What is hepatitis B?

Hepatitis B is a type of liver disease caused by the hepatitis B virus and is one of the most common strains of viral hepatitis (the others are the hepatitis A virus and the hepatitis C virus). Many people who become infected with hepatitis B never feel sick and recover completely. Others get a brief, acute illness with fatigue and loss of appetite and their skin and eyes turn yellow (a condition called “jaundice”). Less than 5% of adults who get acute hepatitis B develop chronic hepatitis, which can lead to cirrhosis (liver scarring) and/or liver cancer later in life. Chronic hepatitis B is a “silent” disease because often no symptoms appear until your liver is severely damaged. Infants and children infected with hepatitis B have a much greater likelihood of developing a chronic infection than adults.

How do I get hepatitis B?

A person who has acute or chronic hepatitis B can spread the infection to other people through his/her blood and other body fluids or by sexual contact. The hepatitis B virus is found mainly in the blood, semen, and vaginal fluid of an infected person. Saliva is also a body fluid but the virus concentration is 1,000 to 10,000 times less than what is found in the blood.

You may risk exposure to hepatitis B through unprotected sex, tattoos, piercings, pedicures, manicures or medical procedures with improperly sterilized equipment, sharing personal hygiene items with an infected person (e.g. razors, toothbrushes, nail clippers) or providing emergency first aid in which you come in contact with blood or other body fluids.

Who is most at risk of getting hepatitis B?

Hepatitis B is common worldwide. In regions where hepatitis B is most common such as countries in Asia and Africa, at least one in five people may be infected with this virus.

You have a high risk of contracting hepatitis B if you:

• have unprotected sex with an infected person;
• have unprotected sex with multiple sexual partners;
• have a sexually transmitted infection (STI);
• were born to a hepatitis B infected mother; 
• use injection drugs and share contaminated drug preparation/injection materials; or
• receive a tattoo or piercing with unsterilized needles or contaminated ink.

You have a moderate risk of contracting hepatitis B if you:

• have siblings or other family members who have hepatitis B;
• share a household with someone who has hepatitis B;
• live or travel to regions where hepatitis B is more common;
• are exposed to blood and body fluids because of your job; or
• receive bite wounds containing blood from an infected person.

Hepatitis B is not passed from person to person by:

• coughing, sneezing;
• touching or shaking hands with an infected person;
• sharing food, drinks or eating utensils;
• using toilet seats;
• hugging and kissing; or
• other casual contact.

What are the symptoms?

What happens to you when you contract hepatitis B depends largely on the age at which you first become infected and how well your immune system copes with the virus. If you are infected as an adult, you may have a brief illness with mild or moderate symptoms such as jaundice, dark urine, fatigue, abdominal discomfort, and loss of appetite.  As an adult, you have a 95% chance of clearing the infection completely and developing lifelong protection against this virus. The acute infection rarely (in less than 1% of cases) leads to severe illness that requires a liver transplant.
 
Most babies and children exposed to this virus never have signs and symptoms. Unfortunately, they are more likely to become carriers of hepatitis B for life because their immune system is unable to fight and clear the virus from their body.  In these cases, chronic infections are often not detected or “picked up” until much later in life when the person becomes seriously ill with liver disease.

Chronic hepatitis B infection goes through different phases that also show how well your body is coping with the virus. Although most people with chronic hepatitis B have inactive disease and will remain healthy, about one in four will have active disease that may lead to cirrhosis (scarring of the liver), liver failure, and liver cancer.

People who are healthy with inactive disease may still be at risk of virus reactivation, especially when their immune system is weakened by medicines such as chemotherapy or by other viral infections.

You will need treatment if you have ongoing active disease that causes a lot of damage to your liver, or if you are going to take medicines that will weaken your immune system.  

If I have no symptoms, how would I know if I have hepatitis B?

To confirm whether or not you have hepatitis B, you will need blood tests.

If you have at least one risk factor (see sections above ‘How do I get hepatitis B?’ and ‘Who is most at risk’), you should ask your health care provider to be tested for hepatitis B.  Also, you should be tested for hepatitis B if:

• you were born in a region where hepatitis B is more common, including Asia, Africa, southern and eastern Europe, the Pacific Islands, the Middle East, and the Arctic;
• one or both of your parents immigrated from a region where hepatitis B is more common;
• you live or travel to regions where hepatitis B is more common;
• you have a family history of liver disease or liver cancer;
• you have been in prison;
• you are pregnant;
• you are a man who has sex with men;
• you have HIV;
• you have chronic hepatitis C;
• you receive kidney dialysis;
• you have ever used injection drugs, even just once;
• you have unexplained abnormal liver enzymes; or if
• you receive medicines that suppress the immune system.

How can I avoid getting hepatitis B?

There is a safe and effective vaccine that can protect you from getting hepatitis B. The vaccine is usually given in three doses over a six month period.  The vaccine will give you long-lasting protection. A combined vaccine for hepatitis A and hepatitis B is also available.

Other ways to protect yourself or your loved ones include:

• Adopt safe sex practices.
• Avoid sharing personal hygiene items (e.g. razors, toothbrushes, nail clippers)
• If you have been exposed to the hepatitis B virus (within the previous seven days or less), an injection of hepatitis B immune globulin may help protect you.
• If you are pregnant, make sure you are screened for hepatitis B. If the test result shows that you have the virus, make sure your baby receives the free hepatitis B vaccine. If you have hepatitis B, breastfeeding is safe if the baby has received both protective antibody called immune globulin, and the first dose of hepatitis B vaccine within the first 12 hours of life. Talk to your doctor about having your newborn immunized (some provinces have universal neonatal hepatitis B immunization while others only immunize babies of mothers infected with hepatitis B).
• If you decide to have a tattoo, piercing, manicure or pedicure, ensure that the facility uses single use needles and inks and/or follows proper sterilization procedures.

Can hepatitis B be treated?

If you know you have been exposed to the hepatitis B virus in the previous seven days or less, you can receive an injection of hepatitis B immune globulin that may prevent you from developing the disease. Besides this, there is no treatment for acute hepatitis B.

If you have chronic hepatitis B, two types of treatment exist: interferon which is a medication administered by a needle, and antiviral medicines that are taken by mouth.  Current approved hepatitis B oral medications include lamivudine, adefovir, telbivudine, tenofovir, and entecavir. These treatments do not provide a cure, but they offer control of the virus so that further damage to your liver can be prevented.   When and how to treat your hepatitis B is a decision between you and your doctor. Availability of the medications listed above may vary from province to province based on provincial government drug plans and individual insurance plans.

The information provided above – as well as more information on how to manage chronic hepatitis B – is available in the Canadian Liver Foundation’s hepatitis B pamphlet and in our ‘LIVERight: Healthy Living with Viral Hepatitis’ booklet. These and other CLF publications are available for download in the Publications Library or by calling 1-800-563-5483 or emailing clf@liver.ca

The CLF offers Living with Liver Disease programs for people living with hepatitis B and others forms of liver disease. You can also help others with hepatitis B by volunteering or donating in support of the CLF's research and education programs. To learn more about the CLF and our programs, check out the links on our home page.