What is hepatitis and hepatitis B?
Hepatitis means inflammation of the liver. There are many causes of hepatitis. For example, alcohol excess and several different viruses can cause hepatitis. One virus that causes hepatitis is called the hepatitis B virus. This page is only about hepatitis B. See other pages for information about hepatitis A and C which are different and are caused by different viruses.
How common is hepatitis B?
The exact number of people infected is not known. In the UK about 1 in 550 people are thought to have chronic (persistent) hepatitis B infection. Worldwide, it is much more common. For example, in parts of Asia and Africa more than 1 in 10 people have chronic hepatitis B infection.
How can you get hepatitis B?
From mother to baby (sometimes call 'vertical transmission')
Worldwide, the most common way the virus is passed on is from an infected mother to her baby. This usually occurs during childbirth. This is very common in some parts of the world where many people are infected with this virus (but is rare in the UK).
From person to person (sometimes called 'horizontal transmission')
Blood and other bodily fluids such as semen, vaginal secretions and saliva contain the virus in infected people. The main ways in which people in the UK become infected include the following:
- Having unprotected sex with an infected person. (Note: many people with hepatitis B do not realize that they are infected and can pass on the virus during sex.)
- From infected blood. You only need a tiny amount of infected blood to come into contact with a cut or wound on your body to allow the virus to enter your bloodstream, multiply and cause infection. For example:
- Sharing needles to inject drugs. Even a tiny amount of blood left on a needle from an infected person is enough to cause spread to others.
- Some people who had a blood transfusion or another blood product several years ago were infected with hepatitis B. Now, all blood donated in the UK is checked for the hepatitis B virus (and for certain other infections). So, the risk of getting hepatitis B from a blood transfusion is now very small.
- From needlestick accidents where the needle has been used on an infected person.
- There is a small risk of contracting the virus from sharing toothbrushes, razors, and other such items which may be contaminated with blood. Also, from using equipment which is not sterile for dental work, medical procedures, tattooing, body piercing, etc.
- A bite from an infected person, or if their blood spills onto a wound on your skin, or onto your eyes or into your mouth.
The virus is not passed on during normal social contact such as holding hands, hugging, sharing cups or crockery, etc.
What are the symptoms and how does hepatitis B progress?
It is helpful to think of two phases of infection with hepatitis B virus. An acute phase when you are first infected, and a chronic (persistent) phase when the virus remains long-term in some cases.
Acute infection
Acute means 'new' or 'for a short time'. Symptoms of acute hepatitis may develop shortly after you first become infected with the virus (within 1-6 months which is the 'inclubation period'). Symptoms include: feeling sick, vomiting, abdominal pains, fever, and feeling generally unwell. Some people become jaundiced (go 'yellow'). This is due to a build up of the chemical bilirubin which is made in the liver and spills into the blood in some liver conditions. (With jaundice due to hepatitis your urine goes dark, your faeces (stools) may go pale, and and you tend to itch.)
Symptoms of acute hepatitis B infection usually go after a few weeks as the immune system either clears the virus, or brings it under control. Rarely, an acute severe ('fulminant') hepatitis develops which is life-threatening.
However, in about half of cases, no symptoms or only mild 'flu-like' symptoms develop in the acute phase. You may not be aware that you have been infected with hepatitis B. In particular, babies who are infected from their mothers during childbirth usually have no symptoms at first.
Following the initial 'acute' phase:
- In more than 9 in 10 cases in adults, the virus is cleared from the body by the immune system within 3-6 months. In this situation you are no longer infectious and you are immune to further infection.
- In up to 1 in 10 cases in adults, the virus remains long-term ('chronic hepatitis B infection'). This may occur whether or not you have symptoms in the acute phase.
- In more than 9 in 10 babies infected from their mothers, the virus remains long-term.
So, in other words, there is a good chance of full recovery and clearing the virus for adults who become infected with hepatitis B, but not so for new-born babies who become infected.
Chronic infection
A chronic hepatitis B infection is one that persists long-term - more than six months. Of those people who develop chronic hepatitis B infection:
- Up to 2 in 3 people remain well. You can have the virus in your body but develop no damage or problems to the liver or other organs. This is called being a 'carrier' and is sometimes called 'chronic inactive hepatitis B'. You may not know that you are infected and are a carrier. However, even if you have no symptoms, you can still pass on the virus to others who may then develop problems. For example, you may pass on the virus if you have sex or share needles for injecting drugs. About 1 in 5 carriers eventually clear the virus from their body naturally, but this may be after several years.
- Some people develop persistent liver inflammation (sometimes called 'chronic active hepatitis B'). Symptoms include: muscle aches, tiredness, feeling sick, lack of appetite, intolerance of alcohol, pains over the liver, jaundice, depression. Symptoms vary in severity and some people have liver inflammation without having any symptoms.
- Some people develop cirrhosis. Cirrhosis is like a 'scarring' of the liver which can cause serious problems, and 'liver failure' when it is severe. Cirrhosis usually takes many years to develop after being infected with hepatitis B. (See separate page called 'Cirrhosis'.)
- A small number of people who develop cirrhosis then develop liver cancer after a further period of time.
- A small number of people develop problems in other parts of the body. For example, the hepatitis B virus can sometimes cause kidney damage.
How is hepatitis B diagnosed and assessed?
A simple blood test can detect if you are infected with the hepatitis B virus. This test detects a protein on the surface of the virus called hepatitis B surface antigen (HbsAg). If you are found to be infected (if you are HBsAg positive), then other tests may be advised to check on the severity of infection, liver inflammation, and damage to the liver. For example:
- A blood test can detect various parts of the virus. This can assess how active the virus is (if it is multiplying rapidly which indicates that it is more likely to cause liver damage).
- Blood tests called liver function tests. These measure the activity of enzymes (chemicals) and other substances made in the liver. This gives a general guide as to whether the liver is inflamed, and how well it is working. See separate page called 'Liver Function Tests'.
- An ultrasound scan of the liver.
- A biopsy (small sample) of the liver may be taken to look at under the microscope. This can show the extent of any inflammation and cirrhosis. See separate page called 'Liver Biopsy'.
- Other tests may be done if cirrhosis or other complications develop.
Can hepatitis B be prevented?
Immunisation
Anyone who is at increased risk of being infected with the hepatitis B virus should consider being immunised. These include:
- Workers who are likely to come into contact with blood products, or are at increased risk of needlestick injuries, assault, etc. For example: nurses, doctors, dentists, medical laboratory workers, prison wardens, etc. Also, staff at day care or residential centres for people with learning disabilities where there is a risk of scratching or biting by residents.
- People who inject street drugs, and their sexual partners and children.
- People who change sexual partners frequently.
- People who live in close contact with someone infected with hepatitis B. This includes all prison inmates. Also, families who adopt or foster a child may be offered immunisation when the hepatitis B status of the child is not known. (You cannot catch hepatitis B from touching people or just normal social contact. So, household visitors and friends are not usually at risk. However, close regular contacts are best immunised.)
- People who regularly receive blood transfusions.
- People with certain kidney or liver diseases.
- People who live in residential accommodation for those with learning difficulties. People who attend day centres for people with learning difficulties may also be offered immunisation.
- Travellers to countries where hepatitis B is common who place themselves at risk when abroad. The risk behaviour includes sexual activity, injecting drug use, undertaking relief work and/or participating in contact sports. Also, if you may need a medical or dental procedure in these countries and the procedure may not be done with sterile equipment.
You need three doses of the vaccine for full protection. The second dose is usually given one month after the first dose. The third dose is usually given five months after the second dose. One month after the third dose you should have a blood test. This checks if you have made antibodies against the hepatitis B virus and are immune. This is because in some people, three doses of the vaccine are not sufficient and further doses are needed.
A schedule of giving three doses quicker than usual may be used in some situations. That is, three doses with each dose a month apart. An even quicker schedule is also sometimes used. That is, the second dose given seven days after the first, and the third dose given 21 days after the first. These quicker schedules may be used if you are at very high risk of infection and need to be immune as soon as possible. For example, if you are soon to travel abroad, are new to prison, or are sharing needles to inject drugs. However, a more rapid schedule may not be as effective for long-term immunity unless a fourth dose is given 12 months after the first dose. Your doctor will advise on the best schedule for your circumstances.
Post exposure prevention
If you are not immunised and have been exposed to the virus you should see a doctor immediately. (For example, if you are a health care worker and you have a needlestick injury.) You can be given an injection of antibodies called immunoglobulin as well as starting a course of immunisation. This may prevent infection from developing.
Preventing infection in new-born babies at risk
All pregnant women in the UK are offered a hepatitis B blood test. If the mother is infected, her baby is given injections of antibodies and also immunised straight after birth. (The transmission of the virus to the baby is thought to mainly occur during childbirth and not during the pregnancy.) With this treatment there is a good chance of preventing infection developing in the baby.
If I am infected, how can I prevent passing on the virus to others?
If you have a current hepatitis B infection you should:
- use condoms when having sex. Also, sexual partners may wish to be tested for hepatitis B, and immunised if appropriate.
- not share any injecting equipment such as needles, syringes, etc.
- not donate blood or semen, or carry a donor card.
- not share razors, toothbrushes, etc, that may be contaminated with blood.
- cover any cuts or wounds with a dressing.
- if any of your blood spills onto the floor or other surfaces following an accident, make sure it is cleaned away with bleach.
What is the treatment of hepatitis B?
Treatment for the acute phase
No treatment can clear the virus. If you develop symptoms when first infected, treatment aims to help ease symptoms until they settle and go. For example, drinking plenty of water to avoid dehydration. In rare cases, a severe hepatitis develops which may need specialist hospital care. There is no treatment that can prevent acute hepatitis B from becoming chronic.
Treatment for chronic infection
Not everyone with chronic infection needs treatment. It depends on how 'active' the disease is. The main aim of treatment is to prevent active disease progressing to severe liver inflammation and cirrhosis. A liver specialist will advise on when treatment may help. Briefly:
- If the tests show that the virus is not very active (multiplying slowly) and there is little or no liver inflammation, then you are at low risk of developing severe liver problems such as cirrhosis. You are not likely to need any treatment. You may be advised to have some tests every 6-12 months to keep a check on the liver.
- If the tests show that the virus is multiplying rapidly, or if you have persistent inflammation of the liver, then treatment may be advised. You may be prescribed antiviral medication such as interferon alfa, peginterferon alfa, lamivudine or adefovir dipivoxil. These medicines do not clear the virus from the body. They work by stopping the virus from multiplying. This may prevent or reduce the severity of liver inflammation and damage.
Antiviral treatment does not work in every case and side-effects can be troublesome. Newer medicines are being developed and may prove to be better than the current treatments.
If you develop severe liver damage then a liver transplant may be an option. However, the new liver may also eventually become damaged by the persisting hepatitis B infection.
Diet and alcohol
Most people with chronic hepatitis B will be advised to eat a normal healthy balanced diet. Ideally, anybody with inflammation of the liver should not drink alcohol, or only in small amounts. If you already have liver inflammation, alcohol increases the risk and speed of developing cirrhosis.
Further help and information
Hepatitis B Foundation UK
The Great Barn, Godmersham Park, Canterbury, Kent, CT4 7DT
Tel: 01227 738279 Web:
www.hepb.org.uk
British Liver Trust
©EMIS and PIP 2006
