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.
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.
Hepatitis B is 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 you:
A mother who has the virus can pass it to her baby during delivery. If you are pregnant and think you may have been exposed to hepatitis B, get tested. 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 do not know they have it, because they do not 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 symptoms.
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 liver biopsy.
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.
Treatment 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 whether medicine is the right treatment 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 vaccinated.
A combination vaccine (Twinrix) that protects against both hepatitis B and hepatitis A also is available.
To avoid getting or spreading the virus to others:
Frequently Asked Questions
Learning about hepatitis B:
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Hepatitis B is a liver disease caused by infection with the hepatitis B virus (HBV). Hepatitis B is one of the most common forms of viral hepatitis, which includes hepatitis A, B, C, D, and E. But hepatitis has many other causes, including some medicines, long-term alcohol use, fatty deposits in the liver, and exposure to certain industrial chemicals.
HBV is spread when blood, semen, or vaginal fluids (including menstrual blood) from an infected person enter another person's body, usually in one of the following ways:
In the past, blood transfusions were a common means of spreading HBV. Organ transplants could also spread the disease. Today, all donated blood and organs in Canada and the United States are screened for the virus, so it is extremely unlikely that you could become infected with the virus from a blood transfusion or organ transplant.
Symptoms appear an average of 60 to 90 days (although they can appear 45 to 180 days) after you have contact with the hepatitis B virus (incubation period). Blood, semen, and vaginal fluids (including menstrual blood), whether fresh or dried, are highly contagious (HBV can be easily spread) during this period and for several weeks after the onset of symptoms.
If you have a short-term HBV (acute) infection, you usually cannot spread the virus after antibodies against the surface antigen of HBV appear. This generally takes several weeks. If you have a long-term (chronic) HBV infection, you are able to spread the virus as long as you have an active infection.
Less than half of those with short-term (acute) hepatitis B infections have symptoms. Symptoms include:
Most people with chronic HBV have no symptoms.
You may get infected with HBV without knowing it. You may not find out that you have an HBV infection until you have a routine blood test or donate blood. Finding out 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 cirrhosis or liver cancer (hepatocellular carcinoma). But this is uncommon.
Symptoms of infection with hepatitis B virus (HBV), if they appear at all, usually begin 60 to 90 days (although they can appear from 45 to 180 days) after the virus enters the body.
Most people have acute (short-term) HBV infection. In this infection:
About 1 or 2 out of 10 people with acute HBV infection develop joint pain and rashes.1 In rare cases, HBV causes hives; swelling of the lips, tongue, or other tissue; swelling of the voice box (larynx); or pain in the abdomen.
If you stay infected with HBV for 6 months or longer, you have chronic hepatitis B. The risk of having chronic HBV infection is related to the age at which you first become infected with the virus.2
Most people with chronic infection have no symptoms. But they can spread the virus to others (especially to people who live with them and to their sex partners) unless they receive treatment that controls the infection.
Although many people with chronic hepatitis B will not develop complications, about 15% to 25% of people with chronic HBV infection will die of cirrhosis or liver cancer.3 Having a lot of virus in the body (a high viral load) increases the risk of developing cirrhosis and liver cancer.
Other problems that can develop in relation to HBV infection but are uncommon include:
People who practice certain behaviours or have certain jobs are at high risk for becoming infected with hepatitis B virus (HBV). If you are a member of a high-risk group, you should receive the hepatitis B vaccine.4
Risk factors for hepatitis B that you can control include:
Job and lifestyle risk factors for hepatitis B include:
Risk factors for hepatitis B that you cannot control include:
Most people in North America who have hepatitis are in one of the high-risk groups. But some people do not know how they became infected.
People with hepatitis B who engage in high-risk behaviour (such as having multiple sex partners or injecting illegal drugs) are at increased risk for hepatitis C and HIV, the virus that causes AIDS.
Contact a doctor immediately if you have been diagnosed with hepatitis B and develop severe dehydration (caused by vomiting and an inability to hold down fluids) or any of the following signs of rapidly developing liver failure:
If you witness a person with hepatitis B become unconscious, call 911 or other emergency services.
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 is not recommended if you have symptoms of hepatitis B or if you think you have come in contact with the hepatitis B virus (HBV). Because all forms of viral hepatitis have similar symptoms, it is important to see a doctor for a blood test when symptoms arise, so that he or she can rule out other forms of the illness. A doctor also can advise you about how to prevent the spread of the virus.
You may be referred to one of the following specialists who may work with your doctor to plan treatment:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will diagnose hepatitis B virus (HBV) infection based on a physical examination, your medical history, and blood tests. You will be asked questions about risk factors for hepatitis B (such as about your job or sexual activity) and about factors that could make the disease worse (such as your alcohol use or family history of liver cancer).
If your doctor thinks you may be infected with the virus, you will need tests to find out more about your condition.
Blood tests done to help diagnose hepatitis B include:
Blood tests done to help find out if your liver has been damaged include:
Tests may be done if you have chronic HBV infection and are considering antiviral treatment. These tests also may be used to find out whether treatment has helped control liver damage caused by chronic HBV infection. They include:
If you have chronic hepatitis B, the Canadian National Advisory Committee on Immunization (NACI) recommends that you be vaccinated for hepatitis A if you have not been vaccinated or are not immune to this disease.4 For more information on Hepatitis A, see the topic Hepatitis A.
If you are at risk for liver cancer, an alpha-fetoprotein (AFP) test may be done. If the AFP level is elevated, it may point to liver cancer.
If you have chronic HBV infection, you will need to visit your doctor regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus in your body. Some of the tests can tell your doctor whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to cirrhosis or liver cancer (hepatocellular carcinoma).
The Canadian National Advisory Committee on Immunization (NACI) recommends that all pregnant women have the hepatitis B surface antigen test.4 This test can tell if a woman has an active HBV infection. This test also may be repeated later in the pregnancy if a woman is at high risk for infection. For more information on risk factors, see the What Increases Your Risk section of this topic.
People who were exposed to the hepatitis B virus in the past, especially people who moved to Canada from a country where the virus is common, often develop lifelong protection (immunity) against HBV and do not need to be vaccinated. But people from countries where HBV infection is common may carry the virus and should be screened for the virus.
You can be tested for hepatitis B before getting vaccinated.
Treatment of hepatitis B viral (HBV) infection depends on how active the virus is and whether you are at risk for liver damage such as cirrhosis. Short-term (acute) hepatitis B usually goes away on its own. Home treatment is used to relieve symptoms and help prevent spread of the virus. In long-term (chronic) HBV infection, treatment includes monitoring the condition and using antiviral medicines to prevent liver damage. If hepatitis B has severely damaged your liver, a liver transplant may be considered.
The Canadian Association for the Study of the Liver has made recommendations on who should receive antiviral treatment for chronic hepatitis B based on the presence of hepatitis B antigens, level of HBV DNA, and the levels of liver enzymes in your blood.5
Initial treatment for hepatitis B infection depends on whether you:
If you believe you have recently been exposed to HBV, you should receive the first of three immunization shots of hepatitis B vaccine. You may also receive a shot of hepatitis B immunoglobulin (HBIG). 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 more effective treatment is.
If you have the symptoms of acute hepatitis B, treatment with medicine is usually not needed. Home treatment usually will relieve your symptoms and help prevent the spread of the virus. To help relieve symptoms and prevent the spread of the infection:
For more information on treating the symptoms of acute HBV infection, see the Home Treatment section of this topic.
You may be given medicine to treat an acute hepatitis B infection if:
But using medicine to treat hepatitis B is not usually done unless a person is very sick.
If you have chronic HBV infection, treatment depends on how active the virus is in your body and the potential for liver damage. The goal of treatment is to stop liver damage by preventing 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 medicine for hepatitis B includes:
Antiviral therapy is not recommended for everyone who has a chronic hepatitis B viral infection. Your doctor may recommend antivirals if you have or are likely to develop liver damage, such as cirrhosis. For more information, see:
Whether or not you are taking medicine, you will need to visit your doctor regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can find out whether HBV is actively multiplying in your liver, which increases your risk of liver damage, such as cirrhosis or liver cancer. If you develop advanced liver damage because of hepatitis 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 from hepatitis B virus (HBV) infection by avoiding contact with the body fluids of someone whose health and sexual history are not known to you. To prevent infection:
The hepatitis B vaccine is the most effective way to prevent infection with HBV. The vaccine is up to 95% effective against HBV infection if you receive all the shots in the vaccination series (3 or 4 shots given at different times).6 The vaccine provides protection against HBV infection for at least 20 years.7 A combination vaccine for hepatitis A and B also is available. Immunization schedules vary from province to province. Vaccination is generally recommended for:
Discuss vaccination with your doctor even if you are not in one of the above categories. In the United States, about 15 out of 100 of those who become infected do not know how they got infected.1
In some cases, a doctor will order post-vaccination testing to make sure you have developed immunity to the hepatitis B 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 long-term (chronic) HBV infection.
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, HBIG will prevent infection until the vaccine takes effect.
If you have had sex with someone who has hepatitis B and you have not received all doses of hepatitis B vaccine, you should receive a shot of HBIG—in addition to continuing the vaccine series—within 14 days of being exposed to HBV.
Hepatitis B is easily spread, so if you are already infected, there are many steps you can take to prevent the spread of HBV to others (such as not donating blood or not sharing razors or other toiletries). If you are not infected, there also are steps you can take to protect yourself against HBV infection (such as getting vaccinated or using condoms). For more information on preventing the spread of hepatitis B, see the topics Immunizations and Exposure to Sexually Transmitted Infections.
Home treatment is important for relieving symptoms and preventing the spread of hepatitis B virus (HBV).
There is no specific medical treatment for short-term (acute) hepatitis B. But there are some things you can do that may help you feel better while the illness is running its course.
It is important that you keep your body well-hydrated when you have hepatitis B, especially if you have been vomiting.
Hepatitis impairs your liver's ability 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. In addition, alcohol and some drugs can make liver damage worse.
People with hepatitis sometimes develop itchy skin. You can control itching by keeping cool and out of the sun, wearing cotton clothing, or using non-prescription medicines such as Benadryl or Chlor-Tripolon. Talk to your doctor if you want to take non-prescription medicines.
Be sure to follow the instructions that are provided with the product. And stop using the product if you have any side effects.
If you have been diagnosed with long-term (chronic) HBV infection, your doctor will recommend that you be vaccinated for hepatitis A if you have not been vaccinated or are not immune to this disease. For more information on hepatitis A, see the topic Hepatitis A. You also will need to visit your doctor regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can tell your doctor whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to liver disease such as cirrhosis or liver cancer (hepatocellular carcinoma).
For people with short-term (acute) hepatitis B infection (HBV), treatment with medicine is not usually recommended. Antiviral medicine may be used for long-term (chronic) HBV infection if the virus is multiplying or liver damage exists or may develop.
But antiviral therapy is not recommended for everyone who has chronic hepatitis B viral infection. It is an option for people who have or appear likely to develop liver damage such as cirrhosis. Antiviral therapy may not help if you already have severe liver damage.
The Canadian Association for the Study of the Liver has made recommendations on who should receive antiviral treatment for long-term (chronic) hepatitis B based on the presence of hepatitis B antigens in your blood, the level of hepatitis B virus DNA (HBV DNA) in your blood, and the levels of your liver enzymes.5
Hepatitis B is a viral infection that affects the liver. There is no surgical treatment for hepatitis B.
If you have advanced liver damage because of hepatitis and your condition becomes life-threatening, you may need a liver transplant.
In rare cases, short-term (acute) hepatitis B progresses rapidly to liver failure, a life-threatening condition called fulminant hepatitis. For some people, liver transplantation offers the only hope for survival.
|Canadian Digestive Health Foundation|
The Canadian Digestive Health Foundation provides educational information about digestive diseases and supports research into their causes and treatment.
|Canadian Liver Foundation|
|2235 Sheppard Avenue East|
|Toronto, ON M2J 5B5|
The Canadian Liver Foundation funds medical research and offers education and support programs for liver disease patients, their families and friends, health professionals, and the general public.
|Centers for Disease Control and Prevention (CDC): Division of Viral Hepatitis|
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.
|Hepatitis Foundation International|
|504 Blick Drive|
|Silver Spring, MD 20904-2901|
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 support groups.
|U.S. National Digestive Diseases Information Clearinghouse|
|2 Information Way|
|Bethesda, MD 20892-3570|
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.
- Berenguer M, Wright TL (2006). Hepatitis B and D. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 1647–1679. Philadelphia: Saunders Elsevier.
- Centers for Disease Control and Prevention (2009). Hepatitis B: Frequently asked questions for health professionals. Available online: http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm.
- American Public Health Association (2008). Viral hepatitis B. In Control of Communicable Diseases Manual, 19th ed., pp. 284–293. Washington, DC: American Public Health Association
- National Advisory Committee on Immunization (NACI) (2006). Canadian Immunization Guide, 7th ed., pp. 1–372. Ottawa: Public Health Agency of Canada. Also available online: http://publications.gc.ca.
- Sherman M, et al. (2007). Management of chronic hepatitis B: Consensus guidelines. Canadian Journal of Gastroenterology, 21(Suppl C): 5C–24C.
- American Academy of Pediatrics (2006). Hepatitis B. In LK Pickering, ed., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 335–355. Elk Grove, IL: American Academy of Pediatrics.
- World Health Organization (2009). Hepatitis B fact sheet. Available online: http://www.who.int/mediacentre/factsheets/fs204/en/index.html.
Other Works Consulted
- 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.
- 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.
- 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.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Primary Medical Reviewer||Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine|
|Specialist Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Steven L. Flamm, MD - Gastroenterology|
|Last Revised||February 2, 2011|
Last Revised: February 2, 2011
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