What precautions are necessary when caring for a patient with hepatitis B?

Hepatitis B is a contagious liver infection caused by the hepatitis B virus (HBV).  The natural course of hepatitis B disease is different from one person to another.

• The first phase of disease, during the first 6 months after a person becomes infected, is called acute hepatitis B infection. During this phase, many people show no symptoms at all. Among those who do have symptoms, the illness is usually mild and most people don’t recognize that they have liver disease.
• In 90% of persons who become infected as adults with hepatitis B, the immune system successfully fights off the infection during the acute phase — the virus is cleared from the body within 6 months, the liver heals completely, and the person becomes immune to hepatitis B infection for the rest of their life. In the other 10%, the immune system cannot clear the virus and hepatitis B infection persists past 6 months, usually for the rest of the person’s life. This persistent state is known as chronic hepatitis B infection.
• When babies become infected at birth or during infancy, the percentages are reversed — only 10% clear the infection. The remaining 90% develop chronic hepatitis B infection.
• In chronic hepatitis B infection, the liver becomes inflamed and scarred over a period of years. However, the speed at which inflammation and scarring take place varies between people. Some develop severe liver scarring (cirrhosis) within 20 years. In others, liver disease progresses slowly and does not become a major problem during their lifetime.
• Another concern is the potential for liver cancer. Hepatitis B infection is the single most important cause of hepatocellular (liver) cancer.

Treatment with anti-viral drugs works for some people with HBV who are starting to develop liver damage. Whether treatment will be successful depends on many factors, and these are best discussed with a physician who specializes in liver diseases. When treatment is successful, liver scarring and the potential for liver cancer are reduced.

How do people get the HBV Virus?

Hepatitis B virus is found in the blood of people with HBV infection. It enters the body through blood-to-blood contact.

Reliable blood tests for HBV were developed many years ago. Since blood donors and blood products are tested for HBV, this is no longer the typical means of infection.

In many parts of the world, hepatitis B virus infects more than 8% of the population. HBV-infected women pass the infection to their babies during the birth process. People can also get hepatitis B by sharing needles for injection drug use, through sexual contact with an infected person, by an accidental needlestick with a contaminated needle, or from improperly sterilized medical, acupuncture, piercing, or tattooing equipment.

Who is at Risk for Infection?

• Persons born in places where hepatitis B infection is common (especially China, Southeast Asia, the Pacific Islands, sub-Saharan Africa, and the Amazon basin in South America).
• Children of parents born in those places.
• Injecting drug users
• Hemodialysis patients
• Health care and public safety workers who may have contact with blood
• People having sex with an HBV-infected partner
• Men who have sex with men
• Those living in the same household with an HBV-infected person
• Travelers to places where hepatitis B infection is common who will have extended, close contact with the local population.

How is Hepatitis B Prevented?

Testing & Vaccination

• The hepatitis B vaccine offers excellent protection against HBV. The vaccine is safe and highly effective. Vaccination consists of 3 doses of vaccine (shots) over the course of 6 months. Protection lasts for 20 years to life.
• The American Academy of Pediatrics recommends that all children should receive hepatitis B vaccine starting at birth. (AAP Policy).
• The CDC recommends hepatitis B vaccine for persons traveling to countries where HBV is common (Yellow Book).
• If you have one or more risk factors for hepatitis B infection, you should get a simple HBV blood test. The blood test will determine whether you are:
  • immune to hepatitis B; or
  • susceptible to hepatitis B and need vaccination; or
  • infected with hepatitis B and need further evaluation by a physician
• The basic test for acute HBV infection is called the “Hepatitis B Core IgM Antibody test.” People who have acute hepatitis B show positive IgM antibodies on this test.
• Find out where to get hepatitis B testing and vaccination in San Francisco

Perinatal Hepatitis

• California law requires testing of all pregnant women for hepatitis B infection
• If the mother is HBV-infected, she will pass the infection to the baby during the birth process, unless the baby gets immunized within hours of birth
• Giving the infant HBIG (hepatitis B immune globulin) and HBV vaccine right away will reliably prevent infection of the infant
• Other family members should best tested for hepatitis B too, and given vaccine if they are not already infected or immune

Healthy Habits

The best way to prevent hepatitis B is with vaccination. Other ways to reduce your risk of getting hepatitis B, hepatitis C, and HIV:

• Do not inject drugs. If you do inject drugs, stop and get into a treatment program. If you can’t stop, never share needles, syringes, water, or “works”
• Do not share personal care items that might have blood on them (razors, toothbrushes)
• If you are a health care or public safety worker, follow universal blood/body fluid precautions and safely handle needles and other sharps
• Consider the risks if you are thinking about tattooing, body piercing, or acupuncture – are the instruments properly sterilized?
• If you’re having sex with more than one steady partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases, including viral hepatitis and HIV.

After Exposure to Hepatitis B

• Hepatitis B infection can be prevented by getting vaccine and HBIG (hepatitis B immune globulin) soon after coming into contact with the virus.
• Persons who have recently been exposed to HBV should get HBIG and vaccine as soon as possible and preferably within 24 hours, but not more than 2 weeks after the exposure.
• If you have recently been exposed to hepatitis B, you should immediately contact your doctor or call the Communicable Disease Control Unit at (415) 554-2830.

What are the Symptoms of Hepatitis B?

After the virus enters the body, there is an incubation period lasting 1.5 to 6 months (average 4 months) until illness begins.  During the acute phase (first 6 months after infection) most persons have no symptoms or might experience a mild illness. Symptoms of acute HBV infection, when present, may include:

• Jaundice (yellowing of the skin and eyes)
• Dark-colored urine, light-colored stools
• Fatigue
• Abdominal pain
• Loss of appetite
• Nausea
• Diarrhea
• Fever

During the chronic phase (> 6 months after infection) hepatitis B usually progresses silently, with no symptoms at all during the first 10-20 years. Signs of severe liver scarring (cirrhosis) may include:

• Ascites (accumulation of fluid and swelling of the abdominal cavity)
• Star-shaped vein pattern developing on the swollen belly
• Jaundice
• Itching
• Easy bruising and bleeding

Chronic HBV infection can lead to serious liver disease, liver scarring (cirrhosis), and hepatocellular (liver) cancer.

Because symptoms of hepatitis B are usually absent, persons with risk for HBV infection should be tested.  If you think you have hepatitis B, or are at risk for hepatitis B, you should contact your doctor.

Additional Information

Key facts

• Hepatitis B is a viral infection that affects the liver.
• Symptoms of hepatitis B include dark urine, nausea and fatigue. However, many people have no symptoms at all.
• Hepatitis B infection can be either acute (when the illness lasts for less than 6 months), or chronic (the illness lasts for longer than 6 months).
• Hepatitis B can be prevented with vaccination.

Hepatitis B is a liver infection caused by the hepatitis B virus. It can cause long lasting liver damage.

Hepatitis B can be acute or chronic. If a person has acute hepatitis B, the virus makes them sick for a short time (less than 6 months), then their body clears the virus and they recover.

If the infection last for more than 6 months, it is called chronic hepatitis. Chronic hepatitis is a lifelong illness.

Vaccination can prevent hepatitis B.

What are the symptoms of hepatitis B?

Many people do not have any symptoms when they are first infected with hepatitis B.

People who do have symptoms or signs may get:

Symptoms usually start 2 to 3 months after infection with the virus and may last from 6 weeks to 6 months.

CHECK YOUR SYMPTOMS — Use our Symptom Checker and find out if you need to seek medical help.

What causes hepatitis B?

Hepatitis B is caused by the hepatitis B virus. It can happen through exposure to infected blood and other bodily fluids in the following situations:

• sharing needles and other injecting drug equipment
• sharing razors, toothbrushes or nail clippers
• sexual contact (either heterosexual or homosexual)
• tattooing with unsterilised needles and equipment
• close family contact with someone who has hepatitis B
• being born to a mother with hepatitis B (although this is uncommon in Australia as pregnant women are screened for hepatitis B and treated if necessary, and also babies are vaccinated soon after birth)
• accidental exposure such as a needle stick injury or being splashed with infected blood or body fluid
• blood transfusion — this is now very rare as blood in Australia is screened for hepatitis B

You cannot catch hepatitis B through being coughed or sneezed on by infected people or by consuming contaminated food and drink. You cannot catch the virus from saliva, breast milk or tears.

How is hepatitis B diagnosed?

A diagnosis of hepatitis B infection is made using blood tests.

Because many people do not have symptoms when they get hepatitis B, they may never be diagnosed. That’s why screening for hepatitis B is recommended in a number of people including:

• people at higher risk
• people who have injected drugs
• men who have sex with men
• people born in areas of the world where hepatitis B is widespread
• Aboriginal and Torres Strait Islander people
• people about to have chemotherapy or other treatment that can suppress the immune system
• people with HIV or hepatitis C
• pregnant women

If you think you have been exposed to infected blood or body fluids, see a doctor as soon as possible. There are treatments that can reduce your risk of developing the infection, if given shortly after exposure.

FIND A HEALTH SERVICE — Our Service Finder can help you find doctors, pharmacies, hospitals and other health services.

How is hepatitis B treated?

There is no specific treatment for acute hepatitis B infection. Treatment aims to maintain good health but not to cure the illness.

Not everyone with chronic hepatitis B needs treatment. In general, people who have chronic hepatitis B but do not have any signs of current liver damage will not need treatment. But it is important to have regular medical checkups to watch for signs of liver damage.

Those who already have liver damage should have close medical supervision and may need antiviral medications, regular monitoring and screening for liver cancer. Antivirals help reduce the risk of developing liver disease in the long term. If you have chronic hepatitis B, you may have to take medicines for the rest of your life.

If you have hepatitis B, you should drink plenty of fluids, eat a healthy balanced diet, get enough rest and avoid alcohol.

What if I am pregnant?

It's recommended that all pregnant women have a blood test for hepatitis B in early pregnancy.

If you have hepatitis B and are pregnant, treatments can reduce the risk of transmission of hepatitis B to the baby.

If you have hepatitis B, it is important to protect others from infection.

Important ways to prevent the spread of hepatitis B include:

• vaccination of all your close contacts (family members and sexual contacts)
• practise safe sex (use condoms) until your sexual contacts are fully vaccinated and immune
• do not donate blood, organs or body tissue
• do not allow your blood to contact another person (cover cuts, clean blood spills with bleach)
• inform healthcare workers (including dentists)
• if your work involves potential for your blood or other body fluid to spread to other people, discuss your situation with your doctor

The hepatitis B vaccine is safe and effective in protecting against hepatitis B infection, providing protection in 95 in 100 vaccinated people.

In Australia, hepatitis B vaccination is part of the standard immunisation schedule for all newborn babies and infants. It's also recommended for adults who are at high risk of exposure, people who are immunosuppressed or have other liver disease. People in these risk groups should be vaccinated against hepatitis B. Talk to your doctor about your level of risk and whether hepatitis B vaccination is recommended for you.

If you weren’t vaccinated against hepatitis B as a child, or if you’re not sure whether you are vaccinated, talk to your doctor about whether you need a catch-up vaccine.

Hepatitis B vaccine

Vaccination is your best protection against hepatitis B. The hepatitis B vaccine is safe and effective in protecting against hepatitis B infection, providing protection in 95 in 100 vaccinated people. In Australia, hepatitis B vaccination is recommended for:

• babies in the first 7 days after birth and children aged 2 months, 4 months and 6 months
• people who live with or share living facilities with a person who has hepatitis B
• sexual partners of people who have hepatitis B
• people who attend sexual health services, if they are not immune to hepatitis B
• men who have sex with men, if they are not immune to hepatitis B
• migrants from countries where hepatitis B is common, if they are not immune to hepatitis B
• Aboriginal and Torres Strait Islander people, if they are not immune to hepatitis B
• people with kidney disease who need dialysis
• people who are about to have an organ transplant, if they are not immune to hepatitis B
• people who have recently had a stem cell transplant
• people living with chronic liver disease or hepatitis C
• people who inject drugs, if they are not immune to hepatitis B
• people who need blood transfusions or blood products
• people with developmental disability who go to day-care facilities, and the staff who work there
• inmates and staff in prisons, detention centres and similar facilities
• sex workers
• anyone whose work may involve blood or body fluids, including healthcare workers, police, people in the military, funeral workers, tattooists and body piercers
• people who are travelling overseas to areas where hepatitis B is common

If you were not vaccinated against hepatitis B as a child, or if you’re not sure whether you are vaccinated, talk to your doctor about whether you need a catch-up vaccine.

This table explains how the vaccine is given, who should get it, and whether it is on the National Immunisation Program Schedule. Some diseases can be prevented with different vaccines, so talk to your doctor about which one is appropriate for you.

What are the complications of hepatitis B?

The course of hepatitis B infection depends mostly on the age at which a person is infected.

People infected as infants are likely to develop long term (chronic) infection and can get complications such as scarring of the liver (cirrhosis) or liver cancer. Infants have a 9 in 10 chance and children have a 3 in 10 chance of developing a chronic, lifelong infection.

People infected as teenagers or adults are likely to become unwell with symptoms (acute hepatitis), but have a smaller chance of developing a chronic infection. Others develop a silent infection, without any symptoms.

Most people infected as adults (approximately 95 in 100) clear the virus from the body within 6 months. They develop immunity to future hepatitis B infections and do not develop long-term liver damage.

However, approximately 1 in 20 adults cannot clear the virus and develop chronic hepatitis B. They are at risk of developing complications such as cirrhosis and liver cancer in the longer term.

Resources and support

• If you are concerned about hepatitis B, see your doctor or use healthdirect’s Symptom Checker to find out what to do next.
• Call the National Hepatitis Infoline on 1800 437 222 — it will direct you to the community-based hepatitis organisation in your state or territory.