Hepatitis B

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What is Hepatitis B
Symptoms of Hepatitis B
Testing for Hepatitis B

What is Hepatistis B ?

Hepatitis B is an infection of the liver caused by the hepatitis B virus.
It can cause inflammation (swelling) of the liver, and sometimes significant liver damage.
Many people do not even realise they have been infected with the virus, because the typical flu-like symptoms may not develop immediately, or even at all.
You can become infected with hepatitis B if you are not immune (resistant) to the virus and have been exposed to the blood or body fluids of an infected person (see below).
A vaccine is available to protect against hepatitis B.

How do you catch it?

The hepatitis B virus is present in body fluids such as blood, saliva, semen and vaginal fluid. It can be passed from person to person through unprotected sex (without using a condom) or by sharing needles to inject drugs, for example.
Hepatitis B is 100 times more infectious than HIV.
Infected mothers can also pass the virus to their baby during childbirth, often without knowing they are infected.
The incubation period (time from coming into contact with the virus to developing the infection) is between one and six months.

Chronic illness

In some people, the hepatitis B virus will go on to cause a chronic (long-term) illness, where it lasts for longer than six months. This is very common in babies and young children, but it can also occur in 2-10% of infected adults.
If you develop chronic hepatitis B, you may not have symptoms and pass on the virus without realising you are infected. If you do have symptoms, these may come and go. There is a chance you may develop serious liver damage.

How common is it?

Hepatitis B is not very common in the UK: approximately one in 1000 people are thought to have the virus.
However, in some inner-city areas with a high percentage of people from parts of the world where the virus is common, as many as one in 50 pregnant women may be infected.
Worldwide, the occurrence of hepatitis B is highest in sub-Saharan Africa, south-east Asia and the Pacific islands, such as the Hawaiian islands, the Solomon islands and Fiji.
The lowest incidence of hepatitis B is found in Australia, New Zealand, northern and western Europe, and North America. There are approximately 350 million carriers of the virus around the world.

Outlook

The vast majority of people who are infected with hepatitis B are able to fight off the virus and fully recover from the infection within a couple of months.
However, most babies infected with hepatitis B have a poorer outlook, as their infection usually becomes chronic. Symptoms of hepatitis B 
The vast majority of people who are infected with hepatitis B are able to fight off the virus, meaning their infection never becomes chronic (long-term).
They may remain healthy and do not have any symptoms while they clear the virus from their bodies. Some will not even know they have been infected.
However, until the virus has been cleared from their body, they can pass the virus on to others.

Common symptoms

Other people will have symptoms similar to those of hepatitis A, which include:

• flu-like symptoms, such as tiredness, general aches and pains, headaches and fever,
•  loss of appetite and weight loss,
•  nausea or vomiting,
•  diarrhoea,
•  stomach pains, and
•  jaundice.

Chronic infection

Hepatitis B is said to be chronic when you have been infected for longer than six months.
The earlier the disease is contracted, the greater the chance of developing chronic viral infection. Therefore, babies and children are particularly at risk of developing chronic disease.
It is less common in adults: only 2-10% of those with hepatitis B will go on to have a chronic infection in the UK.
If you have chronic hepatitis B you may not have symptoms, and may carry on spreading the virus without realising you are infected.
If you do have symptoms, these may come and go. There is a chance you will go on to develop permanent scarring of the liver, called cirrhosis, and you may eventually develop liver cancer.

Fulminant hepatitis B

Very rarely, a serious type of hepatitis called fulminant hepatitis B occurs. Symptoms include collapsing, severe jaundice and swelling of your stomach, and it can be fatal. You can become infected with hepatitis B if you are not immune (resistant) to the virus and you come into contact with the blood or body fluids of an infected person.
Many people with hepatitis B do not even realise they are infected.
The risk of hepatitis B for tourists is considered to be low. However, this risk will increase with certain activities, such as unprotected sex or receiving medical or dental treatment in a developing country. Therefore, travellers are advised to get vaccinated against hepatitis B before visiting any country where this is a problem.

Exposure to infected blood

You are at risk of catching hepatitis B if you:

• inject drugs and share needles and other equipment, such as spoons and filters, 
• have an open wound, cut or scratch, and come into contact with the blood of someone with hepatitis B,
• have medical or dental treatment in a country where equipment is not sterilised properly,
• work closely with blood (for example, healthcare workers and laboratory technicians are at increased risk of needlestick injury when the skin is accidentally punctured by a used needle),
• have a blood transfusion in a country where blood is not tested for hepatitis B,
• have a tattoo or body piercing in an unsafe, unlicensed place (see Risks of body piercing), or
• share toothbrushes, razors and towels that are contaminated with infected blood.

Exposure to infected body fluids

You are also at risk of catching hepatitis B if you have vaginal or anal intercourse with an infected person and do not use a condom.
Generally, your risk increases if you are sexually active and have unprotected sex with several different partners.

Diagnosing hepatitis B 

Hepatitis B is diagnosed by a blood test that shows a positive reaction to hepatitis B surface antigen (the outer surface of the hepatitis B virus that triggers a response from your immune system).
Your GP may also request a liver function test. This is a blood test that measures certain enzymes and proteins in your bloodstream, which indicate whether your liver is damaged. These will often show raised levels if you are infected with the hepatitis B virus.

Hepatitis B tests

There are routinely two main tests for Hepatitis B, an antigen test which looks for current infection, and an antibody test which looks to see if a patient has immunity because of a past infection or vaccine.

HBsAg (hepatitis B surface antigen)
This refers to the outer surface of the hepatitis B virus that triggers an antibody response. A "positive" or "reactive" HBsAg test result means that the person is infected with the hepatitis B virus. This can be an "acute" or a "chronic" infection. Infected people can pass the virus on to others through their blood.

HBsAb or anti-HBs (hepatitis B surface antibody)
This refers to the protective antibody that is produced in response to an infection. It appears when a person has recovered from an acute infection and cleared the virus (usually within six months) or responded successfully to the hepatitis B vaccine shots. A "positive" or "reactive" HBsAb (or anti-HBs) test result indicates that a person is "immune" to any future hepatitis B infection and is no longer contagious.

Please consult your GP for further clarification of these tests.