Complications Of Hepatitis B
Most people do not have any lasting problems after having a hepatitis B infection.
If left untreated, chronic hepatitis B can cause liver damage and increase your risk of getting liver cancer.
It is important to take any medicine you have been prescribed and go for regular check-ups to make sure your liver is working properly.
Page last reviewed: 01 July 2022 Next review due: 01 July 2025
What Is Hepatitis B Virus
Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It is a major global health problem and the most serious type of viral hepatitis. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer.
Worldwide, an estimated two billion people have been infected with the HBV and about 250 million have chronic liver infections.A vaccine to prevent catching HBV has been available since 1982. Hepatitis B vaccine is 95% effective in preventing HBV infection and its chronic consequences, and is the first vaccine against a major human cancer.
Acute Hepatitis B Symptoms
There are three phases of acute hepatitis B infection, and symptoms may differ depending on the stage. Early in the disease, called the prodromal phase, symptoms may include:
- Dark urine and light stool color
During the icteric phase:
- Jaundice develops
- Anorexia, nausea and vomiting may worsen
- Irritated skin lesions may develop
- Other symptoms may subside
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How Common Is Hepatitis B
Hepatitis B is fairly common in Africa and the western Pacific region. Throughout the world, there are about 292 million people who are infected with chronic hepatitis B. In the U.S., the figure exceeds 2 million people.
The number of infections had been falling in the U.S., but fewer vaccinations among adults combined with the onset of the opioid crisis and injected drug usage has resulted in the numbers rising again. Infected women can pass the infection on to their babies. Children who are infected before age 5 are more likely to have chronic infection than those infected later in life.
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Myth: All Hepatitis Viruses Are The Same
Fact: Hepatitis A, B, C, D, E are different kinds of viruses. They have different modes of transmission and manifestations. While A and E are transmitted by ingestion of contaminated food, B and C are transmitted by blood . Hepatitis D occurs only in patients affected by Hepatitis B through direct contact with infectious blood.
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How Are Hepatitis B And C Treated
Hepatitis B: Not all patients with chronic hepatitis B infection require treatment. At Yale Medicine, specialists decide on an individual basis whether a patient is an appropriate candidate for treatment. Generally, patients require treatment when their hepatitis B virus level is high, and when laboratory tests demonstrate significant inflammation or injury to the liver.
There are currently seven approved drugs for hepatitis B, two of which are considered to be first-line treatments. These drugs are oral pills taken once daily, and while they’re very effective at suppressing the virus to very low or undetectable levels over the long term, they are not considered curative.
Therefore, the goal of treatment is to control the virus long-term and decrease the risk of hepatitis B related complications such as cirrhosis and liver cancer.
Hepatitis C: For the greater part of the last 20 years, treatment of hepatitis C required the use of a chemotherapy-like injection drug called interferon, which has been associated with serious side effects and a low cure rate. Fortunately, advances in hepatitis C treatments within the last three years now allow for the use of oral medications that are significant improvements in terms of safety and effectiveness.
Blood And Bloodstain Preparation
Bloodstain samples were prepared by soaking cotton buds in 0.1 mL of HBV-infected whole blood samples for 1 min and then drying at room temperature for up to 60 days. HBV-infected whole blood samples were placed in sealed 2-mL test tubes and kept at room temperature for up to 60 days. The prepared blood and bloodstain samples were analyzed at 3, 9, 27, and 60 days after preparation.
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What Are The Symptoms Of Hepatitis B And C
In most patients, hepatitis B develops slowly over the course of several decades, and thus most patients have no symptoms. People who have advanced liver disease such as cirrhosis of the liver may experience complications and symptoms that reflect liver failure. Other symptoms include:
- A buildup of fluid within the abdominal cavity
- Confusion and tremors , which are complications due to the inability of the liver to filter out toxins that are normally cleaned out by a healthy liver
- Vomiting of blood, or blood within the stool . This is a complication in which enlarged veins within the esophagus or stomach bleed as a consequence of increased pressure around the diseased liver.
Most patients with chronic hepatitis C infection report no symptoms. But some patients may have very nonspecific symptoms related to fatigue and discomfort on the right side of the abdomen. Often, symptoms that lead to a diagnosis of hepatitis C are noticeable only at the end stage of liver disease, when the patient has developed liver cirrhosis and liver failure.
Because hepatitis B and C typically have no specific symptoms, many people who have the viruses dont even know it.
Who Is Most At Risk For Chronic Disease
The likelihood that an HBV infection will become chronic depends upon the age at which a person becomes infected, with young children who become infected with HBV being the most likely to develop chronic infections.
About 90% of infants infected during the first year of life develop chronic infections 30% to 50% of children infected between one to four years of age develop chronic infections. About 25% of adults who become chronically infected during childhood die from HBV-related liver cancer or cirrhosis. About 90% of healthy adults who are infected with HBV will recover and be completely rid of the virus within six months.
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Prevent Infection After Contact With The Virus
If you think you have been in contact with the hepatitis B virus, see your doctor right away. Doctors typically recommend a dose of the hepatitis B vaccine to prevent infection. In some cases, doctors may also recommend a medicine called hepatitis B immune globulin to help prevent infection. You must get the vaccine dose and, if needed, HBIG shortly after coming into contact with the virus, preferably within 24 hours.
Treatments For Hepatitis B
Hepatitis B usually clears up on its own without treatment. You may be offered medicine to help with the symptoms, such as painkillers or medicines to stop you feeling sick.
Your GP will refer you to see a liver specialist who will check how well your liver is working.
If hepatitis B lasts for over 6 months it is called long-term hepatitis B.
It is usually treated with antivirals and medicine to help relieve symptoms such as itchiness, pain, and sickness. You will also need to see a liver specialist for regular check-ups.
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Hepatitis B And Pregnancy
Hepatitis B can be transmitted from a birthing parent to a newborn infant. This is because the newborn is exposed to blood and bodily fluids during delivery.
In fact, 90% of mothers with an acute hepatitis B infection and 10% to 20% of mothers with chronic hepatitis B will transmit the virus to their newborn, estimates the American College of Obstetricians and Gynecologists.
For this reason, birthing parents are routinely screened for hepatitis B during each pregnancy.
Additionally, the hepatitis B vaccine and hepatitis B immune globulin are both administered to infants with an HBV-positive birthing parent within of birth to prevent infection.
According to the
- people with hepatitis C infection
- men who have sex with men
- people with multiple sexual partners
- people who are seeking treatment for a sexually transmitted infections
- people with current or recent injection drug use
- family members or sexual partners of those with hepatitis B
- people with chronic liver disease
- people traveling to areas with high rates of hepatitis B
- people on maintenance dialysis
- people who are incarcerated
The hepatitis B vaccine is usually administered in three shots, given 1 month and 6 months after the first dose. Another recently approved vaccine is completed in two doses spaced 1 month apart.
Measles Virus Vaccine Mumps Virus Vaccine
Vaccine Use insulated container. Must be shipped with refrigerant.Maintain at 10 C or less. If shipped with dry ice, diluent must beshipped separately.
Diluent May be shipped with vaccine but do not freeze.
Condition on Arrival
*Should be below 10 C . If above this temperature, see instructions below. Do not use warm vaccine. Refrigerate on arrival.
Vaccine may be stored separately from diluent. Store as follows:Vaccine Refrigerate immediately on arrival. Store at 2 -8 C .Protect from light at all times, since such exposure may inactivate thevirus.
Diluent May be stored at 15 -30 C room temperature. Do notfreeze.
Special Note: Freeze dried vaccines may be maintained atfreezer temperatures.
Vaccine Up to 2 years. Check date on container or vial.
Diluent Check date on container or vial.
Instructions for Reconstitution or Use
Reconstitute just before using. Use only the diluent supplied toreconstitute the vaccine.
Single Dose Vials Inject diluent into the vial of lyophilized vaccineand agitate to ensure thorough mixing. Withdraw entire contents intosyringe and inject total volume of vaccine subcutaneously.
Multidose Vials Withdraw all diluent from vial into syringe. Injectinto vial of lyophilized vaccine and agitate to ensure thorough mixing.
10-Dose Vials Withdraw 0.5cc of reconstituted vaccine into separatesterile needle and syringe for each immunization. Licensed for jetinjector use.
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Whats The Difference Between Acute And Chronic Hepatitis B
Hepatitis B can be either acute or chronic:
- Acute hepatitis B lasts for a short period of time. If you have acute hepatitis B, you may be asymptomatic or have symptoms and develop icteric hepatitis. It can transition into chronic hepatitis B if the virus doesnt naturally go away after 6 months.
- Chronic hepatitis B lasts for at least 6 months. If you have this type of hepatitis, you may carry the hepatitis B virus for the rest of your life. Its possible to have chronic hepatitis B that started as acute, but many people dont have acute hepatitis B first.
Most people with acute hepatitis B make a full recovery. Some may never even show any symptoms. But those with chronic hepatitis B often need treatment to help manage the infection. Chronic hepatitis B also increases your risk of developing cirrhosis and certain types of liver cancer.
Your risk of developing chronic hepatitis B depends on when you first received your diagnosis of the virus. Children who receive a diagnosis of hepatitis B, especially those under the age of 5 years old, have a higher risk of the infection becoming chronic. Adults are less likely to develop chronic hepatitis B. Around 90 percent of adults who develop it will fully recover.
Keep in mind that hepatitis B can be present for years before you start to show any symptoms.
Chronic Hepatitis B Complications
Chronic hepatitis B can lead to
- cirrhosis, a condition in which scar tissue replaces healthy liver tissue and prevents your liver from working normally. Scar tissue also partly blocks the flow of blood through the liver. As cirrhosis gets worse, the liver begins to fail.
- liver failure, in which your liver is badly damaged and stops working. Liver failure is also called end-stage liver disease. People with liver failure may require a liver transplant.
- liver cancer. Your doctor may suggest blood tests and an ultrasound or another type of imaging test to check for liver cancer. Finding cancer at an early stage improves the chance of curing the cancer.
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Who Should Be Vaccinated For Hepatitis B
All newborns should be vaccinated. Also, people who are under 18 who were not vaccinated at birth should also get the vaccine. Other groups who should be sure to be vaccinated are those in certain high-risk categories, such as:
- People who have more than one sexual partner.
- Men who have sex with men.
- Adults with diabetes.
- Sexual partners of infected people and people who share households with infected individuals.
- People who are exposed to blood and other bodily fluids, including healthcare and public safety professionals, and people who work in jails and other places taking care of people who cant take care of themselves.
How Common Is It
In 2006, the Public Health Agency of Canada reported the incidence of HBV as 2.0 cases for every 100,000 or about 650 cases reported annually in Canada. In the year 2013, the incident rate was 0.5 per 100,000 . Incidence of the disease varies from region to region but has been declining due to increasing use of the vaccine and universal immunization programs.
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Who Is More Likely To Get Hepatitis B
People are more likely to get hepatitis B if they are born to a mother who has hepatitis B. The virus can spread from mother to child during birth. For this reason, people are more likely to have hepatitis B if they
- were born in a part of the world where 2 percent or more of the population has hepatitis B infection
- were born in the United States, didnt receive the hepatitis B vaccine as an infant, and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection
People are also more likely to have hepatitis B if they
- are infected with HIV, because hepatitis B and HIV spread in similar ways
- have lived with or had sex with someone who has hepatitis B
- have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
- are men who have sex with men
- are injection drug users
- work in a profession, such as health care, in which they have contact with blood, needles, or body fluids at work
- live or work in a care facility for people with developmental disabilities
- have been on kidney dialysis
- live or work in a prison
- had a blood transfusion or organ transplant before the mid-1980s
In the United States, hepatitis B spreads among adults mainly through contact with infected blood through the skin, such as during injection drug use, and through sexual contact.12
What Do I Need To Know About Having Hepatitis B
If you have chronic hepatitis B, getting the right medical care can help you stay healthy. Taking good care of your liver is important. Talk with your doctor before you take any prescription medication, over-the-counter drugs, vitamins, or nutritional supplements to make sure they wont hurt your liver. You should also stay away from alcohol, because drinking can damage your liver.
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What Laboratory Tests Are Available For Hepatitis B
Tests are available to detect the types of antigens used to identify the hepatitis B virus. The tests determine if the virus is present in the body tissue or blood. The amount of each type of antigen present indicates how advanced the disease is and how infective the individual has become.
Other tests are available to detect the bodys reaction to the viral infection or the bodys reaction to vaccination against the virus. These tests work by measuring the number of antibodies present in the blood.
Whats The Prognosis For Hepatitis B
Your doctor will know youâve recovered when you no longer have symptoms and blood tests show:
- Your liver is working normally.
- You have hepatitis B surface antibody.
But some people don’t get rid of the infection. If you have it for more than 6 months, youâre whatâs called a carrier, even if you donât have symptoms. This means you can give the disease to someone else through:
- Unprotected sex
- Contact with your blood or an open sore
- Sharing needles or syringes
Doctors donât know why, but the disease does go away in a small number of carriers. For others, it becomes whatâs known as chronic. That means you have an ongoing liver infection. It can lead to cirrhosis, or hardening of the organ. It scars over and stops working. Some people also get liver cancer.
If youâre a carrier or are infected with hepatitis B, donât donate blood, plasma, body organs, tissue, or sperm. Tell anyone you could infect — whether itâs a sex partner, your doctor, or your dentist — that you have it.
CDC: âHepatitis B Questions and Answers for Health Professionals,â âHepatitis B Questions and Answers for the Public.â
Mayo Clinic: âHepatitis B.â
UpToDate: âHepatitis B virus: Screening and diagnosis.â
HealthyPeople.gov: âHepatitis B in Pregnant Women: Screening.â
Annals of Internal Medicine: âScreening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement.â
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How Do Doctors Treat The Complications Of Hepatitis B
If chronic hepatitis B leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, minor medical procedures, and surgery. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order blood tests and an ultrasound or another type of imaging test to check for liver cancer.
If chronic hepatitis B leads to liver failure or liver cancer, you may need a liver transplant.