What is it?

Hepatitis B, sometimes called hep B or HBV, is a virus carried in the blood and body fluids which infects and can damage the liver and is the most widespread form of hepatitis worldwide. It is common in South-East Asia, the Indian subcontinent, the Middle and Far East, Southern Europe and Africa. In the UK, approximately one in 350 people are thought to be chronically infected with hepatitis B.

Some people with acute hepatitis B may only have a mild illness and feel they are not ill enough to see a doctor. There are many general symptoms, some of which may be confused with flu.

A few people develop a serious illness and need to be looked after in hospital. More severe symptoms may include:

  • diarrhoea
  • pale bowel motions
  • dark urine
  • jaundice (a condition in which the whites of the eyes go yellow and in more severe cases the skin also turns yellow)

Hepatitis B can cause an acute or a chronic illness.

  • An acute illness is a sudden illness that lasts for a short period (less than six months)
  • A chronic illness is one that lasts more than six months, possibly for the rest of your life. Sometimes symptoms may come and go.

Acute & Chronic Hepatitis B

It can take a while to recover from acute hepatitis B and, even though most people will feel better within a few weeks, they may still experience tiredness and lack of energy for many months. Other people may recover and ‘clear’ (rid) the virus from their body without ever knowing they have been infected.

Up to one in ten people (between 5 and 10%) with acute hepatitis B may go on to have chronic hepatitis B if infected as an adult. Up to 95% of children infected will remain infected. Many people are infected in childhood and are often not aware that they have hepatitis B. They may only find out when they develop future complications caused by the virus. The earlier you are infected in life, the higher your chance of developing a chronic illness.

Some people who are chronically infected with hepatitis B are known as ‘inactive’ carriers. This means they have the hepatitis B virus in their blood and can pass it on to others, but the virus is not causing their liver any consistent damage, their viral levels are persistently low and they do not require any medication.

Sometimes the virus can reactivate, it is therefore important for inactive carriers to be monitored regularly.

If tests show that levels of the virus in your blood are high and affecting your liver, then it is likely that you have an active infection. Over time, the virus can damage the liver and this can cause scarring of the liver (fibrosis) and then a hardening of the liver (cirrhosis).  Some people with advanced cirrhosis will develop liver failure, liver cancer or will need a liver transplant.

Transmission

Hepatitis B is known as a ‘blood-borne virus’ (BBV) and can be spread by blood to blood contact. However, hepatitis B is also present in other body fluids such as saliva, semen and vaginal fluid. These can be a source of infection, particularly if they have become contaminated with blood. The highest amounts of the virus are present in blood. Even a tiny amount of blood from someone who has the virus can pass on the infection if it gets into your bloodstream, through an open wound, a cut or scratch, or from a contaminated needle. The virus is able to survive outside the body for at least a week. This means objects and surfaces contaminated with dried blood also pose a risk.

Hepatitis B can be transmitted in the following ways:

  • Sex – High risk if unprotected

Hepatitis B can be transmitted by having penetrative, anal or oral sex with an infected person if a condom or dental dam is not used

  • Mother to baby – High risk unless treated
  • Receiving blood in hospital (blood product infusions) in UK before September 1991 – high risk
  • Sharing equipment if you inject drugs including needles, syringes, filters, spoons or water – high risk

  • Travel – Medium to high risk if not vaccinated
  • Family contact – Medium risk if not vaccinated

The risk of infection to non-sexual family members (i.e. parents or children) is very small.

  • Working in an environment that may involve contact with infectious blood or body fluids containing blood – medium risk
  • Medical or dental treatment abroad in countries where infection control procedures may be poor – medium risk
  • Tattoos, piercings, acupuncture or electrolysis in unlicensed premises (such as prison, abroad etc) – medium risk
  • Sharing personal items such as razors, hair clippers, toothbrushes, nail scissors and tweezers – Low to medium risk

Hepatitis B cannot be transmitted through normal social contact.  There is no risk to your friends and family from everyday activities like hugging and kissing, sharing toilets or sharing cups, plates or cooking utensils. However, if your child has hepatitis B the risk of transmission via social contact is greater as they are less likely to understand how to prevent the spread of infection, or why preventing further infection is important.

Prevention & Treatment

As hepatitis B is spread through body fluid and blood to blood contact, there are other simple ways to prevent spread:

  • always use a condom for anal or vaginal sex
  • always use a condom or dental dams for oral sex
  • always use a dental dam when licking or kissing someone’s anus
  • If you inject drugs, do not share any injecting equipment with other people. This includes needles, syringes, water, spoons and filters
  • Do not share personal items such as toothbrushes, razors, or nail clippers

Vaccination for Hepatitis A and B

Both hepatitis A and hepatitis B can be prevented with vaccination. Most centres use a combined vaccine but separate hepatitis A and B vaccines are also available. The vaccination is given to you by injection in your arm. A course of at least three injections is required. There are several options for the timing of these injections (schedules) and the one you follow will depend on your risks. It is important to have all three doses of the vaccine in the schedule as you will not be fully protected until you have had the third injection.

Who should have the hepatitis B vaccination?

In the UK the government has a ‘selective’ vaccination policy. This means that
they recommend vaccination of the following people who are considered to be at
‘high risk’ of getting hepatitis B:

  • babies born to infected mothers*
  • close family and friends of infected people such as partners, children and other household members
  • people travelling to countries with high to medium prevalence of hepatitis B
  • injecting drug users (IDUs)
  • sex workers, both male and female
  • people who change their sexual partners frequently or men who have sex
  • with men
  • people whose type of work places them at risk, such as nurses, doctors, prison wardens, dentists, healthcare workers and laboratory staff people who live and work in accommodation for people with severe learning difficulties
  • prisoners
  • families adopting children from countries with high to medium prevalence
  • of hepatitis
  • people who are infected with a blood borne virus (BBV), or have another form of hepatitis, such as hepatitis A, C, D, E or HIV and are at risk of co-infection

*In the UK from Autumn 2017, the routine childhood vaccination programme will be replaced by a six in one (hexavalent) vaccine which also protects against hepatitis B ensuring all children are vaccinated

People who are at risk can get vaccinated at sexual health services, drug services, and their GP practice or travel health clinics. If you are at risk for medical reasons, the vaccine is provided free of charge by the NHS. However, if you need to be vaccinated because your job puts you at risk or you are travelling, GPs may charge for the vaccine or direct you to a private clinic.

If you are at risk as a result of your working environment, your employer has an obligation to pay for and arrange vaccination.

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If you think you might be at risk of having hepatitis B, a simple blood test will tell you.

Hepatitis B is detected by a blood test that looks for antibodies (protein substances) produced by your body’s immune system to fight the virus. You can have the blood test at a GP surgery, a hospital clinic, a sexual health clinic or drug services.

If your test result is positive (there are antibodies in your blood), your GP or other healthcare worker will refer you to the Hepatitis Specialist Service to assess how long you have had the virus and its activity (viral load).

People with the acute phase of hepatitis B do not require treatment. For the majority of people, the symptoms resolve and the person can ‘clear’ the infection, usually within six months, meaning they are no longer infectious; their blood will always show the hepatitis B antibodies but they should never be infected again (they become ‘immune’).

Long term infection or chronic hepatitis B is very difficult to cure but treatment can stop or reduce the activity of the virus, stopping it from damaging the liver.

Not everyone will require treatment straight away. If you have low levels of the virus in your blood (a low viral load) and there is little sign of liver damage, it is likely that regular monitoring will be recommended and treatment started only if there are signs of disease progression.

The time frame before treatment is required will vary with each person; it may be several years. Once treatment is started it may need to be continued long term.

Services & Team

The Hepatitis Service is based at Ninewells Hospital, Dundee.  Clinics are held at locations throughout Tayside.  For more information on referral or clinics, contact the specialist nurses on 01382 740 078