Hepatitis means ‘inflammation of the liver’. Hepatitis B (also referred to as hep B) is caused by the hepatitis B virus (HBV) and is a viral infection that can lead to serious illness or death. The virus is found in blood and, to a lesser degree, in body fluids such as semen and vaginal secretions.
You can get hepatitis B by having unsafe sex, sharing unsterile piercing or injecting drug equipment, or engaging in other activities where the blood or body fluids of an infected person enters the bloodstream of an uninfected person. The virus may also be passed from a pregnant mother to her baby. In about 30 to 40 per cent of cases, infections occur without a known cause.
Most adults who have hepatitis B recover completely and do not require ongoing treatment. Children with hepatitis B are more likely to develop liver disease or cancer in later life.
All children and adults at increased risk should be immunised against hepatitis B.
Symptoms of hepatitis B
Some people who are infected with the hepatitis B virus have mild, flu-like symptoms and some do not become sick at all. Children who are infected are less likely to have symptoms than adults, but the consequences for children can be more serious.
In more severe cases, hepatitis B can cause:
- loss of appetite
- nausea and vomiting
- pain in the liver (under the right ribcage)
- pain in the joints
- jaundice (the eyes and skin become yellow).
Normally, these symptoms disappear in a few weeks. Even when the person feels much better, they may still be infectious. Most adults who become infected with the hepatitis B virus recover completely and do not become infected again. A few people become very ill and some may even die.
Complications of hepatitis B
A small proportion of people who become infected with the hepatitis B virus develop a long-term hepatitis B infection. They may ‘carry’ the virus in their bloodstream for their entire life without realising they are infected and without showing any symptoms.
A person with long-term hepatitis B may be at risk of developing illnesses such as chronic liver disease or liver cancer later in life. Treatment is essential because it is not possible to be a ‘healthy carrier’ of the hepatitis B virus.
Babies and children who are infected are more likely than adults to develop long-term hepatitis B. This occurs more commonly in some population groups including Aboriginal and Torres Strait Islander people and people from China, South-East Asia, the Pacific Islands and sub-Saharan Africa.
Causes of hepatitis B
Hepatitis B is spread through contact with blood that contains the hepatitis B virus. If infected blood or body fluids enter another person’s bloodstream, that person may become infected.
Activities that can cause infection include:
- sharing unsterile equipment for injecting drugs
- piercing the skin with equipment that is not properly cleaned, disinfected and sterilised
- sharing razor blades or toothbrushes
- coming into contact with infected blood through open cuts or the mucous membranes of another person
- having unprotected sex – for example, without a condom, especially if there is blood present.
Mothers who have hepatitis B sometimes pass the virus to their babies or children. Some babies are infected in the womb (rarely) or during birth, but most infection occurs shortly after birth. If the newborn baby is quickly immunised, they can be protected from the disease.
The time from infection to the appearance of symptoms (if they occur) is from 45 to 180 days. The person is infectious to others for several weeks before and after any acute illness. Even if symptoms do not occur, the person can infect others.
All blood and blood products produced for medical purposes in Australia are carefully screened for hepatitis B and other blood-borne viruses. The risk of getting infected with hepatitis B from a blood transfusion is extremely low (approximately 1 in 764,000).
Reducing the risk of hepatitis B
Simple steps that everyone can take to protect themselves against hepatitis B include:
- making sure you and your child are immunised
- using condoms every time you have anal or vaginal sex
- avoiding oral sex if you or your partner has herpes, ulcers or bleeding gums – it is unlikely that you will contract hepatitis through oral sex unless blood is present
- choosing to have any body piercing or tattooing done by an experienced practitioner who follows good sterilisation and hygiene practices, and who works at premises registered by the local council
- wearing single-use gloves if you give someone first aid or need to clean up blood or body fluids
- never sharing needles and syringes or other equipment, such as spoons, swabs or water, if you inject drugs. Always use sterile needles and syringes. These are available from needle and syringe programs and some pharmacists. Always wash your hands before and after injecting.
If you have hepatitis B, you should:
- Avoid sharing injecting equipment or personal items such as toothbrushes or razors.
- Make sure your partner and close contacts are immunised against hepatitis B.
- Completely cover any cut or wound with a waterproof dressing.
- Practise safe sex.
- Consider discussing your condition with your healthcare professional when undergoing any medical or dental procedure, although there is no legal obligation to do so.
Diagnosis of hepatitis B
Blood tests are available to determine if you are or have been infected with hepatitis B. It may take six months from the time of infection before a blood test can detect antibodies to hepatitis B, so follow-up testing may be required. During this six-month period, you may be infected with hepatitis B and should take action to prevent potential infection of other people.
There are also tests that can assess liver damage from hepatitis B. The interpretation of these tests can be complicated and specialist advice is needed, so it is best to talk to your doctor.
Treatment for hepatitis B
The immune system of most adults who become infected with hepatitis B will clear the infection. In these cases, ongoing treatment may not be necessary. Only a few adults (about five per cent) will develop long-term hepatitis B and require long-term treatment that will help to clear the virus and reduce liver damage.
Current treatments available include antiviral medications, some of which are covered by the Pharmaceutical Benefits Scheme. If you have long-term hepatitis B, you should consult with your doctor who will monitor your condition and, if necessary, refer you to a specialist. It is also a good idea to limit how much alcohol you drink and to eat a well-balanced, low-fat diet.
Contact with someone with hepatitis B
If you think you have been exposed to hepatitis B, see a doctor immediately. Your doctor can give you treatment in some instances, which greatly reduces the risk of you becoming infected with hepatitis B.
Immunisation for hepatitis B
Immunisation is the best protection against hepatitis B infection and a course of vaccination is recommended for all babies and those in high-risk groups. Immunisation can be with a vaccine against hepatitis B alone or with a combination vaccine. To be immunised, contact your doctor or local council.
Protection against hepatitis B is available free of charge under the National Immunisation Program Schedule. In Victoria, immunisation against hepatitis B is free for:
- babies at birth – immunisation against hepatitis B alone as soon as possible after birth
- babies at two, four and six months – immunisation in the form of a diphtheria, tetanus, whooping cough, hepatitis B, polio and Haemophilus influenzae type b (Hib) vaccine (six-in-one vaccine)
- premature babies at 12 months – premature babies born under 32 weeks gestation or under 2,000 g birth weight receive a single booster dose
- children up to and including nine years of age.
In Victoria, free hepatitis B vaccine is provided for people who are at increased risk including:
- household contacts and sexual partners of people living with hepatitis B
- people who inject drugs or are on opioid substitution therapy
- people living with hepatitis C
- men who have sex with men
- people living with HIV
- prisoners and people on remand who do not have hepatitis B or immunity against hepatitis B
- people no longer in a custodial setting who commenced, but did not complete, a free vaccine course while in custody.
Immunisation is also recommended, but not necessarily free, for people who are at increased risk, including:
- healthcare or emergency workers, or members of the police force or armed forces
- workers who come into regular contact with blood or tissue such as funeral workers, embalmers, tattooists or other people who come into regular contact with human tissue, blood or body fluids and/or used needles or syringes
- workers in the sex industry.
- Aboriginal and Torres Strait Islander people
- migrants from areas where hepatitis B is widespread, including Africa, Asia, Russia and Eastern Europe
- adults on haemodialysis and people with severely impaired renal function in whom dialysis is anticipated
- solid organ and haematopoietic stem cell transplant recipients
- immunocompromised adults
- people with a blood-clotting disorder or who require ongoing transfusions with blood products
- people who have more than one sexual partner
- people with chronic liver disease or a liver transplant
- residents or staff members at facilities for people with developmental disabilities
- travellers to hepatitis B endemic areas either long term or for frequent short visits, or undertaking activities that increase their risk of exposure
- people with a history of injecting drug use
Remember that being immunised against hepatitis B does not protect you against HIV, hepatitis C or other diseases spread by blood or bodily fluids. It is important that you take precautions to ensure you are not exposed to these diseases.
Pregnancy and hepatitis B immunisation
Hepatitis B vaccine is not usually recommended for women who are pregnant or breastfeeding, but could be recommended by your doctor if you are not immune to hepatitis B and you are at increased risk of infection.
Where to get help
- Your doctor
- Your local community health centre
- In an emergency, always call triple zero (000)
- Emergency department of your nearest hospital
- Australian Red Cross Blood Service – Transfusion Medicine Services Tel. 9694 0152
- Your local government immunisation service
- Maternal and Child Health Line (24 hours) Tel. 132 229
- NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
- National Immunisation Information Line Tel. 1800 671 811
- DirectLine Tel. 1800 888 236 – for 24-hour confidential drug and alcohol telephone counselling, information and referral
- Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 (toll free from outside Melbourne metropolitan area only)
- Your local pharmacist
- SAEFVIC Tel. 1300 882 924 – the line is attended between 10 am and 3.30 pm and you can leave a message at all other times
Things to remember
- Hepatitis B is a viral infection but immunisation is available.
- Immunisation is about 95 per cent effective and is recommended for all infants and young children, adolescents and those in high-risk groups.
- Hepatitis B causes liver inflammation and may lead to serious illness or death.
- In about 30 to 40 per cent of cases, infection occurs without a known cause.
- Hepatitis B is spread through sharing unsterile injecting or piercing equipment, unsafe sex or other activities where the blood of an infected person enters your bloodstream.
- Hepatitis B can be passed from an infected mother to her baby.