Hepatitis B

What is hepatitis B?

Hepatitis B is a viral infection of the liver. The liver gets inflamed. It may also be swollen and tender. Areas of liver tissue may be destroyed. Hepatitis B is a serious, sometimes severe type of hepatitis. It can be fatal.

How does it occur?

Hepatitis B is caused by the hepatitis B virus. You get the virus from contact with the blood or other body fluids of someone who has hepatitis B. For example, you can get it from:

• having unprotected sex with someone who is infected
• sharing needles for drug injection
• getting a body part pierced or a permanent tattoo with nonsterile equipment
• being exposed to blood at work if you are a healthcare worker.

A pregnant woman can pass the infection on to her baby if she is infected when the child is born.

The disease can be spread by people who do not have any symptoms and may not know they carry the virus. These people are called asymptomatic carriers.

Because of improved blood screening methods, it is now rare to get hepatitis B from a blood transfusion.

What are the symptoms?

You may not have any symptoms of hepatitis until several weeks or months after you are infected with the virus. Or you may never have any symptoms.

If you do have symptoms, they may include:

• yellowish skin and eyes (jaundice)
• tiredness
• dark urine
• abdominal pain
• loss of appetite
• nausea and vomiting
• joint pain
• mild fever

How is it diagnosed?

Your healthcare provider will ask about your medical history and symptoms. Especially important is your history of hepatitis risk factors such as IV drug abuse or unsafe sex.

Your provider will look at your skin and eyes for signs of hepatitis. Your provider will check your belly to see if the liver is bigger than it should be or hurts when it is touched.

You will have blood tests to identify the virus that is causing your symptoms and tests to see if your liver is working normally.

You may need to have a liver biopsy to check for damage to the liver. Your skin will be numbed and then a needle will be put through your skin and into your liver. The needle is used to get a small piece of the liver for tests.

How is it treated?

Your treatment will depend on whether your hepatitis B infection is new (“acute”) in medical terms) or has been ongoing (chronic).

If your infection is acute, the usual treatment is rest and a healthy diet and lifestyle. Many people are able to fight off the virus in a few weeks. Your healthcare provider will recommend that you avoid alcohol for at least 6 months.

Because this is a virus, antibiotics are not helpful.

Usually it is not necessary to stay at the hospital. If you become too dehydrated from nausea and vomiting, you may need to go to the hospital to get intravenous (IV) fluids.

You will have tests to check your liver to make sure your liver is starting to work normally and is not damaged.

If you have chronic form of hepatitis B, your body is not successfully fighting the virus and you are at risk for serious liver damage. In this case you need careful medical monitoring and antiviral medicine. Antiviral drugs can slow or stop the virus from damaging the liver. You may be treated with more than 1 drug. The goal of treatment is not just to make you feel better, but to try to prevent damage to your liver.

If you have liver damage from hepatitis B, you need to protect yourself from other viruses that damage the liver. You should get vaccinated against hepatitis A and be tested for hepatitis C. There is no vaccine for hepatitis C, but it’s important for your provider to know if you are infected with both B and C viruses because this may change your treatment plan.

Doctors are continuing to search for the best ways to treat hepatitis B. As new information becomes available, treatments change. You should discuss possible new treatments with your healthcare provider.

How long will the effects last?

The symptoms generally last several weeks. Usually you will slowly get better until you have completely recovered. It may take 6 months before tests of your liver show that it is working normally again.

Some people who have hepatitis B develop the chronic form of the disease. This means the virus keeps affecting the liver for several months or years. Damage to the liver by the infection can scar the liver. This scarring of the liver is called cirrhosis. The infection and damage might even cause liver failure. Your healthcare provider will test your blood at your follow-up appointments for signs of chronic liver disease.

Chronic hepatitis B infection increases your risk for liver cancer.

A liver transplant is a possible treatment for a failing liver, but whether you are a candidate for this surgery depends on factors, such as your overall health. Also, there are many more people who need a liver transplant than there are liver donors, so the wait for a liver to transplant may be long.

How can I take care of myself?

• Keep your follow-up appointments as often as requested by your healthcare provider.
• Follow your provider's instructions for taking medicine for your symptoms. You need to avoid taking medicines that can damage the liver more (for example, acetaminophen). Ask your provider which medicines you can safely take for your symptoms, such as itching and nausea.
• Follow your provider's advice for how much rest you need and when you can go back to your normal activities, including work or school. As your symptoms get better, you may slowly start being more active. It is best to avoid too much physical exertion until your provider says it’s OK.
• Eat small, high-protein, high-calorie meals, even when you feel nauseated. Sipping soft drinks or juices and sucking on hard candy may help you feel less nauseated.
• Don’t drink alcohol unless your provider says it is safe.
• Contact your healthcare provider if:
  • Your appetite gets worse instead of better.
  • You are getting more tired.
  • You have continued or worsening vomiting, diarrhea, or abdominal pain.
  • Your skin turns yellow.

What can be done to help prevent the spread of hepatitis B?

Hepatitis B is very contagious for 2 to 6 weeks before you start having symptoms. And it keeps being contagious for some time after you start having symptoms. After you have been diagnosed, your healthcare provider will want to see you for follow-up. Your provider may test your blood to see if you are still contagious. Some people who get hepatitis B become chronic carriers of the virus, which means that they can keep infecting others even after they feel completely recovered. A blood test can find whether you are a chronic carrier.

To avoid spreading the disease to others:

• Don’t let your body fluids, including saliva, contact others.
• Clean any blood spills or stains with a mixture of 1 part household bleach to 9 parts water.
• Cover your cuts and open sores.
• Do not share anything that might have blood on it, such as needles, toothbrushes, or razor blades.
• Avoid sexual contact with others until your provider says that you are no longer contagious. If you are in a long-term relationship with one partner, ask your provider if you need to be using condoms.
• Do not donate blood, body organs, other tissues, or sperm.

Three shots of the hepatitis B vaccine can prevent infection with the hepatitis B virus. All people who live with you should get the vaccine. The second shot is given 1 to 2 months after the first shot. The third shot is given 4 to 6 months after the first shot.

It is recommended that all adults not yet immunized against hepatitis B get vaccinated for lifetime protection. The shots are especially important for people who have a high risk of hepatitis, such as:

• healthcare workers
• public safety workers who work with drug abusers or who are exposed to blood
• people who work at homeless shelters
• sexual partners of people who carry the virus
• men who have sex with other men.

All children should get hepatitis B shots. As recommended by the Centers for Disease Control (CDC) and pediatricians, most newborns get their first hepatitis shot before they leave the hospital. Teenagers and young adults are also encouraged to get the shots if they didn’t get the 3-shot series in infancy. Ask your healthcare provider if you need hepatitis B shots. A hepatitis B antibody blood test can see if you have had the shots or if your shots are still protecting you from hepatitis.

There are special concerns if you are pregnant and have hepatitis B or are at risk of getting hepatitis.

• If you do not have hepatitis B but your healthcare provider determines that you have an increased chance of getting infected with the virus, your provider may recommend that you get the hepatitis B shots to prevent infection. Although it is best to get this vaccine before you are pregnant, it can be given safely during pregnancy.
• If your blood test shows that you have hepatitis B, then you may need more blood tests to determine the chance that your baby will get hepatitis.
• A baby born to an infected mother should be given HBIG (hepatitis B immune globulin) and the first dose of the hepatitis vaccine within 12 hours after birth. This will help keep the baby from having chronic hepatitis B and from becoming a carrier of the hepatitis virus.
• If you have an active hepatitis B infection, ask your healthcare provider about breast-feeding your baby. In most cases, if the baby got the recommended shots right after birth, breastfeeding should be safe.
• For more information, contact:

  American Liver Foundation
  Phone: 1-800-GOLIVER (465-4837)
  Web site: http://www.liverfoundation.org