Hepatitis B fact sheet

What is hepatitis B?

Hepatitis B is an infection caused by the hepatitis B virus.

It can cause short term symptoms, known as acute infection. Sometimes, the body will get rid of, or “clear" the virus, within 6 months after being infected. Once the virus is cleared, a person cannot get infected again or pass the virus onto others.

Some people infected with hepatitis B do not clear the virus and have lifelong infection, called chronic infection. Chronic hepatitis B can cause liver damage, liver cancer or liver failure. Medication can help prevent serious liver problems.

How is hepatitis B spread?

Hepatitis B can be spread through contact with blood that contains hepatitis B. If infected blood or bodily fluids enter another person's bloodstream, that person can become infected. This could be through broken or penetrated skin, mucous membranes (mouth or genitals), or the eye.

It can spread through:

• unprotected vaginal, oral or anal sex (without a condom or dental dam)
• from mother to their baby during pregnancy or childbirth
• shared equipment or personal items, such as needles, syringes, toothbrushes, razors, sex toys, or unsterile medical equipment.

Hepatitis B is not spread by casual contact such as hugging or holding hands, kissing on the cheek, coughing or sneezing, or sharing food or utensils.

What are the symptoms of hepatitis B?

Acute hepatitis B

Many people with acute hepatitis B infection will not have symptoms.

For people who do have symptoms, these can include:

• fever
• not feeling hungry or loss of appetite
• feeling sick (nausea and/or vomiting)
• abdominal pain
• feeling tired
• dark urine or pale coloured stools
• the skin and eyes turning yellow (jaundice)

Symptoms usually start about 1 to 4 months after infection and last many weeks.

People with acute hepatitis B infection can 'clear' the virus and get better without treatment.

Chronic hepatitis B

Chronic hepatitis B is when the body does not 'clear' the initial infection in the first 6 months.

Not everyone with chronic hepatitis B will have symptoms. Some people may have the same symptoms as acute hepatitis B infection. Sometimes people will have no symptoms until they develop more serious liver problems. Chronic hepatitis B infection is serious and can lead to liver damage (cirrhosis), liver cancer or liver failure. These conditions can be fatal.

For more information, see 'How is hepatitis B treated?'

Who is most at risk of hepatitis B?

Anyone who has never had hepatitis B or a hepatitis B vaccine is at risk of hepatitis B infection.

People at higher risk of hepatitis B infection are:

• people born in parts of the world where hepatitis B is more common (such as South-East Asia, Western Pacific or African regions)
• people who have ever injected drugs
• people in custodial settings
• people who have unprotected sex (without a condom or dental dam)
• people who have pierced the skin using unsterile equipment. This includes people who have had tattoos, piercings, cosmetic or medical procedures overseas
• men who have sex with men
• babies born to mothers with hepatitis B
• people who live with someone with hepatitis B and are not fully vaccinated
• people who work in settings where needlestick injuries may happen e.g. healthcare

How do I protect myself against hepatitis B?

Vaccination is the best protection against hepatitis B.

A course of vaccination is recommended for all children and people in high-risk groups. People who have not been vaccinated should talk to their doctor about whether a hepatis B vaccination is recommended.

Vaccination is free for children and recommended at the following ages:

• birth
• 6 weeks
• 4 months
• 6 months

All doses are important for long term protection.

People under 20 years old who did not receive the hepatitis B vaccines in childhood, and refugees and other humanitarian entrants of any age, may also be eligible to get free vaccinations​.

People can also help protect themselves from hepatitis B by:

• always using condoms or dental dams with sexual partners
• never sharing needles, syringes and other injecting equipment
• making sure tattoo, acupuncture, and body piercing equipment is sterile
• not having direct contact with other people's body fluids (e.g. using gloves to dress wounds and to clean up spills of blood and other body fluids)
• not sharing personal items such as razors, toothbrushes, or sex toys.

Information for people in close contact with hepatitis B

All sexual partners and people who live with someone with chronic hepatitis B infection should:

• have a hepatitis B test (a blood test)
• get vaccinated if not immune. People who were not vaccinated as a child should talk to their doctor about how to get a vaccination course.

Post-exposure prophylaxis (PEP) is a medication that may prevent infection in people who have been recently exposed to hepatitis B. People who think they have had a high risk contact to someone with hepatitis B should contact their doctor. Hepatitis B PEP is not needed for people who have been vaccinated against hepatitis B and are immune.

Testing during pregnancy

During pregnancy, women will be offered a test for hepatitis B as part of their routine care. This allows them to get treatment during pregnancy and reduce the risk of the baby getting hepatitis B.

For further information on hepatitis B in pregnancy, see 'What should I do if I test positive to hepatitis B?'

How is hepatitis B diagnosed?

Hepatitis B is diagnosed by a blood test.

It can take weeks after first exposure for the test to be positive. More than one test may be needed.

The blood test can show if a person has hepatitis B. It can also show if they have had hepatitis B in the past, have 'cleared' the virus and are no longer infectious.

Other tests (such as liver imaging) might be needed if a blood test indicates chronic hepatitis B.

How is hepatitis B treated?

Acute hepatitis B:

• Some people will get better on their own without medicine or treatment
• Rest, eating well, and drinking plenty of water is recommended
• If symptoms are more severe, antiviral medicine or hospitalisation may be needed.

Chronic hepatitis B:

• It is very important that people with chronic hepatitis B have regular check-ups with their doctor. This includes at least 6 to 12 monthly testing of liver function and/or liver imaging. These tests help make sure that treatment can be started as soon as needed to help stop liver damage.
• Antiviral medicines are available depending on the stage of infection – which can only be detected with regular tests.
• Not everyone who has chronic hepatitis B will need to take medication. However, patients who do need it will usually have to take the medication for the rest of their lives.

What should I do if I test positive for hepatitis B?

If you have been diagnosed with hepatitis B, you should:

• talk with your doctor to understand what the next steps are
• think about any sexual partners and people who live in your house. They should talk to their doctor about how to protect themselves including getting tested and vaccinated. Talk with your doctor or nurse about which sexual partners you think may be at risk. Your doctor or nurse can help you to tell them. This can be done anonymously and they do not need to know who you are.

If you have hepatitis B and are pregnant, or planning to become pregnant, make sure you talk to your doctor. Depending on your blood test results, you may need treatment during pregnancy. Babies born to a mother who has tested positive for hepatitis B will need extra treatment at birth. This includes an injection of hepatitis B immunoglobulin (antibodies) as well as the routine hepatitis B vaccine. These treatments are important in reducing the risk of the baby getting hepatitis B.

For more information, see Hepatitis B vaccination for babies.

Further information

• Hepatitis NSW​​ is a not-for-profit charity providing information, support, referral and advocacy for people affected by hepatitis B and C.
• Hepatitis Infoline​ for information, support and referrals across NSW. This is a free and confidential service available on 1800 803 990.
• Multicultural HIV and Hepatitis Service​ for support and information about hepatitis for people from culturally and linguistically diverse communities. Available on (02) 9515 1234 or 1800 108 098 (Free call - outside Sydney).
• Hepatitis B vaccination for babies factsheet
• ASHM HBV Prescriber map​ provides up-to-date information on the location and contact details of hepatitis B specialist clinicians.