Hepatitis B

Medically Reviewed by Zilpah Sheikh, MD on March 22, 2024
Written by Lori M. King, PhD
15 min read

Hepatitis is the medical term for inflammation (swelling) in your liver. Hepatitis B is liver inflammation caused by infection with the hepatitis B virus (HBV). Inflammation can damage your liver. 

HBV can spread through contact with blood, open sores, or body fluids of a person who is infected.

Most adults who are infected with HBV will have mild symptoms that last 6 months or less, and their body will fight off the virus. In this case, you'll be immune for the rest of your life and never get hepatitis B again. But in some adults, hepatitis B can become a long-term, or chronic, condition. If that happens, it can scar your liver and lead to liver failure, cancer, or even death.

If you get it at birth or when you're younger than 6, it’s much more likely to become a long-term condition that can damage your liver.

There's no cure for chronic hepatitis B, but there's a vaccine that can protect you from getting infected with HBV.

Hepatitis B vs. C

In addition to HBV, hepatitis can also be caused by the hepatitis A virus (HAV) and hepatitis C virus (HCV). HAV spreads in a slightly different way than HBV and HCV. The hepatitis A virus spreads through close personal contact with an infected person or if you eat or drink something that the virus is in. There is a vaccine for HAV.

Hepatitis B and C have similar symptoms and are usually spread through contact with the blood or body fluids of an infected person. In the U.S., most people get infected with hepatitis C by sharing needles and other equipment that they use to inject drugs. 

The main difference between hepatitis B and C is that there's a vaccine for hepatitis B, but there is no vaccine for hepatitis C. The best way to prevent hepatitis C is to avoid sharing drug injection materials with others.

You may have no symptoms, mild symptoms, or serious symptoms. Some children younger than 5 years old and adults who have immune suppression often have no symptoms.

You're more likely to have symptoms if you are age 30 years or older when you are infected. 

Symptoms usually start within 90 days after you're exposed to HBV, although it can take up to 6 months. If you do have symptoms, they may include:

  • Fever
  • Fatigue that lasts for weeks or months
  • Loss of appetite
  • Nausea
  • Vomiting
  • Belly pain
  • Dark pee
  • Light-colored poop (It may look clay-colored, which is a light gray, beige, or white.)
  • Joint pain
  • Jaundice (Your skin or the whites of the eyes turn yellow, and your pee turns brown or orange.)

 

You get hepatitis B from contact with blood, spit, semen, or other body fluids from a person infected with HBV. Someone with HBV can spread it even if they don't feel sick. The most common ways for this to happen include:

  • Sharing needles, syringes, or drug injection equipment
  • Sharing toothbrushes, razors, or medical equipment (such as glucose monitors)
  • Direct contact with the blood or open sores of a person who is infected
  • Sexual contact with a person who is infected
  • Contact with blood from needlesticks or sharp instruments used by a person who is infected
  • Being in a health care facility that doesn't control infections well
  • From the birthing parent to an infant during pregnancy and delivery

HBV transmission can happen through saliva, but it doesn’t spread through kissing, hugging, sharing food or water, sharing utensils, coughing, sneezing, or nursing.

Can I get it from blood transfusions?

All donated blood is tested for HBV, and any infected blood is discarded. No test is perfect, but your chance of getting the disease from a transfusion is very low. The American Red Cross doesn't accept blood donations from people who:

  • Have symptoms of viral hepatitis
  • Have hepatitis B
  • Have ever had hepatitis B

In the U.S., HBV transmission happens most often through contact with infected blood; for instance, by sharing equipment for injection drug use, or through having sex with an infected person.

People who are more likely to get hepatitis B include those who:

  • Use injection drugs, or if you share needles or have sex with someone who uses injected drugs
  • Have had more than one sex partner in the last 6 months or have a history of sexually transmitted infections
  • Are infected with HIV
  • Are born in the U.S. to a person who has hepatitis B, or if your parents were born in a part of the world where more than 8% of people are infected with HBV and you didn't get a vaccine as an infant 
  • Are born in a part of the world where more than 2% of people are infected with HBV
  • Live or work in a jail, prison, or other detention center
  • Work in health care or another profession where you have contact with blood, needles, or body fluids
  • Live or work in a care facility for people with developmental disabilities
  • Have diabetes
  • Are infected with HCV
  • Have lived with or had sex with someone who has hepatitis B
  • Are on kidney dialysis
  • Have high levels of liver enzymes, such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST)
  • Have lived in or travel often to parts of the world where hepatitis B is common
  • Had a blood transfusion or organ transplant before the mid-1980s, when blood and organ banks began testing donated blood and organs

In the U.S. in 2020, experts estimate that about 14,000 people were diagnosed with acute hepatitis B. The average rate of new HBV infections is about 0.7 per 100,000 people in the population. In 2019, this new infection rate dropped, possibly due to fewer people getting tested during the COVID-19 pandemic. Among adults with hepatitis B, about 95% recover completely and won't go on to have a chronic infection.

Between 580,000 and 1.2 million people have chronic hepatitis B in the U.S. Experts think about 67% of these people don't know they have the infection.

Nearly 25,000 babies are born to a birthing parent with hepatitis B in the U.S. each year. And about 4% of those babies are born with the virus. These babies have more than a 90% chance of getting chronic hepatitis B if they're not properly treated at birth. But you can prevent infecting your baby if you get treatment for an HBV infection or vaccinated against HBV if you've never had an infection.

About 30% of kids between 1 and 5 years old who are infected will get chronic hepatitis B.

 

Acute hepatitis B. This is a short-term illness you get, usually within the first 6 months after you've been exposed to HBV. Many people with acute hepatitis B have either no or only mild symptoms. But some people have severe symptoms and need to go to a hospital. Some people who are exposed to HBV before adulthood are able to fight the virus off without any treatment.

Chronic hepatitis B. This is a lifelong infection with HBV. People with chronic hepatitis B usually had an acute case that they weren't able to fight off. The younger you are when you're infected with HBV, the more likely it is that you will have a chronic infection. About 90% of infants who are infected go on to get a lifelong infection, but this risk goes down as a child gets older.

Chronic hepatitis B can cause serious health complications, such as liver damage, cirrhosis, liver cancer, and death.

 

Your doctor will do a physical exam and ask about your:

  • Symptoms
  • Health history
  • Family history of liver disease
  • Other things that might increase your risk of getting viral hepatitis

But the only way to know if you have hepatitis B is to do blood tests and other tests to check for liver damage and other liver diseases. 

Hepatitis tests

The CDC recommends testing with a triple panel test that includes:

Hepatitis B surface antigen (HBsAg). Antigens are proteins on the surface of HBV that your immune system recognizes as a foreign invader. If you have HBsAg in your blood, it shows you have been infected with HBV and can infect other people.

Hepatitis B surface antibody (anti-HBs). Antibodies are proteins your immune system makes to fight HBV. If you have anti-HBs in your blood, it shows that you have fought off HBV and now can't get it. Or this can show that you have gotten the hepatitis B vaccine.

Total antibody to hepatitis B core antigen (anti-HBc). This tests for a couple of kinds of antibodies your immune system makes to fight off HBV. If you have anti-HBc in your blood, it shows that you have an ongoing infection or a previous infection with HBV, but your body won't make this if you've gotten the hepatitis B vaccine.

Another blood test you doctor may order is the IgM antibody to hepatitis core antigen (IgM anti-HBc) test. If you have IgM anti-HBc in your blood, then you were infected with HBV less than 6 months ago, so you likely have acute hepatitis B.

If you are pregnant, you should also have a blood test for HBV DNA to see if you need to take antiviral medicine to prevent passing on HBV to your baby.

After you're diagnosed with hepatitis B, your doctor may order blood and imaging tests (such as an ultrasound) to check if your liver has been damaged by HBV. You may also get regular (about every 6 months) checkups and testing for liver disease.

Treatment for preventing HBV infection after you've been exposed

If you think you’ve been exposed to the virus, get to a doctor as soon as possible. Your doctor may recommend you get preventive treatment so you don't get an infection, such as:

  • An immediate dose (preferably within 24 hours of your exposure) of the hepatitis B vaccine
  • Hepatitis B immune globulin (HBIG), which is made from antibodies against HBV from human blood

Treatment for acute hepatitis B

You likely won't need specific treatment for acute hepatitis B, because if you got infected as an adult, you will recover on your own. If you have serious symptoms, your doctor may offer you the following to make you feel better:

  • Pain medicines
  • IV fluids
  • IV nutrition

Treatment for chronic hepatitis B

You may or may not need treatment for chronic hepatitis B. Your doctor will likely only treat you if you have signs of liver disease because the medicines used seem to work best in these people. They don't cure it, but they boost your immune system to slow down how fast the virus reproduces and keep your liver from getting damaged.

Your doctor may prescribe any of the following:

Oral antiviral medicines. These seem to be the best at slowing down how fast the virus reproduces. You may get only one or a combination of them based on your medical situation and how well you respond. You will usually need to take these for the rest of your life. Common antivirals include:

Interferon shots. These are synthetic versions of the antibodies your body makes to fight an infection. You generally get multiple injections over 6-12 months. This is the preferred treatment for children with chronic hepatitis B. They include:

Liver surgery or transplant. This may be an option if you have serious damage – such as cirrhosis, liver failure, or liver cancer – from an HBV infection. If enough healthy tissue is left, you may only need to have the damaged part removed. But if you have too much damage, you may need to have a transplant, where a surgeon replaces your damaged liver with a healthy liver from a donor.

Lifestyle changes recommended for people with chronic hepatitis B

Whether or not you are taking medicine, your doctor will likely recommend you make a few changes to protect your liver, such as:

  • Avoid alcohol.
  • Eat a healthy, balanced diet.
  • Limit how much fat and sugar you eat and drink.
  • Check with your doctor before taking other drugs, herbs, or supplements because some can damage your liver.

Rarely, acute hepatitis B can cause your liver to fail suddenly. Sudden liver failure is an emergency. Get to the doctor right away if you have any of the following symptoms:

  • Yellowing of your skin and eyeballs (jaundice)
  • Pain in your belly, especially if it's in the upper right part
  • Feeling confused
  • Mood and personality swings
  • No control over your behavior or impulses
  • Problems remembering things and concentrating
  • Trouble staying awake and aware

Chronic hepatitis B can lead to:

Cirrhosis . This is when scar tissue replaces your healthy liver tissue. This can make it harder for the liver to do its job and can eventually lead to liver failure.

Liver cancer. The leading cause of liver cancer is chronic hepatitis B, and liver cancer is one of the leading causes of death in people with chronic hepatitis B.

Liver failure. This is when your liver is no longer able to do its work. You may also hear it called “end-stage” liver disease. This can happen in severe cases of chronic hepatitis B.

Hepatitis D. This is another infection that only happens to people with chronic hepatitis B. It makes the stress on your liver worse and can cause acute liver failure.

Reactivated hepatitis B.

People who are at higher risk for reactivation of HBV include:

  • Those who take medicines that suppress their immune system, such as chemotherapy for cancer, medicines for autoimmune conditions, medicines for organ or bone marrow transplant, or steroids for more than a few weeks
  • Those who take medicine for hepatitis C
  • Those with HIV

If you’re pregnant and carry HBV, you might pass it on to your baby during pregnancy or at birth. This is a serious risk for your baby, so the CDC recommends all pregnant people get tested for HBsAg during your first trimester at each pregnancy, whether or not you've had the hepatitis B vaccine or had a test before (unless you've had a negative triple panel test and know you haven't been exposed to HBV after your test).

Also, babies and young children can get hepatitis B from close contact with family members or others who might be infected. All babies should get the first shot of the hepatitis B vaccine within 24 hours of birth, followed by a shot at 1-2 months old and the last shot when they are between 6 and 18 months old. 

Who should get the hepatitis B vaccine?

The CDC recommends the hepatitis B vaccine for:

  • All infants
  • All unvaccinated children or teens younger than 9 years old
  • All adults ages 19-59 years
  • Adults age 60 years or older with known risk factors for hepatitis B infection

Your doctor may also recommend it if you're age 60 years or older and don't have a risk factor for hepatitis B.

Get the hepatitis B vaccine (if you haven’t already been infected). It’s key to prevention. 

Hepatitis B vaccine schedule

For adults 19-59 years old, the CDC recommends a two-, three-, or four-dose series, depending on the vaccine. For instance:

  • For Heplisav-B, you should get two doses 4 weeks apart.
  • For Engerix-B, PreHevbrio, or Recombivax HB, you should get three doses 4 weeks apart.
  • For Twinrix (used for both HAV and HBV), you should get either three doses, with the first and second 4 weeks apart and the third 5 months after the second; or four doses, with the first three doses 7 days apart and a fourth booster dose at 12 months after the first.

For children and teens 19 years old or younger, the CDC recommends three vaccine doses, with the second 1-2 months after the first dose, and the third and last 6 months after the second, regardless of the vaccine.

The CDC recommends all infants get the first hepatitis B vaccine dose within 24 hours of birth, followed by a second dose at 1-2 months old, and the third and final dose when they are 6-18 months old. Infants born to people who are positive on an HBsAg test should get the first shot of the hepatitis B vaccine and HBIG within 12 hours after they are born, followed by followed by a second dose at 1-2 months old, and the third and final dose when they are 6-18 months old.

If you miss a dose of the vaccine, you don't have to start the series over again, but you should get the next dose as soon as possible.

How long does the hepatitis B vaccine last?

The vaccine generally protects you against HBV infection for at least 20 years and probably for life.

Where to get a hepatitis B vaccine

You can get the hepatitis B vaccine at your doctor's office, your local health department or community health clinic, or some pharmacies.

To reduce your risk of getting hepatitis B:

  • Get vaccinated.
  • If you are traveling to an area with high rates of hepatitis B, make sure you've completed your hepatitis B vaccinations (the whole series can take months to complete) before you leave.
  • Get treatment to protect yourself if you've been exposed to HBV.
  • Use a latex or polyurethane condom every time you have sex.
  • Don’t share razors, toothbrushes, nail care tools, needles, or medical equipment.

If you have hepatitis B, you can help prevent other people from getting it by:

  • Getting a diagnosis and treatment if you need it
  • Telling any sexual partners that you have hepatitis B and encouraging them to get vaccinated for it
  • Using a latex or polyurethane condom every time you have sex
  • If you use injection drugs, disposing of your needles safely and washing your hands after you inject
  • If you're pregnant, telling your doctor so they can help plan the treatment for your baby right after they are born

 

The CDC recommends that people in these groups get screened for hepatitis B:

Adults. All adults ages 18 and older should be screened at least once during their lifetime with a triple panel test (this includes HBsAg, anti-HBs, and anti-HBc).

Infants. All infants should be screened for HBsAg and anti-HBs. Infants who are born to people who are positive for HBsAg should also get tested 1-2 months after they get three or more doses of the vaccine.

Pregnant people. All pregnant people should be screened for HBsAg in the first trimester at each pregnancy.

People at increased risk of exposure to HBV. All people who have a higher risk of exposure should be screened with a triple panel test about every 6 months.

Anyone who requests HBV testing. 

Whether or not hepatitis B is curable depends on whether you were infected as an infant or child or as an adult. Most adults (about 95%) who get acute hepatitis B will fight off the virus. Once your body has fought off the virus, you generally can't get it again. (In other words, you're immune.) But if you develop chronic hepatitis B, it's not curable. You will generally have it the rest of your life, but your doctor can help you manage it with medicines and treatment for your symptoms.

The younger you are when you are infected with HBV, the more likely you are to get a chronic infection. About 90% of infants and 30% of children younger than 6 years old who are infected develop a chronic hepatitis B infection. These kids will have the infection the rest of their life and are at a higher risk of getting liver damage. 

 

If you have acute hepatitis B, your doctor will know you’ve recovered when you no longer have symptoms and your blood tests show:

  • Your liver is working normally.
  • You're positive for these antibodies on tests: HBsAg, anti-HBs, anti-HBc.

Some people don't get rid of the infection. If you have it for more than 6 months, you’re what’s called a carrier, even if you don’t have symptoms. This means you can give the disease to someone else.

Doctors don’t know why, but the disease does go away in a small number of carriers. For others, it becomes chronic. About 25% of people with chronic hepatitis B get liver cancer as a complication of hepatitis B.

If you’re a carrier or are infected with hepatitis B, don’t donate blood, plasma, body organs, tissue, or sperm. Tell anyone you could infect – whether it’s a sex partner, your doctor, or your dentist – that you have it.

Most adults who get hepatitis B recover fully within about 6 months. Infants and children who get hepatitis B are more likely to have a long-term infection. When you have a chronic infection, you will have it the rest of your life. The best way to prevent getting it is to get vaccinated. If you do get a chronic infection, your doctor can help you manage your condition with medicine, which will help you live a long, full life.