Hepatitis B
Hepatitis B is irritation and swelling (inflammation) of the liver due to infection with the hepatitis B virus (HBV).
Other types of viral hepatitis include hepatitis A, hepatitis C, and hepatitis D.
Hepatitis B is also known as serum hepatitis and is spread through blood and sexual contact. It is seen with increased frequency among intravenous drug users who share needles and among the homosexual population. This photograph is an electronmicroscopic image of hepatitis B virus particles. (Image courtesy of the Centers for Disease Control and Prevention.)
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Chronic hepatitis is a liver disease caused by infection, drug ingestion, metabolic or autoimmune disorders. Necrosis (death) of liver cells, inflammation, and fibrosis that occur in chronic hepatitis may lead over time to liver failure.
The hepatitis B vaccine is recommended for healthcare workers, people who live with someone with hepatitis B, and others at higher risk. The hepatitis B virus can damage liver cells. Immunization is also recommended for all infants and unvaccinated adolescents.
If you've been diagnosed with hepatitis B, you may worry about your health and about spreading the disease to others. Let's talk about hepatitis B. Hepatitis B is irritation and swelling of the liver from infection with the hepatitis B virus. Infection can spread through contact with the blood, semen, vaginal fluids, and other body fluids of someone who already has the disease. Hepatitis B can also be passed to an infant during childbirth if the mother is infected. Most of the damage from the virus happens because of how the body responds to the infection. When the body's immune system detects the infection, it sends out special cells to fight it off. These disease-fighting cells, in turn, can cause liver inflammation. After you first become infected with the hepatitis B virus, you may have no symptoms at all. Or you may feel sick for a period of days or weeks, with some people becoming very ill. If you're body is able to fight off the infection, symptoms should go away within a few weeks to months. Early symptoms may include loss of appetite, weakness, a low-grade fever, muscle and joint aches, nausea, vomiting, or maybe yellow skin. Sometimes, your body can't get rid of the infection. If so, you have chronic (or long-term) hepatitis B. You may have few - or even no - symptoms at all. You may not even look sick. This is a problem, because people with chronic hepatitis B often do not know they're sick, and they can spread the virus to other people. If your doctor thinks you have hepatitis B, you will need blood tests to confirm diagnosis. If your disease is acute (or short-term), you may not need treatment, other than occasional blood tests to check the health of your liver and other body functions. Your doctor will tell you to get plenty of bed rest, to drink plenty of fluids, and to eat healthy foods. Some people may have chronic hepatitis and need antiviral medications or another medicine, called peginterferon. These medicines can remove hepatitis B from your blood and reduce your risk of cirrhosis (scarring of the liver) and reduce your risk of liver cancer. If you have severe chronic hepatitis B, you may eventually need a liver transplant. If you have acute hepatitis B, you will probably get better. If your infection is chronic, however, you should avoid alcohol and check with your doctor before taking any over-the-counter medicines or herbal supplements. And you will need ongoing blood tests to monitor the health of your liver.
Causes
You can catch hepatitis B infection through contact with the blood or body fluids (semen, vaginal fluids, and saliva) of a person who has the virus.
Exposure may occur:
- After a needlestick or sharps injury
- If any blood or other body fluid touches your skin, eyes or mouth, or open sores or cuts
People who may be at risk for hepatitis B are those who:
- Have unprotected sex with an infected partner
- Receive blood transfusions (not common in the United States)
- Have contact with blood at work (such as health care workers)
- Have been on long-term kidney dialysis
- Get a tattoo or acupuncture with unclean needles
- Share needles during drug use
- Share personal items (such as toothbrush, razor, and nail clippers) with a person who has the virus
- Were born to a hepatitis-B infected mother
All blood used for blood transfusions is screened, so the chance of getting the virus in this way is very small.
Symptoms
After you first become infected with the HBV:
- You may have no symptoms.
- You may feel sick for a period of days or weeks.
- You may become very ill very quickly (called fulminant hepatitis).
Symptoms of hepatitis B may not appear for up to 6 months after the time of infection. Early symptoms include:
- Appetite loss
- Fatigue
- Low fever
- Muscle and joint aches
- Nausea and vomiting
- Yellow skin and dark urine
Symptoms will go away in a few weeks to months if your body is able to fight off the infection. Some people never get rid of the HBV. This is called chronic hepatitis B.
People with chronic hepatitis may not have symptoms and may not know they are infected. Over time, they may develop symptoms of liver damage and cirrhosis of the liver.
You can spread the HBV to other people, even if you have no symptoms.
Exams and Tests
A series of blood tests, called the hepatitis viral panel, is done for suspected hepatitis. It can help detect:
- New infection
- Older infection that is still active
- Older infection that is no longer active
The following tests are done to look for liver damage if you have chronic hepatitis B:
You may also have a test to measure the level of HBV in your blood (viral load). This lets your health care provider know how your treatment is working.
People at higher risk for hepatitis should be screened with a blood test. This may be needed even when they have no symptoms. Factors that lead to increased risk include:
- The risk factors described above in the Causes section.
- People from countries where a higher number of people have hepatitis B. These countries or areas include Japan, some Mediterranean countries, parts of Asia and the Middle East, West Africa, and South Sudan.
Treatment
Acute hepatitis, unless severe, needs no treatment. Liver and other body functions are watched using blood tests. You should get plenty of rest, drink plenty of fluids, and eat healthy foods.
Some people with chronic hepatitis B may be treated with antiviral drugs. These medicines can decrease or remove hepatitis B from the blood. Examples include pills such as tenofovir and lamivudine or an injection called interferon. They also help to reduce the risk for cirrhosis and liver cancer.
It is not always clear which people with chronic hepatitis B should receive drug therapy and when it should be started. You are more likely to receive these medicines if:
- Your liver function is quickly becoming worse.
- You develop symptoms of long-term liver damage.
- You have high levels of the HBV in your blood.
- You are pregnant.
For these medicines to work best, you need to take them as instructed by your provider. Ask what side effects you can expect and what to do if you have them. Not everybody who takes these medicines responds well.
If you develop liver failure, you may be considered for a liver transplant. A liver transplant is the only cure in some cases of liver failure.
Other steps you can take:
- Avoid alcohol.
- Check with your provider before taking any over-the-counter medicines or herbal supplements. This includes medicines such as acetaminophen, aspirin, or ibuprofen.
Severe liver damage or cirrhosis can be caused by hepatitis B.
Support Groups
More information and support for people with HBV condition and their families can be found by joining a support group. Ask your provider about liver disease resources and support groups in your area.
Outlook (Prognosis)
The acute illness most often goes away after 2 to 3 weeks. The liver returns to normal within 4 to 6 months in most people.
Almost all newborns and about one half of children who get hepatitis B develop the chronic condition. Very few adults who get the virus develop chronic hepatitis B.
There is a much higher rate of liver cancer in people who have chronic hepatitis B.
When to Contact a Medical Professional
Contact your provider if:
- You develop symptoms of hepatitis B.
- Your hepatitis B symptoms do not go away in 2 to 3 weeks, or new symptoms develop.
- You belong to a high-risk group for hepatitis B and have not had the HBV vaccine.
Prevention
Children and people at high risk for hepatitis B should get the hepatitis B vaccine.
- Babies should get a first dose of the hepatitis B vaccine at birth. They should have all 3 shots in the series by age 6 to 18 months.
- Children younger than age 19 years who have not had the vaccine should get "catch-up" doses.
- Health care workers and those who live with someone who has hepatitis B should get the vaccine.
- Infants born to mothers who have acute hepatitis B or have had the infection in the past should get a special hepatitis B vaccine within 12 hours of birth.
The hepatitis B vaccine or a hepatitis B immune globulin (HBIG) shot may help prevent infection if you receive it within 24 hours of contact with the virus.
Measures to avoid contact with blood and body fluids can help prevent the spread of hepatitis B from person-to-person.
References
Centers for Disease Control and Prevention website. Adult immunization schedule by age.
Centers for Disease Control and Prevention website. Child and adolescent immunization schedule.
Janssen HLA, Fung S. Hepatitis B. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 79.
Pawlotsky J-M. Acute viral hepatitis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 134.
Pawlotsky J-M. Chronic viral and autoimmune hepatitis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 135.
Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH; American Association for the Study of Liver Diseases. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63(1):261-283. PMID: 26566064
Version Info
Last reviewed on: 2/6/2022
Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Internal review and update on 02/10/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
