Frequently Asked Questions for the Public

Index of Questions

Overview

What is hepatitis?

Hepatitis means inflammation of the liver. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can all cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common hepatitis viruses are hepatitis A virus, hepatitis B virus, and hepatitis C virus.

What is the difference between hepatitis A, hepatitis B, and hepatitis C?

Hepatitis A, hepatitis B, and hepatitis C are liver infections caused by three different viruses. Although each can cause similar symptoms, they are spread in different ways and can affect the liver differently. Hepatitis A is usually a short-term infection. Hepatitis B and hepatitis C can also begin as short-term infections but in some people, the virus remains in the body and causes chronic, or lifelong, infection. There are vaccines to prevent hepatitis A and hepatitis B; but there is no vaccine available for hepatitis C.

The page “What is viral hepatitis?” explains in detail the differences between hepatitis A, hepatitis B, and hepatitis C.

What is hepatitis B?

Hepatitis B is a liver infection caused by the hepatitis B virus. Some people with hepatitis B are sick for only a few weeks (known as “acute” infection), but for others, the disease progresses to a serious, lifelong illness known as chronic hepatitis B.

What is acute (short-term) hepatitis B?

Acute hepatitis B is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis B virus. Some people with acute hepatitis B have no symptoms at all or only mild illness. For others, acute hepatitis B can cause a more severe illness that requires hospitalization.

What is chronic (long-term) hepatitis B?

Some people, especially those who get infected in adulthood, can fight the virus without treatment. For other people, acute hepatitis B leads to life-long infection known as chronic hepatitis B. Over time, chronic hepatitis B can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death.

Who is most likely to get chronic (long-term) hepatitis B?

Age plays a role in whether hepatitis B will become chronic. The younger a person is when infected with the hepatitis B virus, the greater the chance of developing chronic infection. About 9 in 10 infants who become infected go on to develop life-long, chronic infection. The risk goes down as a child gets older. About one in three children who get infected before age 6 will develop chronic hepatitis B. By contrast, almost all children 6 years old and older and adults who get infected with the hepatitis B virus recover completely and do not develop chronic infection.

How common is hepatitis B in the United States?

In 2020, a total of 2,157 cases of acute (short-term) hepatitis B were reported to CDC. Since many people may not have symptoms or don’t know they are infected, their illness is often not diagnosed so it isn’t reported or counted. CDC estimates the actual number of acute hepatitis B cases was closer to 14,000 in 2020. Many more people (about 880,000) are estimated to be living with chronic, long-term hepatitis B.

How common is hepatitis B around the world?

Hepatitis B affects approximately 296 million people, including over 6 million children under 5 worldwide.


Transmission

How is hepatitis B spread?

Hepatitis B is spread when blood, semen, or other body fluids – even in microscopic amounts — from a person infected with the hepatitis B virus enters the body of someone who is not infected-. People can become infected with the virus from:

  • Birth to an infected person
  • Sex with a partner who has hepatitis B
  • Sharing contaminated needles, syringes, or drug preparation equipment
  • Sharing contaminated items such as toothbrushes, razors, or medical equipment (like a glucose monitor) with a person who has hepatitis B
  • Direct contact with the blood or open sores of a person who has hepatitis B
  • Exposure to the blood from a person who has hepatitis B through needlesticks or other sharp instruments
  • Poor infection control in healthcare facilities

Although the hepatitis B virus can be found in saliva, it is not spread through kissing or sharing utensils. Hepatitis B is not spread through sneezing, coughing, hugging, breastfeeding or through food or water.

Can a person spread the hepatitis B virus and not know it?

Yes. Many people with hepatitis B don’t know they are infected with the virus because they don’t feel or look sick. However, they can still spread the virus to others.

Can the hepatitis B virus be spread through sex?

Yes. The hepatitis B virus can be found in the blood, semen, and other body fluids of an infected person. A person who has sex with an infected partner can become infected with the virus.

Can hepatitis B be spread through food?

Hepatitis B is not spread through food or water, unlike hepatitis A.

Who is at risk for hepatitis B?

Although anyone can get hepatitis B, these people are at greater risk:

  • Infants born to mothers with hepatitis B
  • People born in certain countries where hepatitis B is common
  • People born in the United States not vaccinated as infants whose parents were born in countries with high rates for hepatitis B
  • People with hepatitis C
  • People who have been incarcerated
  • People who inject drugs or share needles, syringes, and other types of drug equipment
  • Sex partners of people with hepatitis B
  • People who have sexually transmitted infections
  • People with HIV infection
  • Men who have sex with men
  • People who live with someone who has hepatitis B
  • Health care and public safety workers exposed to blood on the job
  • People on dialysis
  • People who have elevated levels of certain liver enzymes

What should I do if I think I have been exposed to the hepatitis B virus?

If you are concerned that you might have been exposed to the hepatitis B virus, see your health care provider or your local health department immediately. Tell your doctor that you may have been infected and ask if the hepatitis B vaccine and/or a shot called “HBIG” (hepatitis B immune globulin) is right for you. These measures can prevent infection if a person gets treatment as soon as possible, ideally within 24 hours after you think you were exposed.

What is hepatitis B immune globulin (HBIG)?

Hepatitis B immune globulin is a substance made from human blood samples that contains antibodies that help fight against the hepatitis B virus. A doctor or healthcare provider can give this as a shot to people exposed to the hepatitis B virus to protect them from infection.

How long does the hepatitis B virus survive outside the body?

The hepatitis B virus can survive outside the body for at least 7 days. During that time, the virus is still capable of causing infection.

If I have been infected with the hepatitis B virus in the past, can I get it again?

No. If you have been infected with hepatitis B virus in the past, you can’t get infected again. However, some people who were infected in the past can become sick if the virus “reactivates”.  Reactivation is rare but there is a risk of it happening if your immune system is suppressed. This can happen if you are starting chemotherapy, or your doctor puts you on other immune suppressive drugs. If you are going to start any of these treatments let your doctor know if you have had hepatitis B in the past.

Other people, especially those infected during early childhood, remain infected for life because they never cleared the virus from their bodies. These people are considered to have chronic infection and are at risk for developing severe liver disease.

What is hepatitis B/hepatitis D coinfection?

People who get infected with both hepatitis B and hepatitis D at the same time are coinfected. Hepatitis D, also known as “delta hepatitis,” only occurs in people who are also infected with the hepatitis B virus. Coinfection with hepatitis B and hepatitis D can cause serious, short-term health problems and even liver failure, but it usually does not lead to life-long illness. There is no vaccine to prevent hepatitis D. However, getting vaccinated with the hepatitis B vaccine will protect you against hepatitis D infection.

Can I donate blood if I have hepatitis B?

Unfortunately, no. The American Red Cross  does not accept blood donations from anyone who has tested positive for hepatitis B or anyone experiencing symptoms of viral hepatitis.

Can I donate organs if I have hepatitis B?

According to the U.S. Department of Health & Human Service’s online information on organ donation and transplantation, few conditions would prevent someone from being an organ, eye, or tissue donor. Even with a history of hepatitis B, you may be able to donate your organs or tissues. The transplant team will determine what organs or tissue can be used based on a clinical evaluation, medical history, and other factors. CDC has recently published information about how to assess solid organ donors and monitor transplant recipients for hepatitis B infection.


Vaccination

Can hepatitis B be prevented?

Yes. The best way to prevent hepatitis B is by getting vaccinated. The hepatitis B vaccine is safe and effective. You need to get all shots in the series to be fully protected.

Who should get vaccinated against hepatitis B?

The following groups may receive hepatitis B vaccination:

  • Adults aged 60 years and older without known risk factors for hepatitis B

Is the hepatitis B vaccine safe?

Yes. The hepatitis B vaccine is safe. As with any medicine, there are very small risks that a serious problem could occur, but soreness at the injection site is the most common side effect. CDC monitors the safety of vaccines. For more information, visit CDC’s vaccine safety site.

Can I get hepatitis B from being vaccinated?

No. The hepatitis B vaccine does not contain any live virus and can’t cause hepatitis B.

Is it harmful to have an extra dose of hepatitis B vaccine or to repeat the entire hepatitis B vaccine series?

No, getting an extra dose of the hepatitis B vaccine is not harmful.

What should I do if I started but did not complete the full hepatitis B vaccine series?

If you start the hepatitis B vaccine series, but then miss a dose the doctor should give the next dose as soon as possible. The first dose(s) does not need to be repeated.

Is the hepatitis B vaccine recommended before international travel?

Hepatitis B vaccination is recommended for all infants, children, and adults through age 59 years regardless of travel. If you are planning international travel, make sure you are up to date on your routine vaccines. To learn more about travel vaccines visit our Travelers’ Health page.

Who should not receive the hepatitis B vaccine?

Anyone who has had a serious allergic reaction to a prior dose of hepatitis B vaccine, any part of the vaccine, or yeast should not get the hepatitis B vaccine.

What is a booster dose, and do I need one?

A “booster” dose is an extra dose of vaccine that can increase or extend the effectiveness of the vaccine. Most healthy people do not need a booster dose, but your doctor can do a blood test to check your immunity and decide if a booster dose of vaccine is necessary.

Is there a vaccine that will protect me from both hepatitis A and hepatitis B?

Yes, there is a combination vaccine, called Twinrix, approved for adults that protects people from both hepatitis A and hepatitis B. The combined hepatitis A and hepatitis B vaccine is usually given as three separate doses over a 6-month period.

Can I get the hepatitis B vaccine at the same time as other vaccines?

Yes. Getting two different vaccines at the same time is not harmful.

Where can I get the hepatitis B vaccine?

Talk to your health care provider or local health department about getting vaccinated. Some clinics offer free or low-cost hepatitis B vaccines.

Can hepatitis B vaccine be given during pregnancy or breast feeding?

Yes. The hepatitis B vaccine does not contain live virus, so neither pregnancy nor breastfeeding should be considered a reason not to get vaccinated. However, of the five available adult vaccines against hepatitis B, there is not enough data on Heplisav-B and PreHevbrio to know if the vaccines are safe to give in pregnancy or during breastfeeding. Thus, pregnant women who need hepatitis B vaccination should receive Engerix-B, Recombivax HB, or Twinrix.

What should I do if I received the HEPLISAV-B vaccine while pregnant?

There is a pregnancy exposure registry that monitors pregnancy outcomes in people who received HEPLISAV-B during pregnancy. A pregnancy exposure registry is a study that collects health information from people who take prescription medicines or vaccines when they are pregnant.

Toll-free number:  1-844-443-7734
Email: heplisavbpregnancyregistry@ppdi.com

What should I do if I received the PreHevbrio vaccine while pregnant?

There is a pregnancy exposure registry that monitors pregnancy outcomes in people who received PREHEVBRIO during pregnancy. If you  received PREHEVBRIO during pregnancy, you should contact 1-888-421-8808 (toll-free).You may also wish to visit a pregnancy exposure registry which is a study that collects health information from people who take prescription medicines or vaccines when they are pregnant.

Why is the hepatitis B vaccine recommended for all babies?

Nearly all newborns who become infected with the hepatitis B virus develop lifelong hepatitis B. This can eventually lead to serious health problems, including liver damage, liver cancer, and even death. The Advisory Committee on Immunization Practices recommends the hepatitis B vaccine for all babies to protect them from this serious but preventable disease.


Symptoms

Does acute (short-term) hepatitis B cause symptoms?

Sometimes. Most children younger than 5 and people with serious health problems (like having compromised immune systems) have no symptoms. Up to half of all older children, adolescents, and adults experience symptoms of acute hepatitis B.

What are the symptoms of acute (short-term) hepatitis B?

Symptoms of acute hepatitis B can include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored bowel movements
  • Joint pain
  • Jaundice (yellow color in the skin or the eyes)

How soon after exposure to the hepatitis B virus will symptoms appear, and how long do they last?

If symptoms occur, they begin an average of 90 days (or 3 months) after exposure to the virus, but they can appear any time between 8 weeks and 5 months after exposure. They usually last several weeks, but some people can feel sick for as long as 6 months.

Can a person spread hepatitis B without having symptoms?

Yes. Many people with hepatitis B have no symptoms, but they can still spread the virus to others.

What are the symptoms of chronic (long-term) hepatitis B?

Most people with chronic hepatitis B do not have any symptoms, do not feel ill, and remain symptom free for decades. When and if symptoms do appear, they are like the symptoms of a new infection, but can also be a sign of advanced liver disease. About 1 in 4 people who become chronically infected during childhood and about 15% of those who become chronically infected after childhood will eventually die from serious liver conditions, like cirrhosis (scarring of the liver) or liver cancer. Some people still do not have symptoms even after their liver becomes diseased, although certain blood tests for liver function might show some abnormalities.

How serious is chronic (long-term) hepatitis B?

Chronic hepatitis B can develop into a serious disease resulting in long-term health problems, including liver damage, liver failure, liver cancer, and even death. There were 1,752 deaths related to hepatitis B virus reported to CDC in 2020, but this is an underestimate.


Screening and Testing

Who should be tested for hepatitis B?

CDC recommends hepatitis B testing for:

  • All adults aged 18 years and older once in their lifetime
  • All pregnant people early during each pregnancy
  • Infants born to pregnant people with HBV infection
  • Any person who requests hepatitis B testing

CDC recommends periodic hepatitis B testing for anyone with ongoing risk for exposure, including:

  • People born in certain countries where hepatitis B is common
  • People born in the United States not vaccinated as infants whose parents were born in countries with high rates of hepatitis B
  • Men who have sex with men
  • People who inject or have injected drugs
  • People who are now or have been incarcerated in jail, prison, or other detention setting
  • People with HIV
  • Household and sexual contacts of people with hepatitis B
  • People with sexually transmitted infection and/or multiple sex partners
  • People who are on immunosuppressive therapy
  • People with end-stage kidney disease (including people on dialysis)
  • People with hepatitis C
  • People with high liver enzyme levels
  • People who are donors of blood, plasma, organs, tissues, or semen

How do I know if I have hepatitis B?

Since many people with hepatitis B do not have symptoms, your doctor can do a blood test to diagnose the infection. All adults should be tested for hepatitis B at least once in their lifetime.  Pregnant people should be tested during each pregnancy.  Any adult who wants to be tested should ask their doctor to test them. There are several different hepatitis B tests. Depending on which test is done, the doctor can determine whether you

  • have chronic or acute hepatitis B;
  • are immune to hepatitis B because of vaccination; or
  • were infected in the past, recovered, and are protected from future infection.

Certain tests can even determine how likely it is that someone who is infected with hepatitis B will transmit it to others. Ask your doctor to explain the tests, when you can expect to get the results, and what those results mean.

What should I do after learning that I have hepatitis B?

If test results show that you are infected with the hepatitis B virus, you should talk to a doctor who is experienced in caring for people with hepatitis B. This can be an internist or family medicine practitioner, or it may be someone who specializes in treating people with infectious, digestive, or liver diseases.

If I am pregnant should I get tested for hepatitis B?

Yes, pregnant women should get tested for hepatitis B, preferably in their first trimester.  Ask your doctor if you have been tested.


Treatment

How is acute (short-term) hepatitis B treated?

There is no medication available to treat acute hepatitis B. For people with mild symptoms, health care providers usually recommend rest, adequate nutrition, and fluids. Those with more severe symptoms may need to be hospitalized.

How is chronic hepatitis B treated?

There are several medications approved to treat people who have chronic hepatitis B, and new drugs are in development. However, not every person with chronic hepatitis B needs medication, and the drugs may cause side effects in some patients. People who start hepatitis B treatment may need to take medication indefinitely because these medications do not lead to a cure.

If a pregnant person has hepatitis B, is there a way to prevent their baby from getting hepatitis B?

Yes. Almost all cases of hepatitis B can be prevented in babies born to pregnant people with hepatitis B, but these newborns must receive the necessary shots at the recommended times. Your doctor should give the combination of hepatitis B immune globulin (known as HBIG) and hepatitis B vaccine to infants born to pregnant people with hepatitis B within 12 hours of birth to protect them from infection. To best protect your baby, follow the advice from your baby’s doctor.

What can people with chronic hepatitis B do to take care of their liver?

People with chronic hepatitis B should be under the care of a health care provider that is knowledgeable about this illness (like an internist or provider that specializes in treating people with infectious, digestive, or liver diseases) and is able to regularly monitor their liver function. People recently diagnosed with hepatitis B should

  • get vaccinated against hepatitis A and tested for hepatitis C;
  • avoid drinking alcohol;
  • follow a healthy diet and stay physically active, especially patients who are overweight (i.e., those with body mass index [BMI] ≥25kg/m2) or obese (BMI ≥30kg/m2); and
  • check with a health professional before taking any prescription pills, nutritional or herbal supplements, or over-the-counter medications, as these can potentially damage the liver.