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Hepatitis B is a
virus that infects the
liver. Most adults who get it have it for a
short time and then get better. This is called acute hepatitis B.
Sometimes the virus causes
a long-term infection, called chronic hepatitis B. Over time, it can damage
your liver. Babies and young children infected with the virus are more likely
to get chronic hepatitis B.
You can have hepatitis B and not know it. You may not have symptoms. If
you do, they can make you feel like you have the flu. But as long as you have
the virus, you can spread it to others.
It's caused by
the hepatitis B virus. It is spread through contact with the blood and body
fluids of an infected person.
You may get hepatitis B if
A mother who has the virus can pass it to her baby during
delivery. Medical experts recommend that all pregnant women get tested for hepatitis
B. If you have the virus, your baby can get shots to help prevent
infection with the virus.
You cannot get
hepatitis B from casual contact such as hugging, kissing, sneezing, coughing,
or sharing food or drinks.
Many people with hepatitis
B don't know they have it, because they don't have symptoms. If you do have
symptoms, you may just feel like you have the flu. Symptoms include:
Most people with chronic hepatitis B have no
A simple blood test
can tell your doctor if you have the hepatitis B virus now or if you had it in
the past. Your doctor also may be able to tell if you have had the vaccine to
prevent the virus.
If your doctor thinks you may have liver damage
from hepatitis B, he or she may use a needle to take a tiny sample of your
liver for testing. This is called a
In most cases, hepatitis B goes
away on its own. You can relieve your symptoms at home by resting, eating
healthy foods, drinking plenty of water, and avoiding alcohol and drugs. Also,
find out from your doctor what medicines and herbal products to avoid, because
some can make liver damage caused by hepatitis B worse.
for chronic hepatitis B depends on whether your infection is getting worse and
whether you have liver damage. Most people with chronic hepatitis B can live
active, full lives by taking good care of themselves and getting regular
checkups. There are medicines for chronic hepatitis B, but they may not be
right for everyone. Work with your doctor to decide if medicine is
right for you.
Sometimes, chronic hepatitis B can lead to
severe liver damage. If this happens, you may need a liver transplant.
The hepatitis B
vaccine is the best way to prevent infection. The vaccine is a series of 3 or 4
shots. Adults at risk and all babies, children, and teenagers should be
A combination vaccine (Twinrix) that protects against
both hepatitis B and hepatitis A also is available.
getting or spreading the virus to others:
Learning about hepatitis B:
Living with hepatitis B:
Health Tools help you make wise health decisions or take action to improve your health.
Hepatitis B is
a liver disease caused by infection with the hepatitis B virus.
The virus is spread when blood,
semen, or vaginal fluids (including menstrual blood)
from an infected person enter another person's body. This usually happens through:
In the past, blood transfusions were a common way of
spreading hepatitis B. Organ transplants could also spread the disease. Today, all
donated blood and organs in the United States are screened for the virus. So it
is extremely unlikely that you could become infected from a
blood transfusion or an organ transplant.
Symptoms appear an average of 60 to 90 days after you
have contact with the virus (incubation period). But they can appear as soon as 45 days to as late as 180 days after contact. Blood, semen, and vaginal fluids,
whether fresh or dried, are highly contagious during
this period and for several weeks after the start of symptoms.
If you have a short-term (acute) infection, in most cases you
can't spread the virus after your body starts making a certain type of hepatitis B antibody.
This generally takes several
weeks. If you have a long-term (chronic) infection, you are able to spread
the virus as long as you have an active infection.
Most people who have an acute hepatitis B infection don't have symptoms. But if you do have symptoms, they may include:
Most people who have chronic infection have no symptoms.
You may get infected without knowing it. You may not find out
that you have an infection until you have a routine blood test or donate
blood. Finding out that a family member or someone you live with is infected also
may cause you to be tested. Some people never know they have hepatitis B until
a doctor finds that they have
Most people who have hepatitis B have an acute
stay infected with the virus for 6 months or longer, you have a chronic infection.
The risk of having chronic infection is related
to the age at which you first become infected. The risk is highest for newborns infected at birth and children up to age 5.
Many people who have chronic hepatitis B won't develop complications. But about 15
to 25 out of 100 people who have chronic infection will die of
liver cancer.1 (This means that 75 to 85 people out of 100 who have a chronic infection won't die of these diseases.) Having a lot
of virus in the body (a high viral load) increases the risk of getting
cirrhosis and liver cancer.
Hepatitis D (delta) virus infection is a problem that can develop in relation to hepatitis B
infection, but it's not common. It occurs only in those with hepatitis B. And it may make that infection more
People who have hepatitis B who engage in high-risk behavior
(such as having multiple sex partners or injecting illegal drugs) are at
increased risk for hepatitis C. They also are at higher risk of getting
HIV, the virus that causes
People who have certain
behaviors or certain jobs are at high risk for becoming infected with
Job risk factors
Lifestyle risk factors include:
Other factors include:
If you see a person with hepatitis B become
unconscious, call 911 or other emergency
Call a doctor right away if you have been diagnosed with
hepatitis B and you have severe
dehydration or these signs of liver
Call to make an appointment if:
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or
condition without using medical treatment. Because of the need to prevent the
spread of hepatitis B, watchful waiting isn't advised if you have symptoms
of the virus or if you think you have come in contact with the
Hepatitis B usually can be
These specialists may work with your doctor to
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will
hepatitis B based on a physical
exam and blood tests. He or she also will ask about your medical history (including possible risks for the virus, such as your job and sexual activity).
tests are done to help diagnose hepatitis B. They include:
Blood tests may be done to help find out if your liver
has been damaged. They include:
Tests may be done if you have chronic hepatitis and are
considering antiviral treatment. These tests also may be used to find out
whether treatment has helped control liver damage. The tests include:
alpha-fetoprotein (AFP) test may be done. If the AFP
level is high, it may point to liver cancer.
If you have
chronic infection, you will need to visit your doctor
regularly. He or she will do blood tests to check your liver function and the
activity of the virus in your body.
Some of the tests can tell your
doctor if the virus is multiplying in your liver. This raises your risk for chronic
The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women have
the hepatitis B surface antigen test. The test can show if a woman has a current hepatitis B infection. This test also may be repeated later in the pregnancy if
a woman is at high risk for infection.
You can be tested for
hepatitis B before getting vaccinated.
hepatitis B infection depends on how
active the virus is and whether you are at risk for liver damage such as
Treatment depends on whether you:
If you have not gotten a hepatitis B vaccine and think you may have been exposed to the virus, you
should get a shot of
hepatitis B immunoglobulin (HBIG) and the first of
three shots of
the hepatitis B vaccine(What is a PDF document?). It is important to receive this treatment within 7 days
after a needle stick and within 2 weeks after sexual contact that may have
exposed you to the virus. The sooner you receive treatment after exposure, the
better the treatment works.
If you have the symptoms of acute
infection, treatment with antiviral medicine usually isn't needed. Home treatment—such as eating well, drinking plenty of fluids, and avoiding alcohol and drugs—
usually will relieve your symptoms.
In some cases, you
may be given medicine to treat an acute infection. But using medicine usually isn't done unless a person is very sick.
Treatment depends on how active the
virus is in your body and your chance of liver damage. The goal of treatment
is to stop liver damage by keeping the virus from multiplying.
Antiviral medicine is used if the virus is active and you are at risk
for liver damage. Medicine slows the ability of the virus to multiply.
Antiviral treatment isn't given to everyone who
has chronic hepatitis B.
Whether or not you take medicine, you will need
to visit your doctor regularly. He or she will do blood
tests to check your liver and the activity of the hepatitis B virus in your body.
Some of the tests can find out whether the virus is multiplying in your liver, which would increase your risk of liver damage.
If you develop advanced liver damage
and your condition becomes life-threatening, you may need
a liver transplant. But not everyone is a good candidate
for a liver transplant.
You can protect yourself against hepatitis B infection by avoiding contact
with the body fluids of someone whose health and sexual history aren't known
to you. To prevent infection:
hepatitis B vaccine is the most effective way to prevent infection. The
vaccine is up to 95% effective against hepatitis B if you receive all the
shots in the vaccination series (3 or 4 shots given at different times).2
The vaccine provides protection against infection for at
least 20 years.3 A
combination vaccine for hepatitis A and B also is
Vaccination is recommended for certain groups of people(What is a PDF document?), such as health professionals, people who have more than one sex partner, and people who have certain illnesses.
Discuss vaccination with your
doctor even if you aren't in one of the recommended groups.
In the United States, about 15 out of 100 of those who become infected don't
know how they got infected.4
cases, a doctor will order
postvaccination testing to make sure you have
developed immunity to the virus. People who need this testing
include those who have an
impaired immune system or those who are health care
workers or sex partners of people who have chronic
If you are exposed to the virus before you have
received all of the shots in the vaccination series, you may be given a dose of
hepatitis B immunoglobulin (HBIG) soon afterward. In
most cases, this will prevent infection until the vaccine takes effect.
If you have had sex with someone who has hepatitis B and you haven't
received all doses of the hepatitis B vaccine, you should receive a shot of
HBIG—in addition to continuing the vaccine series—within 14 days of being
exposed to the virus.
If you are
already infected, you can take steps to
prevent spreading the virus to others. This includes not
donating blood and not sharing razors or other toiletries.
For more information on prevention, see:
Home treatment can help
relieve symptoms and prevent the spread of
hepatitis B virus (HBV).
It is important to keep
your body well-hydrated when you have hepatitis B, especially if you have been
Hepatitis makes it hard for your liver to process drugs and alcohol. If you take drugs (prescription
or illegal) or drink alcohol when you have hepatitis, their effects may be more
powerful and may last longer. They also can make
liver damage worse.
People who have hepatitis
sometimes have itchy skin. You can
control itching by keeping cool and out of the sun,
wearing cotton clothing, or using over-the-counter antihistamines such as Benadryl
or Chlor-Trimeton. Talk to your doctor before taking these medicines.
Treatment with medicine usually isn't recommended for people who have acute
hepatitis B. Antiviral medicine may be used for chronic infection if the virus is multiplying. You also may take medicine if you have liver damage, such as
cirrhosis, or could develop it.
Antiviral therapy may not help if you
already have severe liver damage.
The American Association for
the Study of Liver Disease has made
recommendations on who should receive antiviral
treatment for chronic hepatitis B.5
It's important to weigh the benefits of
treatment against the risks. Treatment for chronic hepatitis B doesn't cure
the disease, but it does suppress it.
There is no surgical treatment for
If you have advanced liver damage because of
hepatitis and your condition becomes life-threatening, you may need a
In rare cases,
acute hepatitis B progresses rapidly to liver failure, a
deadly condition called
fulminant hepatitis. For people who develop this condition, a liver
transplant is the only treatment choice.
Some people who have acute
hepatitis B have severe nausea and
dehydration. If this happens, you might need to stay in the hospital so you can receive fluids
The American Liver Foundation (ALF) funds research and
informs the public about liver disease. A nationwide network of chapters and
support groups exists to help people who have liver disease and to help their families. ALF
also sponsors a national organ-donor program to increase public awareness of
the continuing need for organs. You can send an email by completing a form on the contact page on the ALF website: www.liverfoundation.org/contact.
The Division of Viral Hepatitis provides information
about viral hepatitis online and by telephone 24 hours a day. Pamphlets also
are available. Information is available in English and in Spanish.
The Hepatitis B Foundation is a nonprofit organization that
provides information and patient support programs to the public. It also does
research to find a cure for hepatitis B.
This organization is a grassroots communication and support network
for people with viral hepatitis. It provides education to patients,
professionals, and the public about the prevention, diagnosis, and treatment of
viral hepatitis. The organization will make referrals to local doctors and
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
CitationsAmerican Public Health Association (2008). Viral hepatitis B. In Control of Communicable Diseases Manual, 19th ed., pp. 284–293. Washington, DC: American Public Health Association.American Academy of Pediatrics (2009). Hepatitis B. In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed., pp. 337–356. Elk Grove Village, IL: American Academy of Pediatrics.World Health Organization (2012). Hepatitis B fact sheet. Available online: http://www.who.int/mediacentre/factsheets/fs204/en/index.html.Perrillo R (2010). Hepatitis B and D. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1287–1312. Philadelphia: Saunders Elsevier.Lok SFL, McMahon BJ (2009). Chronic Hepatitis B: Update 2009. Available online: http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Chronic_Hep_B_Update_2009%208_24_2009.pdf.Other Works ConsultedCenters for Disease Control and Prevention (CDC) (2012). Updated CDC recommendations for the management of hepatitis B virus–infected health-care providers and students. MMWR, 61(RR03): 1–12.Janssen, H (2005). Pegylated interferon alfa-2b alone or in combination with lamivudine for HBeAg-positive chronic hepatitis B: A randomised trial. Lancet, 365(9454): 123–129.Lok SFL, McMahon BJ (2009). Chronic Hepatitis B: Update 2009. Available online: http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Chronic_Hep_B_Update_2009%208_24_2009.pdf.Papatheodoridis GV, et al. (2008). Current treatment indications and strategies in chronic hepatitis B virus infection. World Journal of Gastroenterology, 14(45): 6902–6910.Sorrell MF, et al. (2009). National Institutes of Health consensus development conference statement: Management of hepatitis B. Annals of Internal Medicine, 150(2): 104–110.U.S. Preventive Services Task Force (2009). Screening for hepatitis B virus infection in pregnancy: U.S. Preventive
Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine, 150(12): 869–874.Weinbaum CM, et al. (2008). Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR, 57(RR-08): 1–20. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm.
October 29, 2012
Kathleen Romito, MD - Family Medicine & W. Thomas London, MD - Hepatology
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