Hepatitis B

What is hepatitis B?

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:

• yellowing of the skin and eyes (jaundice)
• dark urine
• extreme fatigue
• nausea and vomiting
• muscle and joint pain
• abdominal pain
• loss of appetite
• rashes
• pain in the right-hand side of the abdomen
• fever

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.

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.