Hepatitis B

Hepatitis B is a complex health issue and can be a little overwhelming. This page explores the most important things you need to know about hepatitis B including: 

Hepatitis B is a virus that can cause inflammation and damage to your liver, and if left unmonitored and untreated it can cause chronic liver disease and liver cancer. It is sometimes called hep B or HBV.

Hepatitis B is most commonly transmitted by blood to blood contact and sexual fluids.

Globally as many as 257 million people are estimated to be living with hepatitis B. Here in Australia it is estimated that over 226,000 people are living with chronic hepatitis B. Looking more locally in Queensland it is estimated that almost 35,000 people are living with chronic hepatitis B.

Of the people that are estimated to be living with hepatitis B in Australia, only 154,000 (68%) have been diagnosed, leaving a further 72,000 people not knowing their hepatitis B status. More significantly over 75% of people who are diagnosed are not in regular care for their hepatitis B, this means not receiving six-monthly check-ups or treatment (if required).

The issue with having such a large population of people not diagnosed or not engaged in regular care leads to more people with cirrhosis, advanced liver disease and liver cancer which may have been preventable.

When we consider the priority populations and hepatitis B, we see high rates of hepatitis B in people born in China, Vietnam, Sub-Saharan Africa, Oceania (excluding Australia), and some parts of Europe. Australia’s Aboriginal and Torres Strait Islander population have higher rates of hepatitis B than other non-Indigenous populations. Additionally, other sub groups including men who have sex with men and people who inject drugs also have higher than average rates of hepatitis B.

Acute and chronic hepatitis B

If you have hepatitis B for less than six months, it is called an ‘acute’ infection, and this refers to the length of time that you have had the virus in your body. During the first six months of the infection your immune system may be able to clear the virus naturally from your body. If you have it for longer than six months, it is called a ‘chronic’ infection of chronic hepatitis B and you will have hepatitis B for life.

How your body reacts to a potential hepatitis B infection depends on how old you are when you are exposed. When an adult is exposed to the hepatitis B virus 95% will clear the virus and not develop chronic hepatitis B. This means your immune system will activate and will produce antibodies to fight off the virus, eliminating it from your body. You may experience flu-like symptoms including a fever, runny nose, and fatigue as well as jaundice (yellowing) of the skin and eyes during this time. It is very rare for someone to develop acute liver failure during this time. When the virus has been cleared from your body you will no longer experience symptoms, you will not be able to pass hepatitis B on to other people and will be immune to hepatitis B in the future. When you have blood tests in the future you will have antibodies to hepatitis B – as a marker in your blood that the virus has been there at some point in time.

Babies and hepatitis B

90% of newborn babies who are exposed to hepatitis B at birth will go on to have chronic hepatitis B if there is no intervention at birth. Babies who receive both intervention will only have a 5% chance of contracting hepatitis B. This is because the baby’s immune system is not mature enough and doesn’t recognise the hepatitis B virus as something it should try and eliminate from the body. Currently in Australia babies who are born to mothers with hepatitis B are provided with a vaccination and hepatitis B immunoglobulin (HBIG) within 12 hours of birth. 

Children and hepatitis B

Similarly to babies, young children will clear the hepatitis B virus naturally in approximately 50% of cases.

Chronic hepatitis B phases

There are four phases of hepatitis B. These phases change as your liver function changes as the virus increases or decreases. You may not move from one phase to the next, you may skip a phase or even move back a phase. These phases are important to monitor as it helps your doctor work out your options for treatment.

Immune tolerant phase or silent phase

  • High viral load (HBV DNA)
  • Normal liver function tests – as very little damage to being done to your liver.
  • HBeAg positive
  • Your immune system is controlling the inflammation occurring in your liver
  • Six monthly check-ups are required.
  • Treatment is not required

Immune clearance phase or damage phase

  • High viral load (HBV DNA)
  • Abnormal liver function tests
  • HBeAg positive
  • Your immune system is attempting the attack the virus and reduce the amount of hepatitis B in your blood
  • Your liver is being damaged
  • Referral required to Specialist or prescribing GP
  • Treatment may be required due to increased risk of cirrhosis and liver cancer

Immune control phase or control phase

  • Low viral load (HBV DNA)
  • Normal liver function tests
  • HBeAg negative and anti-HBe positive
  • Your immune system has got the virus under control and no further damage is being done to your liver
  • Six monthly check-ups are required
  • Treatment is not required

Immune escape phase or escape phase

  • High viral load (HBV DNA)
  • Abnormal liver function tests
  • HBeAg negative and anti-HBe positive
  • The virus is not being controlled by your immune system, and your liver is being damaged again, particularly if there was damage done in previous phases
  • Referral required to Specialist or prescribing GP
  • Treatment may be required due to increased risk of cirrhosis and liver cancer

Generally, you will only require treatment when you are in the immune clearance phase and immune escape phase. For more information read our Phases of chronic hep B factsheet

How do you get hepatitis B?

  • Blood-to-blood contact
  • Unprotected sexual contact (in semen and vaginal fluids)
  • From mother with hepatitis B to her newborn baby during birth (vertical or perinatal transmission)

Transmission examples:

  • Unprotected sex – not using a condom during sex (vaginal, anal or oral sex)
  • Contact with blood through blood transfusions, blood products, medical or dental procedures (this is an issue in many countries, but is rare in Australia and has been since 1972)
  • Sharing injecting drug equipment (including syringes, spoons, water, filters and tourniquets)
  • Unsterile cultural or traditional practices that involve blood, skin penetration or blood rituals
  • Unsterile tattooing or piercing
  • Sharing toothbrushes, razors and tweezers
  • Blood-to-blood contact through open wounds (horizontal transmission)
  • Blood contact between children (where one child is hepatitis B positive) more common during the first five years of life (horizontal transmission)
  • Needle-stick injuries (getting hepatitis B this way is rare)
  • Oral sex where they are open cuts, ulcers, or sores in the mouth

What does NOT transmit hepatitis B

  • Sharing food, eating utensils, cups, and plates
  • Hugging and kissing
  • Coughing, sneezing, and spitting
  • Sharing toilets, sinks and showers
  • Providing personal care including changing nappies
  • Blood transfusion or medical procedure in Australia after 1972
  • Mosquito bites

How do you know if you have hep B?

A blood test is the only way to know if you have hepatitis B. This blood test can show if you have had hepatitis B in the past, or if you have it now. The hepatitis B virus can be detected in blood within 30 to 60 days.

To get tested or find out more information, contact your local doctor, Sexual Health Clinic, Aboriginal Medical Service, or contact us for more information.

Symptoms

  • General aches and pains
  • Fever
  • Nausea
  • Loss of appetite
  • Abdominal discomfort
  • Yellowing of the eyes and skin (jaundice)
  • Light coloured faeces and dark urine

How long will it take to show symptoms?

The incubation period (number of days between when you are exposed to when you might see symptoms) of the hepatitis B virus is approximately 75 days. However, it can range between 30 days to as long as 180 days.

How can you prevent getting hep B?

  • Get vaccinated. This is the best protection!
  •  Avoid blood-to-blood contact – be blood aware
  • If you are pregnant and have hepatitis B, talk to your doctor about vaccinations and hepatitis B immunoglobulin (HBIG) for your baby at birth
  • Never share injecting drug equipment (including needles, water, spoons, filters and tourniquets) and dispose of all equipment safely
  • Cover open wounds or cuts with waterproof bandaids and clean up any blood spills with disposable gloves and bleach
  • Always get your tattoos and piercings done by a professional who uses sterile equipment and follows occupational procedures for infection control
  • Don’t share items that may have traces of blood on them like tweezers, razors or toothbrushes
  • It is safe to breastfeed but if your nipples are cracked or bleeding you should stop temporarily
  • If you are not immunised and you have sexual or blood contact with someone that may have hepatitis B, you should talk to your doctor or clinic about getting vaccinated and getting the hepatitis B immunoglobulin (HBIG). HBIG can help your body fight hepatitis B if you have just been exposed to the virus. You should get the HBIG injection within 72 hours of possible contact.
  • Where possible, avoid medical procedures in countries where standard precautions may not be followed such as equipment sterilisation and proper screening of organs, tissues, blood, or blood products. In Australia, the risk of acquiring hepatitis through medical procedures is extremely low.

What is involved in vaccination?

The standard adult immunisation schedule for hepatitis B is given as three injections over a six-month period. Infants and children receive four doses over six months – one at birth, then at 2, 4 and six months of age.

If a baby is born to a mother who is living with hepatitis B, the first immunisation along with the hepatitis B immunoglobulin (HBIG) needs to be given within 12 hours of birth. The baby then follows the normal childhood vaccination schedule.

The hepatitis B vaccine will provide most people with lifelong protection against hepatitis B. If you are unsure you have been vaccinated or would like to make sure that your vaccination is still providing immunity against hepatitis B, you can ask your doctor for a blood test to check your titre level. This simple blood test will show if you have been vaccinated, how high your titre or immunity is, and if you require revaccination or a booster.

See the National Immunisation Program Schedule for more details.

It is recommended that all people with chronic hepatitis B have regular six-monthly check-ups, your specialist or doctor may refer to this process at monitoring. These regular check-ups allow you and your doctor to keep an eye on the virus in your body, your liver health and over time determine if treatment (medication) is required.

Visit our HEPnav directory to find hep B doctors and liver clinics near you for monitoring and treatment.

Why are check-ups important?

Most people with chronic hepatitis B will feel well and healthy but damage may still be occurring in your liver over time. Hepatitis B can progress into cirrhosis (scarring), liver cancer, and liver failure. It is important to regularly check what is happening in your liver and how well it is working. The earlier the changes are detected, the more options you will have in treatment.

What happens at a hepatitis B check-up?

At your check-up, your doctor will test for changes in your liver and for any damage. This can include blood tests and an ultrasound to look at your liver. These tests will help determine the phase of your chronic hepatitis B infection and whether treatment is needed. Your doctor will also talk with you about your overall health, wellbeing and answer any concerns you may have.

Getting tested for hepatitis B

A blood test is the only way to know if you have hepatitis B and it can show if you have had hepatitis B in the past, or if you have it now. Hepatitis B is not part of regular or routine tests such as check-ups so will you need to ask your doctor to test for it. 

To get a blood test for hepatitis B you can visit your local doctor, Sexual Health Clinic, Aboriginal Medical Service or a liver clinic.

Your test results

Hepatitis B test results will tell you if you have:

  • A current infection – You have hep B right now
  • Immunity (vaccination) – You have been vaccinated and you’re immune to hep B. You can’t get hep B.
  • Immunity (past infection) – You had hep B in the past but your body fought it off. You can’t get hep B again.
  • No immunity – You don’t have hep B, but you could still get hep B.

Understanding your test results can be confusing. Our Hepatitis B testing factsheet explains the terms used and what your results mean. 

How can I look after myself?

  • Have regular six monthly check-ups with your specialist or doctor
  • Reduce or avoid alcohol (alcohol can increase your chances of developing cirrhosis or liver cancer)
  • Eat a balanced diet
  • Get regular exercise
  • Reduce your stress and get support
  • Try to maintain a healthy body weight
  • Rest when you need to.

Check out our Hepatitis B: What you need to know factsheet for more information

Is treatment available for hep B?

There is treatment for hepatitis B, but not everyone will need treatment (medication). Whether or not you need treatment depends on your unique situation and what phase of chronic hepatitis B your liver is in. You will only require treatment when you are in the immune clearance phase and immune escape phase. Your doctor will guide you through the options available to you based on the results of your regular blood tests and check-ups.

How does hepatitis B treatment work?

Treatment is sometimes referred to as antiviral therapy as the medication works to slow down or stop the virus replicating in your body. Reducing how quickly the virus is replicating will reduce the amount of hepatitis B virus you have in your body. In turn this reduces the damage that is being caused to your liver as well as giving your liver some time to regenerate. It is unlikely that treatment for hepatitis B will cure or eliminate the virus from your body entirely. Ideally your hepatitis B will become undetectable meaning that on a blood test no hepatitis B virus can be seen, but more importantly this means that very little damage is being done to your liver.

What happens if I stop taking my hep B medication?

It is very important to take your medication as your doctor has prescribed, even when you begin to feel well and healthy again. If you don’t take all of your tablets, or start and stop your medication it will not work properly and it is possible for the virus in your body to increase very quickly causing a flare. This can have serious liver complications.

Can I share my hepatitis B medication?

It is important that you do not share your medication with anyone else who has hepatitis B, even a family member who is sick from their hepatitis B. This can cause serious liver damage for both people and can cause the medication to not work properly in the future.

What treatment will I be given?

The most common medications that are prescribed for someone with hepatitis B are Entecavir (Baraclude) and Tenofovir (Viread). Both of these medications come in tablets. They are very effective and have very few side effects.

Another treatment that is used less commonly is pegylated interferon which is given as an injection in the abdomen once per week for six to twelve months. This medication can have side effects and can interfere with other medications.

Your doctor will discuss all the options for treatment with you before you begin, so you can make an informed choice about what is best for you.

How much does Hepatitis treatment cost?

Hepatitis B medicines are listed on the Pharmaceutical Benefits Scheme (PBS) which means the Government subsidies the cost of the medications for people who hold a Medicare card. As of August 2020, the patient co-payment amounts are:

·        General – $41.00 (Medicare Card)

·        Concessional – $6.60 (Medicare Card, along with Healthcare Card or Pension Card).

There are other options available for people living in Australia who are ineligible for Medicare, contact us for more information.

Pregnancy safety

If you are pregnant and hepatitis B positive it is important that you are in the care of a specialist for the management of your health and your baby’s health. Additionally, if you are diagnosed with hepatitis B during your pregnancy a referral to a specialist is recommended.

During the third trimester (28 weeks – 40+ weeks) of pregnancy mothers with hepatitis B can safely take tenofovir to reduce the amount of virus in the blood and therefore reduce the risk of a blood to blood transmission at birth. Tenofovir may be continued after the baby’s birth to reduce the chance of a flare (rapid increase in virus). It is safe to breastfeed while taking tenofovir.

It is important that even after the birth of the baby, that the mother continues to see the specialist as she can have a risk of flares after pregnancy.

Is it safe to give birth if I have hepatitis B?

There is no data to suggest there is a higher risk for hepatitis B transmission through a vaginal delivery compared to a caesarean section. It is important that the doctor and birth team are aware if the mother is hepatitis B positive so they can avoid using any procedures that may break the baby’s skin and ensure that the baby receives the required vaccinations as soon after birth as possible.

All babies in Australia who are born to mothers who are hepatitis B positive are provided the first hepatitis B vaccination and the hepatitis B immunoglobulin (HBIG) within 12 hours of birth. It is really important that these vaccinations occur as it reduces the baby’s risk of developing chronic hepatitis B from 95% to approximately 5%. The injection site must be thoroughly cleaned before giving the vaccination to prevent any hepatitis B positive blood on the skin entering the baby’s bloodstream.

Can I breastfeed if I have hepatitis B?

Breastfeeding is encouraged for mothers who are hepatitis B positive as it is not linked to an increased risk of transmitting hepatitis B. The antibodies present in the breast milk are important for the baby to fight off infections. If the nipples become cracked or begin to bleed during feeding use one breast or express and throw away the milk until the nipples have healed. Seek the support of a lactation consultant or midwife if you are experiencing bleeding nipples or difficulty breastfeeding.

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