Hepatitis B
Hepatitis B is a viral inflammation of the liver passed on through blood and other body fluids.
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Medicines commonly prescribed for Hepatitis B
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 1 mgActive substance: entecavirManufacturer: Accord Healthcare S.L.U.Prescription requiredDosage form: TABLET, 0.5 mgActive substance: entecavirManufacturer: Fresenius Kabi España, S.A.U.Prescription requiredDosage form: TABLET, 1 mgActive substance: entecavirManufacturer: Bristol-Myers Squibb Pharma EeigPrescription required
Hepatitis B is a viral inflammation of the liver passed on through blood and other body fluids. In an adult the acute infection almost always ends in recovery with lifelong immunity, and the person may never even learn they have had it. In some of those infected, however, the virus stays in the liver for good, and that chronic form is the real problem: it gives no sign of itself for years while it damages the liver. The good news is that there is a vaccine against hepatitis B — one of the most dependable vaccines there is — and that chronic infection can now be kept under control.
How it spreads, and how it does not
The virus is present in blood, semen and vaginal fluid. Infection happens in these ways:
- sex without a condom, whether vaginal, anal or oral: the commonest route in adults;
- sharing needles and syringes, and the equipment used to prepare an injection;
- tattooing, piercing, manicure and cutting pedicure with instruments that have not been properly sterilised;
- a needlestick injury with a used needle, the occupational risk of healthcare staff;
- from mother to baby during birth: the main route in countries where the infection is common;
- at home, through shared razors, toothbrushes, nail clippers, blood glucose meters and their lancets — the virus survives on objects for days;
- through transfusion and transplantation where donors are not screened; donated blood has long been tested across Europe, and this route has become rare.
What there is no need to fear: hepatitis B is not spread by food, water, crockery, towels or the toilet, nor by coughing, sneezing, handshakes, hugs or kisses, nor by mosquito bites, nor in a swimming pool, nor by caring for someone who is ill. An infected parent can hug and kiss their child, and an infected colleague can share an office.
The chance of meeting the virus is higher in sub-Saharan Africa, in East and South-East Asia, in the Amazon basin and in Central Asia. But geography is not the deciding factor: you can be infected at home, in the tattoo studio round the corner.
What happens after infection
Between infection and any symptoms lie six weeks to six months. In two thirds of infected adults the acute phase passes with no symptoms at all, or as a mild off-colour spell. The rest have some weeks of tiredness, poor appetite, nausea and pain under the right ribs and in the joints, followed by dark urine, pale stools, yellowing of the skin and the whites of the eyes, and sometimes an itchy rash.
What comes next depends on the age at which infection happened, and this is the single most important thing to know about hepatitis B:
- in an adult with a normal immune system the body clears the virus in more than nine cases out of ten: the infection is over within months and leaves lifelong protection;
- in a newborn infected during birth it is the other way round: the infection becomes chronic in around nine out of ten, because an immature immune system does not recognise the virus as foreign;
- in young children the risk of chronic infection sits in between, and the younger the child, the higher it is.
That is the whole logic of prevention: an infected baby is left with the disease for life almost certainly, and that is why the vaccine is given in the first months rather than when a person starts leading an adult life.
An infection is called chronic when the virus is still found in the blood more than six months on. As a rule the person feels perfectly well.
Why chronic hepatitis B is dangerous
Chronic infection runs silently for years and decades. Continuous inflammation gradually replaces liver tissue with scar: fibrosis develops, then cirrhosis, at which point the liver can no longer cope. The first visible signs — swollen legs, an abdomen filling with fluid, jaundice, bleeding — arrive at a stage where turning things round is already hard.
The second danger is liver cancer. Hepatitis B raises the risk appreciably and, unlike other causes, the tumour can arise even without cirrhosis. That is why people with chronic hepatitis B are examined regularly even while they feel entirely well: liver cancer found at a check-up can be treated, whereas found through symptoms it is a far worse position.
Two further situations are less widely known. The first is the hepatitis D virus: it can only multiply alongside hepatitis B and, once it joins in, it sharply accelerates the destruction of the liver, so carriers are tested for it at least once. The second is reactivation: if someone with past or dormant hepatitis B is given chemotherapy, prolonged steroids or other drugs that suppress the immune system, the virus can wake up and cause a severe flare. Hepatitis B is therefore always checked before such courses, and a known infection should be mentioned to the doctor without being asked.
Signs that cannot wait
Occasionally acute hepatitis B takes a severe course and the liver fails within days. Call an ambulance (in Europe, the single number 112) or take the person to hospital if, alongside jaundice, there is confusion, unusual drowsiness, odd behaviour or trembling hands; relentless vomiting that has prevented drinking for more than a day; easy bleeding, meaning bruises with no knocks, bleeding gums and nosebleeds, black stools or blood in the vomit; sharply increasing pain under the right ribs with a rapidly swelling abdomen.
Within the next few days, without an ambulance, you should reach a doctor if the skin or eyes turn yellow, if the urine darkens, if you have had contact with someone else's blood or unprotected sex with a person who has hepatitis B, if you were tattooed or pierced with questionable equipment, and also if hepatitis B has been found in a family member or a sexual partner — everyone in the household should then be tested and vaccinated.
Tests, treatment and follow-up
The diagnosis is made on blood. The key marker is the surface antigen of the virus: if it is present the infection is active, and if it persists beyond six months the infection is chronic. Other markers show whether the person has had the illness before and whether vaccination has left protection. Once infection is confirmed, the amount of virus in the blood is measured, liver function is assessed through the enzymes, the state of the liver tissue through elastography or ultrasound, and hepatitis C and D and HIV are checked.
Acute hepatitis B in adults is not usually treated with antivirals: the body manages on its own, and the help amounts to rest, fluids, no alcohol and care with medicines that burden the liver.
Chronic infection is not treated always or in everyone. The decision belongs to a liver specialist and rests on the amount of virus, the state of the liver and the person's age. Where treatment is needed, antiviral tablets are prescribed: they are taken long term, often for years, are well tolerated and suppress the virus reliably. They cannot yet clear it from the body, but they halt the destruction of the liver, and fibrosis that has already started can partly regress. These tablets must never be stopped on your own initiative — the virus comes back with a surge.
Those not yet on treatment need regular monitoring: blood tests and liver ultrasound at a set interval, usually every six months, for life. Alongside that come giving up alcohol, keeping to a healthy weight and being vaccinated against hepatitis A, since a second infection is the last thing a damaged liver needs.
The vaccine and what to do after exposure
The hepatitis B vaccine contains no live virus, only one of its proteins; it is well tolerated and protects almost everyone vaccinated for decades and, on present evidence, for life. In most countries it is part of the schedule: the first doses are given in the first year of life and the course completed afterwards, with the exact timing set by the national schedule. Babies born to a mother with hepatitis B are given the first dose within hours of birth together with ready-made antibodies, which prevents infection almost entirely. For the same reason every pregnant woman is tested for hepatitis B.
For adults the vaccine is indicated if it was not given in childhood, and also where the risk is higher: healthcare and emergency staff in contact with blood, people with liver or kidney disease, those on dialysis or living with HIV, anyone with frequent changes of sexual partner, people who inject drugs, those living with someone who has hepatitis B, and anyone moving for a long stay to a region where the infection is common.
If exposure has already happened — a jab with someone else's needle, another person's blood on broken skin or a mucous membrane, unprotected sex with an infected partner — see a doctor at once, the same day. An unvaccinated person is given the vaccine and, where the risk is high, ready-made antibodies as well; the sooner this is done, the better it works. Waiting for symptoms is pointless: by the time they appear it is too late to intervene.
Online consultation
A remote appointment covers most hepatitis B questions well. The doctor can judge whether there was a real risk of infection, explain which tests to have and how long after exposure they become meaningful, read results you already hold — which are not easy to interpret alone — and say what they mean: past infection, protection from vaccination, or an active virus. Follow-up questions suit the format equally well: when the next ultrasound is due, what to do about a missed vaccine dose, whether the household needs vaccinating, whether a particular medicine is safe with a damaged liver. Examination, ultrasound and blood sampling remain a matter for a face-to-face visit, and after a needlestick or an unprotected contact there is no time to lose — that is help needed the same day.
This material is for information only and does not replace medical advice.
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Online doctors for Hepatitis B
Discuss your symptoms and possible next steps for Hepatitis B with a doctor online.
