What is hepatitis B?
Hepatitis B is a serious public health problem that affects people
of all ages in the United States and around the world. In 2001, an estimated
78,000 people contracted hepatitis B virus (HBV) infection in the United
States. Hepatitis B is caused by a highly infectious virus that attacks
the liver and can lead to severe illness, liver damage, and in some cases,
The best way to be protected from hepatitis
B is to be vaccinated with hepatitis B vaccine, a vaccine used in the
U.S. for more than two decades and proven safe and effective.
Who is at risk for HBV infection?
About 5% of people in the U.S. will get infected with HBV sometime
during their lives. If you engage in certain behaviors, your risk may
be much higher. You may be at risk if you:
- have a job that exposes you to human blood
- share a household with someone who has
lifelong HBV infection
- inject drugs
- have sex with a person infected with HBV
- have sex with more than one partner during
a six-month period
- received blood transfusions in the past
before excellent blood testing was available (1975)
- are a person whose parents were born in
Asia, Africa, the Amazon Basin in South America, the Pacific Islands,
Eastern Europe, or the Middle East
- were born in an area listed above
- were adopted from an area listed above
- are an Alaska native
- have hemophilia
- are a patient or worker in an institution
for the developmentally disabled
- are an inmate of a long-term correctional
- travel internationally to areas with a
high prevalence of hepatitis B
The largest outbreak of hepatitis B in the
U.S. occurred in 1942 in military personnel who were given vaccine to
protect them from yellow fever. It was unknown at the time that this vaccine
contained a human blood component that was contaminated with HBV. The
outbreak caused 28,585 cases of hepatitis B with jaundice.
How is HBV spread?
HBV is found in blood and certain body fluidssuch as serum,
semen, vaginal secretions—of people infected with HBV. HBV is not
found in sweat, tears, urine, or respiratory secretions. Contact with
even small amounts of infected blood can cause infection.
Hepatitis B virus can be spread by:
- unprotected sex
- injecting drug use
- an infected mother to her child during
- contact with the blood or open sores
of an infected person
- human bites
- sharing a household with a chronically
- sharing items such as razors, toothbrushes,
- pre-chewing food for babies or sharing
- using unsterilized needles in ear or body
piercing, tattooing, or acupuncture
- using the same immunization needle on
more than one person
Hepatitis B virus IS NOT spread by:
- casual contact like holding hands
- eating food prepared by an infected person
- kissing or hugging
- sharing silverware, plates, or cups
- visiting an infected person's home
- sneezing or coughing
What are the symptoms of hepatitis B?
Most people who get HBV infection as babies or children don't look
or feel sick at all. Similarly, almost half of adults who get infected
don't have any symptoms or signs of the disease. If people do have signs
or symptoms, they may experience any or all of the following:
- loss of appetite
- yellowing of skin and eyes (jaundice)
- nausea, vomiting
- weakness, tiredness, inability to work
for weeks or months
- abdominal pain and/or joint pain
- dark urine
I'm not in a risk group. How did I get
Many people don't know when or how they acquired the infection. When
they get the blood test results indicating they've been infected with
HBV, they are taken by surprise. Studies have demonstrated that 3040%
of people who acquire HBV infection are unable to identify their own risk
factors explaining why they have the disease.
Do people usually recover from HBV infection?
Nearly 95% of adults recover after several months. They clear the
infection from their bodies and become immune. This means they
won't get infected with HBV again. They are no longer contagious and cannot
pass HBV on to others.
Unfortunately, of those who become newly
infected with HBV, about 5% of adults and up to 90% of children under
age 5 are unable to clear the infection from their bodies; they become
How do I know if I have or have had
The only way to know if you are currently infected with HBV, have
recovered, are chronically infected, or are susceptible, is by having
blood tests. The three standard blood tests are the following:
HBsAg (hepatitis B surface antigen):
when this is "positive" or "reactive," it means
the person is currently infected with HBV and is able to pass the infection
on to others.
Anti-HBc [or HBc-Ab] (antibody
to hepatitis B core antigen): when this is "positive"
or "reactive" it may mean the person has had contact
with HBV. This is a very complicated test to explain because the "anti-HBc"
could possibly be a "false-positive" test result. The interpretation
of this positive test usually depends on the results of the other two
blood tests. Blood banks routinely run an "anti-HBc," but
they do not routinely run an "anti-HBs."
Anti-HBs [or HBs-Ab] (antibody
to hepatitis B surface antigen): when this is "positive"
or "reactive," it means the person is immune to HBV
infection, either from vaccination or from past infection. If the person
was previously infected, s/he cannot pass the disease on to others.
(To repeat, this test is not routinely done by blood banks.)
Interpretation of the Hepatitis B Blood
positive with >10mIU/mL*
due to vaccination
due to natural infection
when it is recommended, should be done 1–2 months after the final
|| May be recovering from
acute HBV infection.
|| May be distantly immune
and the test is not sensitive enough to detect a very low level
of anti-HBs in serum.
|| May be susceptible with
a "false positive" anti-HBc.
|| May be chronically infected
and have an undetectable level of HBsAg present in the serum.
What does it mean if my blood bank said
I tested positive for hepatitis B and can no longer donate blood?
If the blood bank told you your test was "positive," it
is important to find out which test was positive. If the "HBsAg"
was positive, this means that you are either chronically infected
with HBV or were recently infected. If only the "anti-HBc"
was positive, it is most likely that you either had a "false-positive"
test or are immune to hepatitis B. It is important that you understand
the full meaning of your test results. If you are not sure how to interpret
these test results, call your blood bank for an explanation or have the
blood bank send the test results to your physician. You may need to provide
written permission for the blood bank to release these results to your
physician. Your physician may want to repeat the blood tests or perform
additional tests such as an "anti-HBs." Bring this information
sheet along with you to your doctor visit.
And remember, you cannot contract HBV from
donating blood because the equipment used during blood donation is sterile.
CHRONIC HEPATITIS B VIRUS INFECTION
What does it mean to be chronically infected with hepatitis B virus?
People who do not recover from HBV infection
are chronically infected, and there are over one million chronically infected
people in the United States today. A chronically infected person is someone
who has had HBV in her/his blood for more than six months. While approximately
5% of adults who acquire HBV infection become chronically infected, children
less than five years of age have a greater risk. The younger the child
is at the time of infection, the greater the risk that the child will
have a lifelong infection. Many babies born to chronically infected mothers
will also become chronically infected with HBV unless the babies are given
two shots in the hospital and at least two more during the 6 months after
birth to protect them from the infection.
A chronically infected person usually has
no signs or symptoms of HBV infection but remains infected for years or
for a lifetime and is capable of passing HBV on to others. Sometimes chronically
infected people will spontaneously clear the infection from their bodies,
but most will not. Although most chronically infected people have no serious
problems with hepatitis B and lead normal, healthy lives, some develop
liver problems later. Chronically infected people are at significantly
higher risk than the general population for liver failure or liver cancer.
How can I take care of myself if I am
chronically infected with HBV?
A person with HBV infection should see a physician knowledgeable about
the management of liver disease every 6-12 months. The physician will
do blood tests to check the health of the liver as well as test for evidence
of liver cancer. It is best for chronically infected people to avoid alcohol
because alcohol can injure the liver. Additionally, your physician should
know about all the medicines you are taking, even over-the-counter drugs,
because some medicines can hurt the liver. If there are any liver test
abnormalities, consultation with a liver specialist regarding your need
for further testing and treatment is important.
If your liver disease has progressed...
If your physician tells you your liver disease has progressed, here
are some extra precautions you should take:
- Get a yearly influenza vaccination. Patients
with severe liver disease (cirrhosis) should also receive pneumococcal
- Get vaccinated against hepatitis A. Hepatitis
A can further damage your liver.
- Don't eat raw oysters. They may carry
the bacteria Vibrio vulnificus, which can cause serious blood
infections in people with liver disease. Approximately 40% of people
with this blood infection die.
What can I do to protect others from
People with HBV infection might feel healthy but are still capable
of passing the infection on to other people. To protect others from getting
HBV infection, it is important to protect them from contact with your
infected blood and other infectious body fluids, including semen and vaginal
secretions. Sweat, tears, urine, and respiratory secretions do not contain
hepatitis B virus. Hepatitis B virus transmission via saliva has only
been documented through biting.
Important DOs and DON'Ts for people with
chronic HBV infection
- Cover all cuts and open sores
with a bandage.
- Discard used items such as bandaids
and menstrual pads carefully so no one is accidentally exposed
to your blood.
- Wash your hands well after
touching your blood or infectious body fluids.
- Clean up blood spills. Then
reclean the area with a bleach solution (one part household
chlorine bleach to 10 parts water).
- Tell your sex partner(s) you
have hepatitis B so they can be tested and vaccinated (if
not already infected). Partners should be tested after the
three doses are completed to be sure the vaccine worked.
- Use condoms (rubbers) during
sex unless your sex partner has had hepatitis B or has been
immunized and has had a blood test demonstrating immunity.
(Condoms may also protect you from other sexually transmitted
- Tell household members to see
their doctors for testing and vaccination for hepatitis B.
- Tell your doctors that you are
chronically infected with HBV.
- See your doctor every 6-12 months
to check your liver for abnormalities including cancer.
- If you are pregnant, tell your
doctor that you have HBV infection. It is critical that your
baby is started on the hepatitis B shots within a few hours
- Share chewing gum, toothbrushes,
razors, washcloths, needles for ear or body piercing, or anything
that may have come in contact with your blood or infectious
- Pre-chew food for babies
- Share syringes and needles
- Donate blood, plasma, body organs,
tissue, or sperm
What are the long-term effects of HBV
Each year, approximately 5,000 people in the U.S. die of HBV-related
liver failure and another 1,500 die from HBV-related liver cancer. HBV
infection is the most common cause of liver cancer worldwide and ranks
second only to cigarettes as the world's leading cause of cancer.
Is there a cure for hepatitis B?
As of this writing, there are three FDA-approved medications (interferon,
lamivudine, and adefovir) that can help a person who is already infected
with HBV. Their use is reserved for people who have certain blood test
abnormalities. Be sure to ask your doctor if you are a candidate for treatment
or if you might benefit from enrolling in a clinical trial. Researchers
continue to seek additional cures for hepatitis B.
Why is hepatitis B so serious in pregnant
Pregnant women who are infected with HBV can transmit the disease
to their babies. Many of these babies develop lifelong HBV infections,
and up to 25% will develop liver failure or liver cancer later in life.
All pregnant women should be tested early in pregnancy to determine if
they are infected with HBV. If the blood test is positive, the baby should
be vaccinated at birth with two shots, one of hepatitis B immune globulin
(HBIG) and one of hepatitis B vaccine. The infant will need at least two
additional doses of hepatitis B vaccine by 6 months of age.
How can hepatitis B be prevented?
The vaccine can provide protection in 9095% of healthy young
adults. The vaccine can be given safely to infants, children, and adults
usually in three doses over an approximate 6-month period. Even pregnant
women can be safely given these shots if their risk factors warrant it.
Hepatitis B shots are very safe, and side effects are rare. Hepatitis
B vaccine is our first vaccine that prevents cancer—liver cancer.
At what age are hepatitis B shots routinely
In the U.S., hepatitis B shots are routinely recommended for all children
018 years of age. For babies, the first hepatitis B shot is recommended
to be given in the hospital at birth. Older children and teens should
be vaccinated at the earliest opportunity. Any adult who is at risk for
HBV infection should start the vaccine series immediately.
Where can I get hepatitis B shots?
Check with your clinic first. Children's health insurance often covers
the cost of this vaccine since it is routinely recommended for all U.S.
children. If your child is uninsured, ask your local health department
for assistance. For adults, contact your health provider first to find
out if the vaccine is covered under your health plan. If you are uninsured,
call your local health department for advice.
How many shots are needed?
Usually three shots are needed for the best protection against HBV,
but some protection is provided from receiving as little as one dose.
The shots are usually given on a schedule of 0, 1, and 6 months, but there
is great flexibility in the timing of these injections. As with all other
vaccines, if you fall behind on the schedule, you just continue from where
you left off. Hepatitis B shots will not help or cure a person who is
already infected with the hepatitis B virus.
What should I do if I'm in a risk group?
If you are in a risk group for hepatitis B (risk groups are listed
on page 1), get vaccinated! All people in risk groups should protect themselves
from HBV infection. Every day you delay getting vaccinated increases your
chances of getting this highly contagious liver disease. The problems
caused by hepatitis Bliver cancer and liver failureare too
great. See your doctor or visit your health department.
How does hepatitis B differ from hepatitis
A and C?
Hepatitis A, B, and C are all viruses that attack and injure the liver,
and all can cause similar symptoms. Usually, people get hepatitis A from
household or sexual contact with a person who has hepatitis A. Hepatitis
C, formerly known as hepatitis non-A non-B, is caused by the hepatitis
C virus and is spread in much the same way as HBV. Both hepatitis B and
C can cause lifelong liver problems while hepatitis A does not. Vaccines
to prevent hepatitis A are now available. There is no vaccine yet for
hepatitis C. If you've had hepatitis A or C in the past, it is still possible
to get hepatitis B.
Where can I receive more information
about hepatitis B?
Contact your local and state health departments for more information.
You can also contact the following organizations:
Immunization Action Coalition
Hepatitis B Coalition
American Liver Foundation
Centers for Disease Control and Prevention
(888) 443-7232 Hepatitis Hotline, automated
(800) 232-2522 Immunization Hotline
Hepatitis B Foundation
Hepatitis Foundation International
Parents of Kids with Infectious Diseases
What is the Immunization Action Coalition
The Immunization Action Coalition is a nonprofit organization that
works to prevent hepatitis B and all other vaccine-preventable diseases
in people of all ages. The Hepatitis B Coalition, a program of IAC, promotes
vaccination for children 018 years of age, screening for all pregnant
women, testing and vaccination for risk groups, and education and treatment
for chronically infected people.
IAC relies on financial support from from
the Centers for Disease Control and Prevention, corporations, foundations,
health professionals, and other private citizens to maintain its activities.
Financial contributions are always needed, greatly appreciated, and tax-deductible.
You can send your check to IAC at the address below or donate online at
Deborah L. Wexler, M.D.
Immunization Action Coalition
1573 Selby Ave., Suite 234
St. Paul, MN 55104
This article was written in response to
more than 5,000 letters sent to Dr. Wexler after she wrote a letter to
"Dear Abby" about hepatitis B in 1993. It was updated in September
©Copyright Dr. Deborah L. Wexler, MD
Deborah L. Wexler, MD is the Executive
Director of the Hepatitis
B Coalition. Her website provides extensive information and support
on Hepatitis B. The above article was written in response to the letters
sent to Dr. Wexler after her hepatitis B letter appeared in a "Dear
Abby" column in November 1993 and revised in 1998. Reprinted with permission
from Dr. Wexler.