirm protection against hepatitis B.

Hepatitis B vaccine is recommended if:

• you inject illegal drugs
• your sexual behaviour puts you at risk
• your occupation involves the risk of exposure to the hepatitis B virus, for example, if you're a healthcare worker directly working with the virus
• you're travelling to countries where the virus is widespread
• you have a weakened immune system

If you have hepatitis B and are pregnant, your baby will need to be given hepatitis B vaccine within 48 hours of being born to prevent him or her from getting the infection.

Ask your GP if you wish to be vaccinated or go to your local sexual health clinic or a travel clinic. If you're at risk of getting hepatitis B at work, speak to your employer about getting vaccinated.

Hepatitis B immunoglobulin (HBIG)

Hepatitis B immunoglobulin is an injection of antibodies against the hepatitis B virus. If you have been exposed to the hepatitis B virus, your GP 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.

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.

For further advice on protection against hepatitis B, talk to your GP or practice nurse.

Further information

• British Liver Trust
  0800 652 7330
  www.britishlivertrust.org.uk
• Hepatitis B Foundation
  01227 738279
  www.hepb.org.uk

Related topics

• Hepatitis A
• Hepatitis C
• Travel vaccinations

Sources

• How prevalent is HBV? British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008
• Hepatitis B. World Health Organization. www.who.int, accessed 7 July 2008
• Immunizations - travel - background information. Hepatitis B. http://cks.library.nhs.uk, accessed 7 July 2008
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:496-497
• What is hepatitis B? British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008
• Diagnosis of acute hepatitis B. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008
• Treatment of acute hepatitis B. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008
• Diagnosis of chronic hepatitis B. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008
• Natural history of chronic hepatitis B. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008
• Transmission of HBV. www.britishlivertrust.org.uk, accessed 21 August 2008
• Joint Formulary Committee, British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008:344-345
• Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B. National Institute of Health and Clinical Excellence (NICE), 2006, Technology Appraisal 96. www.nice.org.uk
• Entecavir for the treatment of chronic hepatitis B. National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk, accessed 21 August 2008
• Hepatitis B. Immunisation against infectious disease - 'The Green Book'. www.dh.gov.uk, accessed 8 July 2008
• Hepatitis B prevention. British Liver Trust. www.britishlivertrust.org.uk, accessed 22 August 2008
• Indications for treatment. British Liver Trust. www.britishlivertrust.org.uk, accessed 28 October 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: March 2009