Infection with Hepatitis B virus (HBV) can lead to acute or chronic Hepatitis B disease, both of which cause damage to the liver. A vigorous immune response to infection leads to the eventual clearing of the virus from the body; this is called an acute infection.
Hepatitis B in the United States
In the United States, there are between 70,000-1.4 million people who are chronically infected and thousands of new cases each year, some of which will lead to chronic infection. The incidence of new infections has been on the decline since the inclusion of the Hepatitis B vaccine to the list of vaccine recommendations in 1991. This safe and effective vaccine is recommended for all infants, starting at birth. Additionally, if an unvaccinated individual seeks medical attention immediately after exposure, it may still be possible to prevent infection with a shot called Hepatitis B immunoglobulin (HBIG) and completion of the 3-shot vaccine series. Because of these safety measures, outbreaks of Hepatitis B are rare and small in the United States. That being said, people infected with the Hepatitis B virus are at risk of developing serious health complications (cirrhosis, or scarring, of the liver, premature death from liver cancer or liver failure), and should seek care from their medical provider to monitor their health.
Hepatitis B Globally
Hepatitis B is most common in certain areas of Africa, Asia, the Pacific Islands, Eastern Europe, the Middle East, South America, and the Caribbean. Please see this map of the prevalence of chronic hepatitis B infection for more details.
Perinatal Hepatitis B Programs
Hepatitis B virus can be spread from a mother to an infant during childbirth if certain medical steps are not taken. These steps are very safe, and when they are taken immediately after birth, the chance of a mother passing Hepatitis B virus to her child is extremely low. Find out about the Alameda County Health, Public Health Department’s Perinatal Hepatitis B Program, which works with Hepatitis B-positive pregnant women, their babies, and their doctors to keep both mothers and babies healthy. Learn More.
Other Hepatitis Viruses
The word “hepatitis” comes from the words meaning “liver” and “inflammation.” There are many diseases that can lead to liver inflammation, several of which have the word “hepatitis” in their names. Despite their similar-sounding names and their often similar symptoms, these diseases are caused by different viruses, have different modes of transmission, and different methods of treatment and prevention. The most common of these hepatitis diseases, in addition to Hepatitis B, are Hepatitis A and Hepatitis C. Compare these three diseases with the ABCs of Hepatitis Factsheet. Additionally, Hepatitis D and Hepatitis E viruses are also causes of human disease worldwide but are much less common than the others.
Hepatitis B Basics
What is Hepatitis B?
Hepatitis B (HBV) is a virus that infects the liver. There are two categories of disease due to HBV infection: acute Hepatitis B and chronic Hepatitis B. Acute HBV is a short-term illness that occurs within the first 6 months of infection and then may be cleared by the immune system. If it is not cleared by the immune system, it may lead to chronic Hepatitis B infection. Chronic Hepatitis B infection may be symptomless for decades but can ultimately lead to life-threatening complications, such as cirrhosis or liver cancer.
How is Hepatitis B spread?
Hepatitis B is transmitted through the blood and bodily fluids of an infected individual. This can take place during sexual contact, sharing of needles, or from mother to baby during birth. HBV can remain infectious outside the body for more than 7 days, so it is important for infected individuals to maintain their personal hygiene and a level of cleanliness in their surroundings. This means cleaning and covering wounds and sores, and cleaning up spilled blood and other bodily fluids with a mixture of 1 part bleach to 10 parts water. Sharing toothbrushes and razors should be avoided.
Hepatitis B is not spread through food, water, sharing eating utensils, hugging, kissing, hand holding, coughing, or sneezing. It is also not spread by breastfeeding, but as it may be spread through blood, breastfeeding should be stopped if the baby is biting the mother.
Why do some infected individuals develop a chronic infection while others clear the virus at the acute stage?
The risk of developing chronic Hepatitis B disease is related to the strength of the immune response to the infection. A stronger immune response means that the virus is more likely to be cleared. As babies and young children have weaker immune systems than adults, the age at which an individual first contracts the virus plays a significant role in the progression of the disease. Approximately 90% of infected infants will become chronically infected, compared to only 2%–6% of adults.
This also means that people who have compromised immune systems, for example, due to certain medical conditions or treatments, may be at higher risk of developing chronic infection after exposure.
What are the signs and symptoms of Hepatitis B?
Many individuals who are acutely infected with Hepatitis B virus may not experience any signs or symptoms of their infection. Most others may experience very mild symptoms that can be mistaken for the flu, such as fever, fatigue, loss of appetite, and nausea and vomiting. More severe symptoms include abdominal pain, dark urine, joint pain, jaundice (yellowing of the skin), and clay-colored bowel movements. These symptoms usually occur within the first six months of infection.
Individuals who become chronically infected with Hepatitis B may be asymptomatic for many years or decades. However, damage may be occurring to their livers, which could ultimately lead to cirrhosis or liver cancer.
Is Hepatitis B dangerous?
Acute HBV infection may be very uncomfortable or painful, but the disease is not usually fatal. Chronic HBV infection that leads to liver cirrhosis or liver cancer can be fatal. However, regular monitoring and treatment, such as with antiviral medication, can minimize liver damage in chronically infected individuals. The damage done by HBV infection can also be worsened by the consumption of alcohol, so this should be avoided by all infected individuals.
Who is at risk for Hepatitis B?
- Infants born to infected mothers
- Sex partners of infected individuals
- Injection drug users
- Household contacts of persons with chronic HBV infection
- Health care and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluids
- Residents and staff of facilities for developmentally disabled individuals
- Travelers to countries with intermediate or high prevalence of HBV infection
- Men who have sex with men
- Individuals with multiple sex partners
Hepatitis B Prevention
How can I protect myself and my family?
- Through vaccination – Vaccination is the best way to protect yourself and your family from HBV infection. Talk to your healthcare provider about which members of your family should be vaccinated
- Use a condom or dental dam during sex acts
- Do not share needles – utilize needle exchange services
- Do not share toothbrushes or razors
- Wear latex or plastic gloves when in contact with blood, and clean spills with a solution of 1 part household bleach to 10 parts water
- Only get tattooed and pierced by licensed body art practitioners who properly sterilize their needles – find out more about California’s laws on safe body art practices. Please reference the Alameda County Environmental Health Department section for more information.
Who should get vaccinated?
The U.S. recommends three doses of HBV vaccine to ensure full protection. Specific vaccination schedules are recommended by the CDC for babies and children, for preteens and teens, and for adults. For babies, the first dose is typically given at birth, the second at 1-2 months of age, and the third at 6-18 months of age. These shots are part of the normal schedule of vaccines that a child’s pediatrician will administer, and that will be administered at the time of birth. Additionally, anyone through 18 years of age who has not started the vaccine series should be vaccinated.
In addition to the above recommendations, California state law requires that children who attend childcare or K-12 school (excluding home school) have received specific numbers of several vaccines, including Hepatitis B vaccine. Many colleges also require evidence of Hepatitis B vaccination.
Some adults should also be vaccinated if they do not have a history of vaccination, especially if they are at higher risk of infection. Adults who are unsure of their immune status to HBV should speak to their doctor about getting vaccinated. Because infection can be asymptomatic for so long, some people may be advised to get tested for infection before they are vaccinated – especially those who were born in countries where Hepatitis B is endemic.
In brief:
- Infants and Children
- The vaccination schedule used for recommendations in the US includes vaccination with at least 3 doses of HBV vaccine starting at birth
- If these doses are not administered when a child is a baby, they are recommended to follow a “catch up” schedule and get them through age 18
- Students in California
- California law dictates that HBV vaccination is required for school entry into childcare and K-12 education
- Some colleges may also require vaccination
- Adults: Some adults are recommended to receive the Hepatitis B vaccine
How safe is the Hepatitis B vaccine?
The HBV vaccine is very safe. Side effects with this vaccine are uncommon but may include soreness where the shot was given and fever. Fever after vaccination is a common side effect for most vaccines and is due to the immune system mounting a response against the vaccine, which is the desired result of vaccination. This fever is low-grade and will resolve on its own. Because of how the vaccine is made, people with severe yeast allergies are not recommended to get the HBV vaccine.
Where do I go to get myself or my family vaccinated?
The best place to receive an HBV vaccine is at your doctor’s office. Many pharmacies can also administer many vaccines, including those for Hepatitis B. For people without insurance, there are many vaccination clinics in Alameda County. Any time you receive a vaccine, be sure to keep your Immunization Record.
Resources
For Screening, Vaccination, and Treatment
- Your doctor’s office
- Asian Liver Center at Stanford
- Adolescent and Adult Vaccine Quiz
Perinatal Hepatitis B
- Visit the Perinatal Hepatitis B Program
For Child Care Providers and Schools
Hepatitis B Virus Information from other health departments
- California Department of Public Health (CDPH) Hepatitis B Page
- Centers for Disease Control and Prevention (CDC) Hepatitis B Page
Contact Us
For the General Public
Contact your health care provider if you have symptoms or have questions about the Hepatitis B vaccine.
For questions for the Alameda County Health, Public Health Department, you may contact Acute Communicable Diseases or the Perinatal Hepatitis B Program at (510) 267-3250.
For Clinicians
Hepatitis B infection is a reportable disease and acute and chronic cases must be reported by phone, fax, or mail within 7 calendar days:
Alameda County Health, Public Health Department
Acute Communicable Disease
1100 San Leandro Blvd.
San Leandro, CA 94577
Phone: (510) 267-3250
For Information about Hep B Free Alameda County Collaborative
Email: HepB@acgov.org