Hepatitis B Overview
What is hepatitis?
Hepatitis means inflammation of the liver. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can all cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common hepatitis viruses are hepatitis A virus, hepatitis B virus, and hepatitis C virus.
What is the difference between hepatitis A, hepatitis B, and hepatitis C?
Hepatitis A, Hepatitis B, and Hepatitis C are liver infections caused by three different viruses. Although each can cause similar symptoms, they are spread in different ways and can affect the liver differently. Hepatitis A is usually a short-term infection and does not become a long-term infection. Hepatitis B and hepatitis C can also begin as short-term infections but in some people, the virus remains in the body, and causes chronic, or lifelong, infection. There are vaccines to prevent hepatitis A and hepatitis B; however, there is no vaccine for hepatitis C.
The page “What is viral hepatitis?” explains in detail the differences between hepatitis A, hepatitis B, and hepatitis C.
What is hepatitis B?
Hepatitis B is a liver infection caused by the hepatitis B virus. Hepatitis B can range from a mild illness lasting a few weeks to a serious, lifelong illness.
- Acute hepatitis B is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis B virus. An acute infection can range in severity from a mild illness with few or no symptoms to a serious condition requiring hospitalization. Some people, especially adults, are able to clear the virus without treatment. People who clear the virus become immune and cannot get infected with the hepatitis B virus again. Acute infection can — but does not always — lead to chronic infection.
- Chronic hepatitis B is a lifelong infection with the hepatitis B virus. Over time, chronic hepatitis B can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death.
What is the likelihood that acute hepatitis B will become chronic?
The likelihood that hepatitis B will develop from an acute infection into a chronic infection depends on the age of the person infected. The younger a person is when infected with hepatitis B virus, the greater the chance of developing a chronic infection. Approximately 90% of infected infants will develop chronic infection. The risk goes down as a child gets older. Approximately 25%–50% of children infected between the ages of 1 and 5 years will develop chronic hepatitis B. By contrast, about 95% of adults recover completely and do not become chronically infected.
Hepatitis B Statistics
How common is acute hepatitis B in the United States?
In 2017, a total of 3,409 cases of acute hepatitis B were reported to CDC. Since many people may not have symptoms or don’t know they are infected, their illness is often not diagnosed so it can’t be reported or counted. CDC estimates the actual number of acute hepatitis B cases was closer to 22,200 in 2017.
How common is chronic hepatitis B in the United States?
In the United States, an estimated 862,000 people have chronic hepatitis B.
How common is chronic hepatitis B around the world?
Globally, approximately 257 million people have chronic hepatitis B.
Hepatitis B Transmission / Exposure
How is hepatitis B spread?
The hepatitis B virus is spread when blood, semen, or other body fluid infected with the hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus from:
- Birth (spread from an infected mother to her baby during birth)
- Sex with an infected partner
- Sharing needles, syringes, or drug preparation equipment
- Sharing items such as toothbrushes, razors or medical equipment such as a glucose monitor with an infected person
- Direct contact with the blood or open sores of an infected person
- Exposure to blood from needlesticks or other sharp instruments of an infected person
Hepatitis B virus is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.
Can a person spread the hepatitis B virus and not know it?
Yes. Many people with a hepatitis B virus infection do not know they are infected since they do not feel or look sick. However, they can still spread the virus to others.
Can the hepatitis B virus be spread through sex?
Yes. The hepatitis B virus can be in the blood, semen, and other body fluids of an infected person. A person who has sex with an infected partner can become infected with the virus.
Can hepatitis B be spread through food?
Unlike hepatitis A, hepatitis B is not spread routinely through food or water.
Who is at risk for hepatitis B?
Although anyone can get hepatitis B, some people are at greater risk:
- Infants born to infected mothers
- People who inject drugs or share needles, syringes, or other drug equipment
- Sex partners of people with hepatitis B
- Men who have sexual contact with men
- People who live with a person who has hepatitis B
- Health care and public safety workers exposed to blood on the job
- Hemodialysis patients
If I think I have been exposed to the hepatitis B virus, what should I do?
If you are concerned that you might have been exposed to the hepatitis B virus, call your doctor or your health department. If someone who has been exposed to hepatitis B virus gets the hepatitis B vaccine and/or a shot called “HBIG” (hepatitis B immune globulin) within 24 hours, infection with the hepatitis B virus could be prevented.
How long does the hepatitis B virus survive outside the body?
The hepatitis B virus can survive outside the body for at least 7 days. During that time, the virus is still capable of causing infection.
How should blood spills be cleaned from surfaces to make sure that hepatitis B virus is gone?
All blood spills — including those that have already dried — should be cleaned and disinfected with a mixture of bleach and water (one part household bleach to 10 parts water). Gloves should always be used when cleaning up any blood spills. Even dried blood can be infectious.
If I have been infected with the hepatitis B virus in the past, can I get it again?
If you have been infected with hepatitis B in the past and cleared the virus, you cannot get infected again. Once you clear the hepatitis B virus, you have antibodies that protect you for life from getting infected again. An antibody is a substance found in the blood that the body produces in response to a virus. Antibodies protect the body from disease by attaching to the virus and destroying it.
However, some people, especially those infected during early childhood, remain infected for life because they never clear the virus from their bodies. Blood tests are available to tell if you have ever been infected or if you are still infected with the hepatitis B virus.
Can I donate blood if I have hepatitis B?
The American Red Cross does not accept blood donations from anyone with current signs or symptoms of hepatitis, or if you have ever tested positive for hepatitis B.
Can I donate organs if I have hepatitis B?
According to the U.S. Department of Health & Human Service’s online information on organ donation and transplantation, very few conditions would prevent someone from being an organ, eye, or tissue donor. Even with acute or chronic hepatitis B, you may be able to donate your organs or tissues. The transplant team will determine what organs or tissue can be used based on a clinical evaluation, medical history and other factors.
Prevention / Vaccination
Can hepatitis B be prevented?
Yes. The best way to prevent hepatitis B is by getting vaccinated. The hepatitis B vaccine is safe and effective. Completing the series of shots is needed for full protection.
How does the hepatitis B vaccine work?
The hepatitis B vaccine stimulates your natural immune system to protect against the hepatitis B virus. After the vaccine is given, your body makes antibodies that protect you against the virus. An antibody is a substance found in the blood that is produced in response to a virus invading the body. These antibodies will fight off the infection if a person is exposed to the hepatitis B virus in the future.
Who should get vaccinated against hepatitis B?
Hepatitis B vaccination is recommended for:
- All infants
- All children and adolescents younger than 19 years of age who have not been vaccinated
- People at risk for infection by sexual exposure
- People whose sex partners have hepatitis B
- Sexually active people who are not in a long-term, mutually monogamous relationship (for example, people with more than one sex partner during the previous 6 months)
- People seeking evaluation or treatment for a sexually transmitted infection
- Men who have sex with men
- People at risk for infection by exposure to blood
- People who inject drugs
- People who live with a person who has hepatitis B
- Residents and staff of facilities for developmentally disabled people
- Health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job
- Hemodialysis patients and predialysis, peritoneal dialysis, and home dialysis patients
- People with diabetes aged 19–59 years; People with diabetes aged 60 or older should ask their health care professional.
- International travelers to countries where hepatitis B is common
- People with hepatitis C virus infection
- People with chronic liver disease
- People with HIV infection
- People who are in jail or prison
- All other people seeking protection from hepatitis B virus infection
Is the hepatitis B vaccine recommended before international travel?
The risk for hepatitis B virus infection in international travelers is generally low, although people traveling to certain countries are at an increased risk. Travelers to countries where hepatitis B is common should get the hepatitis B vaccine.
Is the hepatitis B vaccine safe?
Yes, the hepatitis B vaccine is safe. Soreness at the injection site is the most common side effect reported. As with any medicine, there are very small risks that a serious problem could occur after getting the vaccine. The safety of vaccines is always being monitored. For more information, visit CDC’s vaccine safety site.
Is it harmful to have an extra dose of hepatitis B vaccine or to repeat the entire hepatitis B vaccine series?
No, getting extra doses of hepatitis B vaccine is not harmful.
What should be done if hepatitis B vaccine series was not completed?
Talk to your doctor to resume the vaccine series as soon as possible. The series does not need to be restarted. If the series is interrupted, the next dose should be given as soon as possible.
Who should not receive the hepatitis B vaccine?
Anyone who has had a serious allergic reactions to a prior dose of hepatitis B vaccine, to any part of the vaccine, or yeast should not get the hepatitis B vaccine. When hepatitis B vaccine is given as part of a combination vaccine, possible reasons for not getting the other vaccine(s) should be checked.
Are booster doses of the hepatitis B vaccine necessary?
It depends. A “booster” dose of hepatitis B vaccine is a dose that increases or extends the effectiveness of the vaccine. Booster doses are not recommended for most healthy people. Booster doses are recommended only in certain circumstances and the need for booster doses is determined by a certain blood test that looks for hepatitis B surface antibody (anti-HBs).
Are there reasons to get tested for hepatitis B immunity?
There are many different reasons for a person to get a blood test that looks for hepatitis B immunity through the presence of surface antibody (anti-HBs). The test is especially important for people who may or have been exposed to the blood of a person infected with the hepatitis B virus. This includes:
- Infants born to mothers with hepatitis B
- Health Care Providers
- Hemodialysis patients
- Sex partners of someone with hepatitis B
- Any other people that have an ongoing risk for exposure to the blood of an infected person
The test can help determine if the person needs another dose of the hepatitis B vaccine in order to help give them further protection against infection.
Is there a vaccine that will protect me from both hepatitis A and hepatitis B?
Yes, there is a combination vaccine approved for adults that protects people from both hepatitis A and hepatitis B. The combined hepatitis A and B vaccine is usually given as three separate doses over a 6-month period.
Can I get the hepatitis B vaccine at the same time as other vaccines?
Yes. Getting two different vaccines at the same time has not been shown to be harmful.
Where can I get the hepatitis B vaccine?
Talk to your doctor or call your health department. Some clinics offer free or low-cost vaccines.
What is hepatitis B immune globulin (HBIG)?
Hepatitis B immune globulin is a substance made from human blood samples that contains antibodies against the hepatitis B virus. It is given as a shot to people exposed to the hepatitis B virus that can protect them from infection. HBIG is given to infants born to hepatitis B infected mothers along with the hepatitis B vaccine within 12 hours of birth, which has been shown to protect them from being infected.
Symptoms
Does acute Hepatitis B cause symptoms?
Sometimes. About 30%-50% of people age 5 years and older have symptoms from acute hepatitis B. Most children under 5 years old and people with serious health problems, such as being immunosuppressed, generally do not have symptoms.
What are the symptoms of acute hepatitis B?
Symptoms of acute hepatitis B, if they appear, can include:
- Fever
- Fatigue
- Loss of appetite
- Nausea
- Vomiting
- Abdominal pain
- Dark urine
- Clay-colored bowel movements
- Joint pain
- Jaundice (yellow color in the skin or the eyes)
How soon after exposure to hepatitis B will symptoms appear?
If symptoms occur, they begin an average of 90 days (or 3 months) after exposure, but they can appear any time between 8 weeks and 5 months after exposure.
How long do acute hepatitis B symptoms last?
If symptoms occur, they usually last several weeks, but some people can be ill for as long as 6 months.
Can a person spread hepatitis B without having symptoms?
Yes. Many people with acute or chronic hepatitis B have no symptoms but can still spread the virus.
What are the symptoms of chronic hepatitis B?
Most individuals with chronic hepatitis B do not have any symptoms, do not feel ill, and can remain symptom free for decades. When and if symptoms do appear, they are similar to the symptoms of acute infection, but can be a sign of advanced liver disease. About 1 in 4 people who become chronically infected during childhood and about 15% of those who become chronically infected after childhood will eventually die from serious liver conditions, such as cirrhosis (scarring of the liver) or liver cancer. Even as the liver becomes diseased, some people still do not have symptoms, although certain blood tests for liver function might begin to show some abnormalities.
How will I know if I have hepatitis B?
Talk to your doctor. Since many people with hepatitis B do not have symptoms, doctors diagnose the infection using blood tests.
How serious is chronic hepatitis B?
Chronic hepatitis B can develop into a serious disease resulting in long-term health problems, including liver damage, liver failure, liver cancer, or even death. There were 1,698 deaths related to hepatitis B virus reported to CDC in 2016, but this is an underestimate.
Tests
What are the common blood tests available to diagnose hepatitis B?
There are many different blood tests available to diagnose hepatitis B. They can be ordered as an individual test or as a series of tests. Ask your doctor to explain what tests were ordered and when you will get the results. Below are some of the common tests and their meanings.
Hepatitis B Surface Antigen (HBsAg) is a protein on the surface of the hepatitis B virus. It can be detected in the blood during acute or chronic hepatitis B virus infection. The body normally produces antibodies to HBsAg as part of the normal immune response to infection.
A positive test means:
- A person has an acute or chronic hepatitis B virus infection and can pass the virus to others
A negative test means:
- A person does not have the hepatitis B virus in his or her blood
Hepatitis B Surface Antibody (anti-HBs) is an antibody that is produced by the body in response to the hepatitis B surface antigen.
A positive test means:
- A person is protected or immune from getting the hepatitis B virus for one of two reasons:
- he or she was successfully vaccinated against hepatitis B
OR - he or she has cleared the virus and recovered from an acute infection (and can’t get hepatitis B again)
Total Hepatitis B Core Antibody (anti-HBc) is an antibody that is produced by the body in response to a part of the hepatitis B virus called the ”core antigen.” The meaning of this test often depends on the results of two other tests, anti-HBs and HBsAg.
A positive test means:
- A person is either currently infected with the hepatitis B virus or was infected in the past but has cleared the infection
IgM Antibody to Hepatitis B Core Antigen (IgM anti-HBc) is used to detect an acute infection.
A positive test means:
- A person was infected with hepatitis B virus within the last 6 months
Hepatitis B “e” Antigen (HBeAg) is a protein found in the blood when the hepatitis B virus is present during an active hepatitis B virus infection. This test is also used to monitor the effectiveness of treatment for chronic hepatitis B.
A positive test means:
- A person has high levels of virus in his or her blood and can easily spread the virus to others
Hepatitis B e Antibody (HBeAb or anti-HBe) is an antibody that is produced by the body in response to the hepatitis B “e” antigen.
A positive test means:
- A person has chronic hepatitis B virus infection but is at lower risk of liver problems due to low levels of hepatitis B virus in his or her blood
Hepatitis B Viral DNA refers to a test to detect the presence of hepatitis B virus DNA in a person’s blood. This test is also used to monitor the effectiveness of drug therapy for chronic hepatitis B virus infection.
A positive test means:
- The virus is multiplying in a person’s body and he or she is highly contagious and can pass the virus to others
- If a person has a chronic hepatitis B virus infection, the presence of viral DNA means that a person is possibly at increased risk for liver damage
Treatment
How is acute hepatitis B treated?
There is no medication available to treat acute hepatitis B. During this short-term infection, doctors usually recommend rest, adequate nutrition, and fluids, although some people may need to be hospitalized.
How is chronic hepatitis B treated?
It depends. People with chronic hepatitis B should seek the care or consultation of a doctor with experience treating hepatitis B. This can include some internists or family medicine practitioners, as well as specialists such as infectious disease physicians, gastroenterologists, or hepatologists (liver specialists). People with chronic hepatitis B should be monitored regularly for signs of liver disease and evaluated for possible treatment. Several medications have been approved for hepatitis B treatment, and new drugs are in development. However, not every person with chronic hepatitis B needs to be on medication, and the drugs may cause side effects in some patients. Once a person starts treatment, he or she will need to take medication for life.
What can people with chronic hepatitis B do to take care of their liver?
People with chronic hepatitis B should be monitored regularly by a doctor experienced in caring for people with hepatitis B. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any lay treatments, prescription pills, nutritional or herbal supplements, or over-the-counter medications, as these can potentially damage the liver.
Pregnancy and Hepatitis B
Are pregnant women tested for hepatitis B?
Yes. When a pregnant woman comes in for prenatal care, she will be given a series of routine blood tests, including one that checks for the presence of hepatitis B virus infection.
If a pregnant woman has hepatitis B, is there a way to prevent her baby from getting hepatitis B?
Yes, almost all cases of hepatitis B can be prevented if a baby born to an infected woman receives the necessary shots at the recommended times. The infant should receive a shot called hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccine within 12 hours of birth. Two or 3 additional shots of vaccine are needed over the next 1–6 months to help prevent hepatitis B. The timing and total number of shots will be influenced by several factors, including the type of vaccine given and the baby’s age and birth weight. In addition, experts recommend that the baby get an antibody test 1-2 months after completion of the vaccine series at age 9-12 months to make sure he or she is protected from the disease. To best protect your baby, follow the advice from your baby’s doctor.
What happens if a baby gets hepatitis B?
Newborns who become infected with the hepatitis B virus have a 90% chance of developing chronic hepatitis B. This can eventually lead to serious health problems, including liver damage, liver cancer, and even death.
Why is the hepatitis B vaccine recommended for all babies?
Hepatitis B vaccination is recommended for all babies to protect them from this serious but preventable disease. Babies and young children are at much greater risk for developing a chronic infection if infected with the hepatitis B virus, but the vaccine is highly effective in preventing the infection.