Introduction

Anyone who is at increased risk of being infected with the hepatitis B virus should consider being vaccinated.

You should also consider vaccination if you are planning to travel to a place where the condition is particularly common, such as south-east Asia, sub-Saharan Africa or the Pacific Islands, such as the Hawaiian Islands, the Solomon Islands and Fiji.

Vaccination
Ask your health visitor or visit any sexual health or GUM (genito-urinary medicine) clinic for the hepatitis B vaccination.

For full protection, you will need three injections of hepatitis B vaccine over a period of four to six months.

A blood test is then taken one month after the third dose, to check that the vaccinations have worked.

You should then be immune (resistant to the virus) for at least five years. A booster injection is usually given five years after the initial injection.

Immunoglobulin
Anyone who has been exposed to the hepatitis B virus should be immediately given an injection of antibodies called immunoglobulin, as well as the hepatitis B vaccine. This is because there is not enough time to wait for the vaccine to work.

Immunoglobulin should ideally be given within 48 hours, but should be considered up to a week after exposure.

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 without 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.

If you have chronic hepatitis B you may not have symptoms. This means you could be spreading the virus without realising it.

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.

Causes of Hepatitis B

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 know 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 (see below). 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 at risk of catching hepatitis B if you have vaginal or anal sex with an infected person without using 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). A positive result means that your body is making antibodies to try and fight the hepatitis B virus.

Your doctor 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.

Treating Hepatitis B

If you have acute (short-term) hepatitis B, there is usually no specific treatment. You may be offered painkillers for your symptoms and advised to rest, eat healthily and avoid alcohol.

Most people tend to be free of symptoms and recover completely within a couple of months, never going on to develop chronic (long-term) hepatitis.

If you are diagnosed as having a hepatitis B infection, you will be advised to have regular blood tests and physical check-ups.

Chronic hepatitis
There are two types of treatment for chronic (long-term) hepatitis B infection:

• interferon, and
• antiviral drugs.

Interferon
Interferon is a protein that is naturally produced by your body in response to a viral infection. It prevents the virus multiplying inside your cells.

Interferon injections can be given to prevent the hepatitis B virus causing more liver damage.

• pegylated interferon (the most common form) is injected once a week, and
• interferon alfa is injected three times a week.

Your doctor can show you how to inject yourself.

Interferon often produces side effects, such as flu-like symptoms, especially in the early stages of treatment. These side effects can be severe, so they are not suitable for long-term treatment.

Your GP will need to monitor you regularly for these potential side effects.

Antiviral drugs
Antiviral drugs also stop the hepatitis B virus from multiplying in your body. They include:

• lamivudine,
• tenofovir,
• entecavir, and
• adefovir.

These drugs are sometimes taken in combination (for example, tenofovir plus lamivudine). The main problem with long-term antiviral treatment is that the virus can become resistant to the drug. Resistance to lamuvudine occurs in more than 60% of cases after three years of treatment.

It is therefore very important that you finish your course of treatment, as stopping treatment early can lead to drug resistance. Always speak to your doctor before you come off these drugs.

Side effects associated with these drugs include headache, fatigue (tiredness), dizziness, nausea and flatulence (wind).

Preventing Hepatitis B

Anyone who is at increased risk of being infected with the hepatitis B virus should consider being vaccinated.

You should also consider vaccination if you are planning to travel to a place where the condition is particularly common, such as sub-Saharan Africa or the Pacific Islands, such as the Hawaiian Islands, the Solomon Islands and Fiji.

Vaccination
Ask your doctor or visit any sexual health or GUM (genito-urinary medicine) clinic for the hepatitis B vaccination.

For full protection, you will need three injections of hepatitis B vaccine over a period of four to six months. A blood test is then taken one month after the third dose, to check that the vaccinations have worked.

You should then be immune (resistant to the virus) for at least five years. A booster injection is usually given five years after the initial injection.

Immunoglobulin
Anyone who has been exposed to the hepatitis B virus should be immediately given an injection of antibodies called immunoglobulin, as well as the hepatitis B vaccine. This is because there is not enough time to wait for the vaccine to work.

Immunoglobulin should ideally be given within 48 hours, but should be considered up to a week after exposure.