Illness & Conditions - Health Conditions
What is hepatitis B?
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.
What causes hepatitis B?
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 you:
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.
What are the symptoms?
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 symptoms.
How is hepatitis B diagnosed?
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 .
How is it treated?
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 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.
Can hepatitis B be prevented?
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
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Hepatitis B is a liver disease caused by infection with the hepatitis B virus.
How hepatitis B is spread
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.
Contagious and incubation periods
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 cirrhosis or liver cancer.
Most people who have hepatitis B have an acute (short-term) infection.
If you 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 cirrhosis or 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 severe.
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 AIDS .
What Increases Your Risk
People who have certain behaviors or certain jobs are at high risk for becoming infected with hepatitis B.
Job risk factors include:
Lifestyle risk factors include:
Other factors include:
When To Call a Doctor
If you see a person with hepatitis B become unconscious, call 911 or other emergency services.
Call a doctor right away if you have been diagnosed with hepatitis B and you have severe dehydration or these signs of liver failure:
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 virus.
Who to see
Hepatitis B usually can be diagnosed by:
These specialists may work with your doctor to plan treatment:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Your doctor will diagnose 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).
Blood tests to diagnose hepatitis B
Blood tests are done to help diagnose hepatitis B. They include:
Blood tests to check for liver damage
Blood tests may be done to help find out if your liver has been damaged. They include:
Tests if you are having treatment or are thinking about it
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:
Test for liver cancer
An 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 hepatitis.
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.
Treatment of hepatitis B infection depends on how active the virus is and whether you are at risk for liver damage such as cirrhosis .
Treatment of short-term (acute) hepatitis B
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 of long-term (chronic) hepatitis B
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
The 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
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
In some 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 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, 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.
Avoiding spreading the virus if you have it
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 vomiting.
Avoid alcohol and drugs
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.
Try to control itching
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.
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.
What to think about
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, 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.
Other Places To Get Help
Last Revised: November 3, 2013
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
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.
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