Hepatitis B

Published by Bupa's Health Information Team, November 2010.

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 an infection with the hepatitis B virus (HBV). Hepatitis B can be prevented with a vaccine.

About hepatitis B

Hepatitis means ‘inflammation of the liver’ and is commonly caused by an infection with a hepatitis virus. It can also be caused by excessive alcohol consumption, certain drugs (eg isoniazid that is used to treat tuberculosis) and other toxins.

Hepatitis B is relatively uncommon in the UK. Areas where it is more common include South Asia, Africa, the Middle East, the Far East and southern and eastern Europe.

Hepatitis B is highly contagious and can be passed from person to person very easily. The virus is present in bodily fluids such as blood, saliva, semen, and vaginal fluid.

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 a few weeks. 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 HBV develops a chronic infection.

Symptoms of hepatitis B

Hepatitis B has an incubation period of about four to 26 weeks. The incubation period is the time from when you’re exposed to the virus to the start of your symptoms. However, many people don’t have any symptoms and are known as ‘asymptomatic carriers’. 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
• tiredness
• aching limbs and/or joint pains
• loss of appetite
• feeling sick and vomiting
• stomach ache and/or diarrhoea
• an intolerance to alcohol

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 doctor.

Complications of hepatitis B

A rare complication of acute hepatitis B is liver failure (known as fulminant hepatitis). This can be fatal. If caught early enough, it can be treated with a liver transplant.

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.

Causes of hepatitis B

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 (eg semen, vaginal fluid).

The virus can survive outside your body for many 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) – this is the most common way that hepatitis B is spread worldwide
• through using 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 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)
• 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.

Diagnosis of hepatitis B

If you think you have been exposed to the hepatitis B virus, contact your GP. Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history. You can also be tested for hepatitis B at your local sexual health clinic.

Your doctor 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. There are a number of laboratory tests that can determine 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. 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.

Treatment of hepatitis B

Most people with acute hepatitis B recover without treatment, within about four to eight 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

If you have acute hepatitis B, your doctor will check your liver function tests and ensure that you’re not developing fulminant (severe) hepatitis. Your doctor will generally advise you to rest. 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 GP may refer you to an infection specialist or hepatologist (a doctor who specialises in liver diseases). Your doctor will aim to prevent the disease progressing to cirrhosis and end-stage liver disease. It is important to avoid alcohol and illegal drugs which might cause further damage to your liver.

Medicines

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
• tenofovir disoproxil fumarate – given as a tablet once a day
• lamivudine – 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.

Prevention of hepatitis B

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, local sexual health clinic 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. 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 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 answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.