Hepatitis B Questions and Answers for the Public

Index of Questions

Hepatitis B 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; however, no vaccine is 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 causes a more severe illness that requires hospitalization.

What is chronic (long-term) hepatitis B?

Some people, especially those who get infected in adulthood, are able to clear the virus from their bodies 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 older children (those aged ≥6) and adults infected with the hepatitis B virus recover completely and do not develop chronic infection.

How common is hepatitis B in the United States?

In 2018, a total of 3,322 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 can’t be reported or counted. CDC estimates the actual number of acute hepatitis B cases was closer to 21,600 in 2018. Many more people (about 862,000) are estimated to be living with chronic, long-term hepatitis B.

How common is hepatitis B around the world?

An estimated 257 million people are living with hepatitis B worldwide.

Hepatitis B Transmission

How is hepatitis B spread?

Hepatitis B is spread when blood, semen, or other body fluid infected with the hepatitis B virus enters the body of someone who is not infected. People can become infected with the virus from:

  • Birth (spread from an infected mother to her baby during birth)
  • Sex with an infected partner
  • Sharing needles, syringes, or drug preparation equipment
  • Sharing items such as toothbrushes, razors, or medical equipment (like a glucose monitor) with an infected person
  • Direct contact with the blood or open sores of an infected person
  • Exposure to an infected person’s blood through needlesticks or other sharp instruments

Hepatitis B is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.

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?

Unlike hepatitis A, hepatitis B is not usually spread through food or water.

Who is at risk for hepatitis B?

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

  • Infants born to infected mothers
  • People who inject drugs or share needles, syringes, and other types of drug equipment
  • Sex partners of people with hepatitis B
  • 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
  • Hemodialysis patients

Who should be tested for hepatitis B?

CDC recommends hepatitis B testing for:

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, call your health-care provider or your local health department immediately. Infection with the hepatitis B virus can be prevented if you get the hepatitis B vaccine and/or a shot called “HBIG” (hepatitis B immune globulin) as soon as possible after exposure to the virus, ideally within 24 hours.

What is hepatitis B immune globulin (HBIG)?

Hepatitis B immune globulin is a substance made from human blood samples that contain antibodies against the hepatitis B virus. It is given 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.

How should blood spills be cleaned from surfaces to make sure that hepatitis B virus is gone?

All blood spills (including those that have already dried) should be cleaned and disinfected with a mixture of bleach and water (1 part household bleach to 10 parts water). Gloves should always be worn when cleaning up any blood spills. Even dried blood can cause 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 in the past, you can’t get infected again. However, some 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.

Can I donate blood if I have hepatitis B?

The American Red Crossexternal icon 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 transplantationexternal icon, 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 infectionpdf icon.

Prevention through 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. Completing the series of shots (2, 3, or 4 doses, depending on the manufacturer) is needed to be fully protected.

Who should get vaccinated against hepatitis B?

Hepatitis B vaccination is recommended for:

  • All infants
  • All children and adolescents younger than 19 years of age who have not been vaccinated
  • People at risk for infection by sexual exposure
    • People whose sex partners have hepatitis B
    • Sexually active people who are not in a long-term, mutually monogamous relationship (for example, people with more than one sex partner in the past 6 months)
    • People seeking evaluation or treatment for a sexually transmitted infection
    • Men who have sex with men
  • People at risk for infection by exposure to blood
    • People who inject drugs
    • People who live with someone who has hepatitis B
    • People who live or work in facilities for people with developmental disabilities
    • Health-care and public-safety workers at risk for exposure to blood or blood-contaminated body fluids on the job
    • People who receive hemodialysis
    • People with diabetes who are 19–59 years of age (people with diabetes who are age 60 or older should ask their health care professional).
  • International travelers to countries where hepatitis B is common
  • People with hepatitis C virus infection
  • People with chronic liver disease
  • People with HIV infection
  • People who are in jail or prison
  • All other people seeking protection from hepatitis B virus infection

Is the hepatitis B vaccine recommended before international travel?

Only people visiting countries where hepatitis B is common should get the hepatitis B vaccine before travel.

Is the hepatitis B vaccine safe?

Yes. The hepatitis B vaccine is safe, and soreness at the injection site is the most common side effect. As with any medicine, there are very small risks that a serious problem could occur after getting the vaccine. The safety of vaccines is always being monitored. 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 extra doses of hepatitis B vaccine is not harmful.

What should be done if hepatitis B vaccine series was not completed?

If the hepatitis B vaccine series is interrupted, the next dose should be given as soon as possible. The first dose(s) does not need to be repeated.

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 a blood test can be performed 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 approved for adults that protects people from both hepatitis A and hepatitis B. The combined hepatitis A and 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.

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 similar to the symptoms of acute infection, but can 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 1,649 deaths related to hepatitis B virus reported to CDC in 2018, but this is an underestimate.

Tests

How do I know if I have hepatitis B?

Talk to your health-care provider if you have risk factors for or think you might have hepatitis B. Since many people with hepatitis B do not have symptoms, blood tests are used to diagnose the infection. Several different hepatitis B tests are available. Depending on the test, they can determine whether you

  • have chronic or acute hepatitis B;
  • are immune to hepatitis B after vaccination; or
  • were infected in the past, have cleared the virus from your body, 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 health-care provider to explain what tests were ordered, 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 consult a health-care provider that 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.

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?

Several medications have been 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.

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.

Pregnant Women and their Newborns

Are pregnant women tested for hepatitis B?

Yes. When a pregnant woman comes in for prenatal care, she is given a series of routine blood tests, including one that checks for hepatitis B virus infection.

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

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

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. Hepatitis B vaccination is recommended for all babies to protect them from this serious but preventable disease.