Frequently Asked Questions About
Hepatitis B
- What is Hepatitis B?
- Who Should Get Screened for Hepatitis B?
- What are the Screening Tests for Hepatitis B?
- What Will Happen if I Don't Get Screened?
- What are the Symptoms of Hepatitis B?
- How is Hepatitis B Transmitted?
- Is There a Vaccine for Hepatitis B?
- What Should I Do if I Have Hepatitis B?
- Misconceptions About HBV
- What are More Ways to Learn About Hepatitis B?
What is Hepatitis B?
Hepatitis B is a virus that infects and damages the liver. Because hepatitis B can hide inside the body, many people do not know they have the virus until they get tested. In the United States, more than 2 million people have the hepatitis B virus (HBV) and 70,000 new cases develop each year.
The word "hepatitis" indicates that there is inflammation, or swelling, in the liver. Once this inflammation begins, scar tissue (called "fibrosis") may form. In 20 – 30% of patients who carry the hepatitis B virus, this scar tissue leads to cirrhosis and/or liver cancer. These consequences are largely preventable with appropriate medical care.
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Who Should Get Screened for Hepatitis B?
If you or your parents were born in Southeast Asia (China, Vietnam, etc.), the Pacific Islands, Africa, the Amazon Basin in South America or the Middle East, you may be more likely to have HBV. The reason is that HBV vaccination is not generally available in these areas and the virus can often be transmitted from a mother to her child at or soon after birth.
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What are the Screening Tests for Hepatitis B?
To screen for hepatitis B infection, you will need to have a small sample of blood drawn. This blood is tested initially for the following markers of HBV infection or protection:
- Surface antigen (HBsAg): A positive test means a patient is infected with the hepatitis B virus and can infect others.
- Surface antibody (HBsAby or anti-HBs): A positive test means a person is usually immune to the hepatitis B virus and cannot infect others.
- Core antibody (HBcAby or anti-HBc) (Optional Test): A positive test usually means the person has been exposed to the hepatitis B virus. It does not indicate active infection or immunity; more testing for HBV may be needed.
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What Will Happen if I Don't Get Screened?
You may be infected and you will not know your status. If you are infected, you may pass the virus to another family member or to someone else with whom you have intimate contact; you also run a significant risk of developing liver failure and cancer. If you are not infected and not immune, you are at risk for acquiring HBV from an infected family member or someone else and you will miss the opportunity to be vaccinated.
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What are the Symptoms of Hepatitis B?
Unless you are acutely infected (that is you only recently got the virus), most infected people have no symptoms until cirrhosis or cancer develops. Others may experience symptoms such as:
- Feeling tired
- Profound fatigue
- Loss of appetite
- Upset stomach and vomiting
- Fever and/or pain (including abdominal pain)
- Jaundice (yellowish eyes or skin)
- Dark urine
- Skin rash
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How is Hepatitis B Transmitted?
Hepatitis B is carried in an infected person’s blood and other body fluids. The virus is contagious and can be spread through:
- Mother-to-child infection
- From a pregnant woman to her baby (“vertical transmission”) - Sexual contact
- Having sex (either heterosexual or homosexual) with an infected person - Blood-borne infection
- Having a tattoo or body piercing done with “dirty” tools that were used on someone else
- Sharing drug needles
- Sharing a toothbrush or razor with an infected person
- Getting pricked with a blood-contaminated needle
- Having a blood transfusion with blood that has not been screened
- Receiving an organ from a person carrying the hepatitis B virus
- Traveling to countries where hepatitis B is common if there is blood exposure
- Living with someone who has hepatitis B for prolonged periods (household contact with blood or body fluid contaminated objects)
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Is There a Vaccine for Hepatitis B?
Yes, there is a vaccine for hepatitis B. This vaccine only protects people not infected with HBV. People who live with or have sexual contact with a person infected with the hepatitis B virus should be vaccinated. In addition, the vaccine should be given to high-risk individuals, such as:
- Babies born to mothers who carry the hepatitis B virus
- People having kidney dialysis
- Male homosexuals
- Drug users who share needles
- the first injection
- the second injection at one month
- the third injection at six months
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What Should I Do if I Have Hepatitis B?
If you have been diagnosed with acute or chronic hepatitis B, you should discuss medical follow-up with your doctor and consider getting an opinion with a liver specialist (hepatologist) who is an expert in treating HBV. Not everyone who tests positive for hepatitis B needs treatment.
If your ALT level is elevated, indicating liver damage, you may need medication for hepatitis B. Hepatitis B medications can suppress the infection in most patients and slow or reverse liver disease. Treatment may include one of the following:
- PEG Interferon (first line therapy)
- Entecavir (first line therapy)
- Adefovir (first line therapy)
- Lamivudine (second line therapy)
- Telbivudine (second line therapy)
| Every | Test | Screens for |
| 3 to 6 months | ALT blood test | Liver damage |
| 6 months | AFP blood test | Your risk for liver cancer |
| 3 to 6 months | HBV DNA | Your need for or response for treatment |
| 6 months to 1 year* | Ultrasound scan | Liver cancer |
* If you are determined to be at increased risk of liver cancer of if you have cirrhosis or a family history of liver cancer, increase the frequency of your ultrasound exam to every 6 months.
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Misconceptions About HBV
There is nothing to be done if you are infected with HBV: WRONG.
HBV can be treated and controlled with medicines.
HBV can be transmitted through sharing food or kissing: WRONG.
Hepatitis B cannot be spread by kissing, shaking hands, hugging, or sharing food or water. It is infectious only with intimate contact or sharing of blood or body fluids.
People from high-risk areas do not need to get tested for HBV before the age of 40: WRONG.
The high-risk individuals listed above are considered "at risk" and should be tested.
HBV vaccine can prevent liver cancer in infected people: WRONG.
The HBV vaccine can help prevent liver cancer only in people who do not have the virus if they develop immunity.
Hepatitis B can be cured: WRONG.
Hepatitis B can be treated with a number of medicines, but these medicines do not cure the disease.
Hepatitis B cannot be treated: WRONG.
Hepatitis B can be treated with a number of medicines. These can suppress the infection in most patients and can slow or reverse liver disease as well as decrease risk of liver cancer.
Slightly raised levels of liver enzymes tests indicate a healthy liver: WRONG.
Hepatitis B can cause liver disease to get worse even with normal or slightly high liver tests. The current major sign for HBV treatment is the level of virus in the blood.
People who have HBV do not need treatment: WRONG.
About a half of the people who are infected with HBV have a lot of virus in the blood and need to meet with an expert or specialist to discuss treatment. This specialist may be a hepatologist, infectious disease expert or a primary care doctor with a special interest in hepatitis B.
The hepatitis B vaccine is dangerous: WRONG.
The hepatitis B vaccine is one of the safest vaccines available. The benefits far outweigh any risks.
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What are More Ways to Learn About Hepatitis B?
The following sources have further information about hepatitis B:
• Healthwise Health Information Database
• Hepatitis B Foundation
• What I Need to Know About Hepatitis B – from NIDDK
• San Francisco Department of Public Health
• Stanford Liver Center
• San Francisco Hep B Free
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