Browse Health A-Z

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Hepatitis B

 

Hepatitis B is an infection of the liver caused by the hepatitis B virus.

It can cause inflammation (swelling) of the liver, and sometimes significant liver damage.

Many people do not even realise they have been infected with the virus, because the typical flu-like symptoms may not develop immediately, or even at all.

You can become infected with hepatitis B if you are not immune (resistant) to the virus and have been exposed to the blood or body fluids of an infected person (see below).

A vaccine is available to protect against hepatitis B.

How do you catch it?

The hepatitis B virus is present in body fluids such as blood, saliva, semen and vaginal fluid. It can be passed from person to person through unprotected sex (without using a condom) or by sharing needles to inject drugs, for example.

Hepatitis B is 100 times more infectious than HIV.

Infected mothers can also pass the virus to their baby during childbirth, often without knowing they are infected.

The incubation period (the time it takes from coming into contact with the virus to developing infection) is between one and six months.

In all cases, hepatitis B is a notifiable condition. This means that when the condition is diagnosed, the doctor making the diagnosis must inform the Medical Officer of Health. Read more about notifying infectious diseases here on the Health Protection Surveillance Centre Website.

Chronic illness

In some people, the hepatitis B virus will go on to cause a chronic (long-term) illness, where it lasts for longer than six months. This is very common in babies and young children, but it can also occur in 2-10% of infected adults.

If you develop chronic hepatitis B, you may not have symptoms and you could pass on the virus without realising you are infected.

If you do have symptoms, these may come and go. You could develop serious liver damage (see Symptoms).

How common is it?

Ireland has a low prevalence of Hepatitis B infection. Quarterly data published by the Health Protection Surveillance Centre (HPSC) show a steady decline in the number of cases notified since 2008.

In the 3 months from October to the end of December 2011 the HPSC received 121 notifications of the disease. Worldwide, the occurrence of hepatitis B is highest in sub-Saharan Africa, south-east Asia and the Pacific islands, such as the Hawaiian islands, the Solomon islands and Fiji.

The lowest incidence of hepatitis B is found in Australia, New Zealand, northern and western Europe and North America. There are approximately 350 million carriers of the virus around the world.

Outlook

The vast majority of people who are infected with hepatitis B as adults are able to fight off the virus and fully recover from the infection within a couple of months.

However, most babies infected with hepatitis B have a poorer outlook, as their infection usually becomes chronic.

Glossary

Acute
Acute means occurring suddenly or over a short period of time.
Carriers
A carrier is a person or animal that spreads an organism that causes disease, but does not become ill themselves.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.

Useful Links www.hpsc.ie

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

The liver

Your liver is your body’s ‘factory’, carrying out hundreds of jobs that are vital for life, including:

  • storing glycogen (carbohydrate that produces short-term energy),
  • making bile, which helps to digest fats,
  • making substances that clot the blood, and
  • processing and removing any alcohol, toxins and drugs.

You only have one liver, but it is very tough. It keeps going even when badly damaged, and it can keep repairing itself until it is severely damaged.

The vast majority of people who are infected with hepatitis B are able to fight off the virus, meaning their infection never becomes chronic (long-term).

They may remain healthy without any symptoms while they clear the virus from their bodies. Some will not even know they have been infected.

However, until the virus has been cleared from their body, they can pass the virus on to others.

Common symptoms

Other people will have symptoms similar to those of hepatitis A, which include:

  • flu-like symptoms, such as tiredness, general aches and pains, headaches and fever,
  • loss of appetite and weight loss,
  • nausea or vomiting,
  • diarrhoea,
  • stomach pains, and
  • jaundice (see box).

Chronic infection

Hepatitis B is said to be chronic when you have been infected for longer than six months.

The earlier the disease is contracted, the greater the chance of developing chronic viral infection. Therefore, babies and children are particularly at risk of developing chronic disease.

It is less common in adults: only 2-10% of those with hepatitis B will go on to have a chronic infection.

If you have chronic hepatitis B you may not have symptoms. This means you could be spreading the virus without realising it.

If you do have symptoms, these may come and go. There is a chance you will go on to develop permanent scarring of the liver, called cirrhosis, and you may eventually develop liver cancer.

Fulminant hepatitis B

Very rarely, a serious type of hepatitis called fulminant hepatitis B occurs. Symptoms include collapsing, severe jaundice and swelling of your stomach, and it can be fatal.

Glossary

Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.
Aches
An ache is a constant dull pain in a part of the body.
Nausea
Nausea is when you feel like you are going to be sick.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Vomiting
Vomiting is when you bring up the contents of your stomach through your mouth.
Loss of appetite
Loss of appetite is when you do not feel hungry or want to eat.
Jaundice
Jaundice is a condition that causes yellowing of the skin and the whites of the eyes, brought on by liver problems.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Acute
Acute means occuring suddenly or over a short period of time.
Fatigue
Fatigue is extreme tiredness and lack of energy.
Immune
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Diarrhoea
Diarrhoea is the passing of frequent watery stools when you go to the toilet.

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Jaundice

Jaundice is when your skin and the whites of the eyes become yellow.

It occurs because your damaged liver is unable to remove bilirubin, a yellow substance in the blood that is a by-product of red blood cells. Bilirubin may also turn your urine very dark, and you may have pale stools (faeces). 

Jaundice occurs in about 10% of younger children and 30–50% of adults with hepatitis B.

You can become infected with hepatitis B if you are not immune (resistant) to the virus and you come into contact with the blood or body fluids of an infected person.

Many people with hepatitis B do not know they are infected.

The risk of hepatitis B for tourists is considered to be low. However, this risk will increase with certain activities, such as unprotected sex or receiving medical or dental treatment in a developing country (see below). Therefore, travellers are advised to get vaccinated against hepatitis B before visiting any country where this is a problem.

Exposure to infected blood

You are at risk of catching hepatitis B if you:

  • inject drugs and share needles and other equipment, such as spoons and filters,
  • have an open wound, cut or scratch, and come into contact with the blood of someone with hepatitis B,
  • have medical or dental treatment in a country where equipment is not sterilised properly,
  • work closely with blood (for example, healthcare workers and laboratory technicians are at increased risk of needlestick injury when the skin is accidentally punctured by a used needle),
  • have a blood transfusion in a country where blood is not tested for hepatitis B,
  • have a tattoo or body piercing in an unsafe, unlicensed place or
  • share toothbrushes, razors and towels that are contaminated with infected blood.

Exposure to infected body fluids

You are at risk of catching hepatitis B if you have vaginal or anal sex with an infected person without using a condom.

Generally, your risk increases if you are sexually active and have unprotected sex with several different partners.

Glossary

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood donations
Blood donation is volunteering to give some of your blood to help people who need extra blood after or during surgery. The blood is taken from a vein
Blood transfusions
A blood transfusion involves transferring blood into a person using a tube that goes directly into a vein in the arm.
Immune
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Immunoglobulin
Immunoglobulins (antibodies) are types of proteins in the body that fight off infection.
Sneezing
Sneezing is an involuntary expulsion of air and bacteria from the nose and mouth.

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Safety of blood transfusions

There is a very low chance of getting a hepatitis infection from donated blood in Ireland, because blood is very carefully checked.

All blood donors are unpaid volunteers who are very carefully screened and tested to make sure that the blood they donate is as safe as possibl

Hepatitis B and pregnancy

Mothers with hepatitis B can pass the virus to their babies during pregnancy or when giving birth.

Therefore, all pregnant women in Ireland are tested for hepatitis B. If they are infected, the baby is vaccinated immediately after birth to help prevent infection from developing.

A mother with hepatitis B can breastfeed her baby if the baby receives a vaccine course starting at birth.

Hepatitis B is diagnosed by a blood test that shows a positive reaction to hepatitis B surface antigen (the outer surface of the hepatitis B virus that triggers a response from your immune system). A positive result means that your body is making antibodies to try and fight the hepatitis B virus.

Your GP may also request a liver function test. This is a blood test that measures certain enzymes and proteins in your bloodstream, which indicate whether your liver is damaged. These will often show raised levels if you are infected with the hepatitis B virus.

Glossary

Enzymes
Enzymes are proteins that speed-up and control chemical reactions, such as digestion, in the body.
Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Antibodies
Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

If you have acute (short-term) hepatitis B, there is usually no specific treatment. You may be offered painkillers for your symptoms and advised to rest, eat healthily and avoid alcohol.

Most people tend to be free of symptoms and recover completely within a couple of months, never going on to develop chronic (long-term) hepatitis.

If you are diagnosed as having a hepatitis B infection, you will be advised to have regular blood tests and physical check-ups.

Chronic hepatitis

There are two types of treatment for chronic (long-term) hepatitis B infection:

  • interferon, and
  • antiviral drugs.

Interferon

Interferon is a protein that is naturally produced by your body in response to a viral infection. It prevents the virus multiplying inside your cells.

Interferon injections can be given to prevent the hepatitis B virus causing more liver damage.

  • pegylated interferon (the most common form) is injected once a week, and
  • interferon alfa is injected three times a week.

Your doctor can show you how to inject yourself.

Interferon often produces side effects, such as flu-like symptoms, especially in the early stages of treatment. These side effects can be severe, so they are not suitable for long-term treatment.

Your GP will need to monitor you regularly for these potential side effects.

Antiviral drugs

Antiviral drugs also stop the hepatitis B virus from multiplying in your body. They include:

  • lamivudine,
  • tenofovir,
  • entecavir, and
  • adefovir.

These drugs are sometimes taken in combination (for example, tenofovir plus lamivudine).

The main problem with long-term antiviral treatment is that the virus can become resistant to the drug. Resistance to lamuvudine occurs in more than 60% of cases after three years of treatment.

It is therefore very important that you finish your course of treatment, as stopping treatment early can lead to drug resistance. Always speak to your doctor before you come off these drugs.

Side effects associated with these drugs include headache, fatigue (tiredness), dizziness, nausea and flatulence (wind).

Glossary

Antiviral
Antiviral medicine is used to treat a viral infection. For example, interferon.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Acute
Acute means occuring suddenly or over a short period of time.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Liver transplant

For some people with severe liver disease, such as cirrhosis and other life-threatening complications, having a liver transplant is an option.

However, the virus may infect the new liver and can sometimes cause disease again some time later.

Without treatment, about a third of people with chronic hepatitis B infection go on to develop a disease of the liver, which can be very serious. 

It is estimated that 15-25% of people with chronic hepatitis B die of liver disease.

Cirrhosis

Many people develop cirrhosis (scarring of the liver). When this happens, the liver can no longer carry out its normal functions and liver failure occurs. The only treatment for liver failure is to have a liver transplant.

Liver cancer

Chronic hepatitis B is also associated with an increased risk of developing liver cancer.

Glossary

Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Anyone who is at increased risk of being infected with the hepatitis B virus should consider being vaccinated (see bullet point list below).

You should also consider vaccination if you are planning to travel to a place where the condition is particularly common, such as south-east Asia, sub-Saharan Africa or the Pacific Islands, such as the Hawaiian Islands, the Solomon Islands and Fiji.

Vaccination

Ask your GP or visit any sexual health or GUM (genito-urinary medicine) clinic for the hepatitis B vaccination.

For full protection, you will need 3-4 injections of hepatitis B vaccine over a period of 6 -12 months.

A blood test may then taken one month after the third dose, to check that the vaccinations have worked.

You should then be immune (resistant to the virus).

Immunoglobulin

Anyone who has been exposed to the hepatitis B virus should be immediately given an injection of antibodies called immunoglobulin, as well as the hepatitis B vaccine. This is because there is not enough time to wait for the vaccine to work.

Immunoglobulin should ideally be given within 48 hours, but should be considered up to a week after exposure.

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Who should have the hepatitis B vaccination?

Hepatitis B vaccination is part of the primary immunisation schedule for children.For more information go the website of the National Immunisation office www.immunisation.ie. .

The following groups should also be immunised:

  • babies born to infected mothers
  • close family and friends of infected people
  • patients who receive regular blood transfusions or blood products
  • people with any form of liver disease
  • people with chronic kidney disease 
  • people travelling to high-risk countries
  • sex workers
  • injecting drug users
  • people who change their sexual partners frequently,
  • men who have sex with men
  • people whose work places them at risk, such as nurses, prison wardens, doctors, dentists and laboratory staff
  • prisoners
  • families adopting children from high-risk countries

Where can I find out more?

You can ask for further information regarding immunisation from your GP, Public Health Nurse, S.T.I. clinic (Sexually Transmissable Infections) Clinic or local HSE office.

Babies

Babies born to infected mothers are given a dose of the hepatitis B vaccine after they are born. This is followed by another two doses (with a month in between each), and a booster dose 12 months later.

Some babies also have an injection of immunoglobulin after they are born, to help prevent being infected.


Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.