Hepatitis B - including symptoms, treatment and prevention
Infection with the hepatitis B virus (HBV) causes inflammation of the liver.
Hepatitis B is a notifiable condition1
How hepatitis B is spread
Hepatitis B is spread when infectious body fluids (blood, saliva, semen and vaginal fluid) come into contact with body tissues beneath the skin (for example, through needle puncture or broken skin) or mucous membranes (the thin moist lining of many parts of the body such as the nose, mouth, throat and genitals). In Australia the most likely ways people will have become infected are:
- mother-to-baby transmission at or around the time of birth, particularly for people born outside Australia in countries where hepatitis B is common, and in remote Aboriginal communities
- child-to-child contact usually through contact between open sores or wounds, particularly for people born outside Australia in countries where hepatitis B is common, and in remote Aboriginal communities. A contact is any person who has been close enough to an infected person to be at risk of having acquired the infection from that person.
Other ways of contracting hepatitis B include:
- sharing equipment used for injecting drugs
- unprotected sex (anal and vaginal)
- tattooing and body piercing with unsterilized equipment
- household contact including sharing razors, hair clippers and toothbrushes
- accidental needle stick or blood splash to broken skin or mucous membrane (the thin moist lining of many parts of the body such as the eyes, nose, mouth, throat and genitals).
The risk of spread is increased when there are higher levels of virus in the blood. The level of virus varies considerably between people infected with hepatitis B.
Signs and symptoms
(usually less than 6 months)
About 50% of adults and 90% of children do not develop any symptoms at the time of infection.
Symptoms, if they occur, may include:
- loss of appetite
- nausea and vomiting
- abdominal pain (especially in the right upper abdomen)
- yellow skin or eyes (jaundice) (see image)
- dark coloured urine and pale faeces
- muscle and joint pain
Acute infection may be followed by chronic infection. People unable to eliminate the hepatitis B virus from their body following an acute infection and who remain infected for more than 6 months are said to have chronic hepatitis B infection.
Risks for developing chronic infection are age and immune deficiency. With age,
- 90% of infants will develop chronic infection following acute infection
- only 1 to 10% of older children or adults will develop chronic infection.
Most people chronically infected with hepatitis B have no symptoms but are capable of spreading the infection to others. People chronically infected with hepatitis B have an increased risk of developing cirrhosis (scarring) of the liver and liver cancer later in life.
Both acute and chronic hepatitis B infections are diagnosed by blood tests serology and PCR (polymerase chain reaction) tests in a pathology laboratory.
If liver inflammation continues, a needle may be inserted into the liver to obtain a sample of liver for further testing.
(time between becoming infected and developing symptoms)
Between 45 to 180 days, and rarely from as early as 2 weeks to as late as 9 months.
(time during which an infected person can infect others)
From up to 3 months before symptoms develop until the infected person eliminates the virus from their body. Chronically infected people remain infectious for life although the risk of transmitting the infection to others varies considerably from person-to-person.
Antiviral treatment is available and is of benefit to some people with chronic hepatitis B infection.
People with hepatitis B virus infection but no symptoms were once thought to be 'healthy carriers'. However, all people with chronic hepatitis B should receive regular, lifelong monitoring of disease progression by a general practitioner or liver specialist .
Routine monitoring (at least annually) even when there are no symptoms, can prevent severe liver disease including liver cancer.
- Exclusion from childcare, preschool, school or work is not necessary.
- infected health care workers must comply with the requirements of their professional boards
- any open sores, cuts or abrasions should be covered with waterproof dressings
- all donated blood and organs are screened for evidence of hepatitis B infection
- practice safer sex – use condoms consistently and correctly
- injecting drug users should never share injecting equipment
- if required to handle blood or body fluids, the routine use of standard precautions will reduce the risk of transmission of hepatitis B virus.
Immunisation and immunoglobulin
There is a safe and effective vaccine available for hepatitis B for infants and those at higher risk of acquiring hepatitis B infection and/or higher risk of severe disease. Completion of a full course will give protection against hepatitis B infection in more than 90% of people. See the Hepatitis B vaccine page or the High Risk Hepatitis B Immunisation Program for more information. A combination hepatitis A and B vaccine is available and should be considered for:
- expatriates and travellers in countries where hepatitis A and hepatitis B are common
- individuals whose occupation may put them at risk of acquiring hepatitis A and/or hepatitis B
- individuals whose lifestyle may put them at risk of acquiring hepatitis A and hepatitis B
- solid organ transplant recipients
- residents and staff of facilities for people with developmental disabilities
- patients with chronic liver disease and/or hepatitis C.
Hepatitis B vaccine and/or immunoglobulin can be given soon after exposure to make it less likely a person will develop hepatitis B. This is called post exposure prophylaxis.
Post exposure prophylaxis
Hepatitis B immunoglobulin is a solution made from blood products containing a high level of antibodies specific to the hepatitis B virus.
Hepatitis B immunoglobulin and vaccine are also offered to non-immune people who have had close physical contact with a person known to be infected with hepatitis B in the following situations:
- after needle sharing or needle stick injury
- after sexual exposure.
Immunoglobulin is offered after needle stick injuries unless the source is known to be negative for hepatitis B. Immunoglobulin should be administered as soon as possible within 72 hours after a needle stick injury and within 14 days after sexual exposure.
All women are tested for hepatitis B infection during pregnancy. If a mother is found to have hepatitis B infection, her baby is given immunoglobulin and a dose of hepatitis B vaccine within 24 hours of birth. With this treatment less than 10% of infants become infected with hepatitis B.
- Handling blood and other body substances
- Avoiding sexually transmitted infections (STI)
- When you have a notifiable condition
- Hepatitis SA
- Viral Hepatitis Nursing Support
- Immunise Australia Program
- ASHM Hepatitis B Mapping Project
- Hepatitis Australia
1 – In South Australia the law requires doctors and laboratories to report some infections or diseases to SA Health. These infections or diseases are commonly referred to as 'notifiable conditions'.
Image - Jaundice. Image Courtesy of Public Health Image Library (PHIL), Department of Health and Human Services, Centers for Disease Control and Prevention (CDC-USA) CDC Dr. Thomas F. Sellers / Emory University.
Frequently asked questions
- What is hepatitis B?
- Who is at risk of getting hepatitis B?
- How do you get hepatitis B?
- What are the symptoms for hepatitis B?
- What is acute hepatitis B?
- What is chronic hepatitis B?
- What happens to people with chronic hepatitis B?
- How is hepatitis B treated?
- Can a person spread hepatitis B and not know it?
- How long does the hepatitis B virus survive outside the body?
- What if I am exposed to hepatitis B, what should I do?
- If I’ve had hepatitis B and cleared it, can I get it again?
- What tests are there for hepatitis B?
- How can I protect myself until I am full vaccinated?
Hepatitis B (also called hep B) is a virus that is found in blood and other body fluids including vaginal fluid, semen and breast milk. It is highly infectious and causes inflammation of the liver. Most adults, but not all, who become infected with hepatitis B are able to clear the virus without any problems. However most babies and young children infected with hepatitis B are unable to clear the virus and will develop a chronic hepatitis infection.
Hepatitis B is one of the most common infectious diseases in the world and is a serious public health concern. Hepatitis B is a vaccine preventable illness.
There are around 165 000 people living with hepatitis B in Australia. The majority belong to one or more of the following groups:
- people who have migrated from countries where hepatitis B is endemic (especially North-East and South-East Asia, and sub-Saharan Africa)
- Aboriginal and Torres Strait Islander people
- people who inject drugs
- men who have sex with men.
Hepatitis B is most commonly spread by:
- at birth (from mother to child) or in early childhood (from family members or other close contacts)
- through sharing drug injecting equipment
- through vaginal, anal or oral sex without a condom/dental dam
- through unsterile tattooing or piercing.
There is also a chance that it can be spread through:
- blood-to-blood contact through open wounds
- needle stick injuries
- sharing personal items such as toothbrushes, razor blades or nail clippers
- blood transfusions/products (especially rare in Australia)*
- unsterilised medical equipment (especially rare in Australia)* (screening for hepatitis B in blood supply has been in place in Australia since 1971).
You cannot get hepatitis B from:
- hugging, kissing, another person’s tears or sneezes
- sharing cups, plates, clothes, food, drinks, showers or toilets
- eating food prepared by a person with hepatitis B
- mosquito bites.
Symptoms can take up to 6 months to appear, and are likely to make you sick for between 1 and 3 months. If you do get symptoms, these are the most common:
- yellow skin or eyes (jaundice)
- feeling tired
- losing your appetite and weight loss
- aches and pains in muscles and joint
- dark urine and pale faeces.
If someone has hepatitis B for less than 6 months it is called an acute infection. Most people who get hepatitis B as adults will only have an acute infection and recover from it. If you have acute hepatitis B, you might not experience any symptoms.
The older a person is when they become infected with hepatitis B, the better their chances of successfully fighting it off (‘clearing’ the virus). Around 95% of adults who contract hepatitis B will go on to have an acute infection and are then clear it naturally. On the other hand, up to 90% of babies and 30% of children who become infected will go on to have chronic hepatitis B.
If the infection lasts for longer than 6 months it is called chronic hepatitis B. Most people with chronic hepatitis B contracted it as babies or young children. Many people with chronic hepatitis B have no symptoms, but if they appear they are similar to the symptoms of acute hepatitis B. Chronic hepatitis B is a lifelong illness.
Chronic hepatitis B it is a lifelong illness. Each person’s experience of the illness will be different, and will depend on a number of factors like what stage his or her hepatitis B is currently in, lifestyle factors, and how long he or she has the virus.
However we do know that 20 to 30% of people with chronic hepatitis B will develop advanced liver disease if the virus is left untreated. Advanced liver disease can lead to complications including liver failure and liver cancer, and unfortunately, can lead to death. Treatment for hepatitis B aims to avoid these outcomes.
Treatment aims to stop or slow as much as possible, the increase in numbers of hepatitis B viruses. This decreases the risk of serious liver disease developing later in life and makes it possible for the liver to repair some of the damage and to work better.
Yes. Many people with acute hepatitis B have no symptoms and may not even know they have hepatitis B.
Hepatitis B virus can survive outside the body for at least 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.
You should see your GP or local health centre as soon as possible to discuss your options. You will need to have a blood test and in some cases you may start treatment immediately to stop your body becoming infected with Hepatitis B. Management may include hepatitis B immunoglobulin, an injection of plasma which contains high levels of antibodies to help prevent hepatitis B infection from developing in a person who has been exposed.
If your body has naturally cleared the hepatitis B virus, then you will be immune. This means you cannot get hepatitis B again.
All of the tests used to diagnose hepatitis B are blood tests. Some indicate different stages of the illness or immunity. The following list shows the different tests available, and what a positive result indicates for each of them.
|Test||What a positive result means|
|Hepatitis B surface antigen (HBsAg)||Shows the person has hepatitis B.
It can be detected during acute and chronic infection.
|Hepatitis B surface antibody (HBsAb or anti-HBs)||Shows the person has developed immunity to hepatitis B.
It can be detected in people who have recovered from acute hepatitis B or been vaccinated against it.
|Hepatitis B e antigen (HBeAg)||Shows the hepatitis B virus is multiplying, and that it can be more easily passed on.|
|Hepatitis B e antibody (HBeAb or Anti-HBe)||Shows the person’s immune system has responded to hepatitis B and in some circumstances, the virus is not actively replicating.|
|Hepatitis B core antibody (HBcAb or Anti-HBc)||Shows a person has had hepatitis B, either past or present infection.
(If someone has immunity through vaccination he or she will not test positive)
|Hepatitis B virus DNA (HBV DNA)||Measures the amount of hepatitis B virus in the bloodstream and indicates how actively the virus is multiplying.|
- practice safer sex (use a condom)
- wash hands after touching blood or body fluids
- wear disposable gloves if giving someone first aid, or cleaning up blood or body fluids
- avoid sharing toothbrushes, razors, needles, syringes, personal hygiene items and grooming aids or any object that may come into contact with blood or body fluids
- use new and sterile injecting equipment for each injection
- cover all cuts and open sores with a waterproof dressing
- wipe up any blood spills and then clean the area with household
- throw away personal items such as tissues, menstrual pads, tampons and bandages in a sealed plastic bag.