Page modified at: 21/02/2010
Hepatitis B, sometimes called hep B or HBV, is a virus that is carried in the blood which infects and damages the liver. A virus is a tiny particle that needs to infect and control the cells of your body in order to live and reproduce ('replicate').
Hepatitis B is very infectious - 100 times more infectious than HIV. However, there is a simple test to find out whether you have the virus and an effective vaccine is available to protect you from it.
Where is hepatitis B common?
Hepatitis B is the most widespread form of hepatitis.
It is common in South-East Asia, the Middle and Far East, Southern Europe and Africa.
The World Health Organisation estimates that one third of the world's population has been infected at some time and that there are approximately 350 million people who are infected long term. In Europe, there are estimated to be one million people infected every year.
In the UK, approximately one in 1,000 people are thought to have the virus. In some inner-city areas with a high percentage of people from parts of the world where the virus is common, as many as one in 50 pregnant women may be infected.
The World Health Organization (WHO) estimates that in the UK the prevalence of chronic hepatitis B infection is 0.3%.
Within the UK the major routes of hepatitis B transmission are injecting drug use and sexual activity. The most at-risk populations in Wales are therefore men who have sex with men (MSMs), injecting drug users (IDUs) and commercial sex workers (CSWs).
In 2003 (the last complete year for which the number of cases of acute hepatitis B infection were collated by the HPA), there were 671 confirmed cases of acute hepatitis B reported in England and Wales.
The majority of cases (75%) were in individuals aged between 15 and 44 years. Cases in males exceeded those in females, the annual male to female ratio being 2.4:1. Injecting drug use was the main risk factor associated with acute hepatitis B infection accounting for 35% of individuals with a known risk factor.
Heterosexual exposure accounted for 28% of acute hepatitis B infections with a known risk factor and sex between men accounted for 17% in 2003.
Click on the graph below to link to the National Public Health Service for Wales website for further information
Laboratory-confirmed hepatitis B in Wales per 100,000 per week: 2007-2008
How is hepatitis B passed on?
Hepatitis B is known as a 'blood-borne virus' (BBV) and is spread by blood to blood contact. Highest amounts of the virus are present in blood. Even a tiny amount of blood from someone who has the virus can pass on the infection if it gets into your bloodstream. This might be through an open wound, a cut or scratch, or from a contaminated needle.
People who use drugs and share injecting equipment have a high risk of infection. Having a tattoo or body-piercing or even acupuncture can pose a small risk if unsterile equipment is used.
The virus can also be passed on from medical and dental treatment in countries where equipment is not sterilised properly.
All blood donations in the UK are now tested for hepatitis B, but before testing was introduced it was possible to become infected by receiving blood or blood products from an infected person. In countries where blood is not tested, blood transfusions may still be a cause of infection.
The virus is able to survive outside the body for at least a week. This means that you should take care not to share iems such as a razor or toothbrush which might be contaminated with dried blood.
Hepatitis B can be transmitted by having penetrative sex without a condom with an infected person. Even oral sex can pass on the virus. Sexually active young adults who do not use condoms have a high risk of getting hepatitis B.
Other body fluids
Although it is called a blood-borne virus, hepatitis B may be present in other body fluids such as saliva, semen and vaginal fluid, particularly if these have become contaminated with blood.
Small traces have been found in sweat, tears, breast milk and urine but these fluids are not regarded as infectious.
Some people transmit hepatitis B more easily than others because they have more of the virus in their bloodstream.
Mother to baby
Hepatitis B is usually transmitted to the baby during delivery, as the baby is exposed to the mother’s blood in the birth canal. Transmission to the unborn baby does not usually occur in the uterus (before birth). Infection at birth is called ‘perinatal transmission’ and is the most common way the virus is spread globally. Vaccination of the baby at birth prevents the majority of infections.
Although small amounts of the virus have been found in breast milk, the risk from breastfeeding is not fully known and is prevented by vaccination of the new born baby.
Since April 2000, all pregnant women in the UK are tested for hepatitis B. Pregnant women with high levels of the virus in their blood may be offered additional treatment including antiviral therapy.
Work and environment
Certain jobs can put people at risk from hepatitis because they may involve contact with infectious body fluids.
Other workers who might come into contact with body fluids including morticians, sewage workers, those in emergency services and people in the fi tness industry.
People who might have injuries and come into contact with others with injuries, such as people involved in contact sports or in the building industry.
Foster carers and people who live or work in accommodation for people with severe learning disabilities.
Prison staff and prison inmates are also at risk.
People who may be at increased risk because of their work or environment should be vaccinated against hepatitis B.
More than 10% of cases in the UK are thought to result from people travelling to and working in countries where there is increased risk of hepatitis B infection.
If you think you might have been exposed to hepatitis B, see your doctor immediately.
People who intend to stay in an area where hepatitis B is common, particularly if they are likely to need medical treatment such as dialysis, should get vaccinated.
It is important to remember that you are not naturally protected from infection with hepatitis B just because you are travelling to a country where you or your parents were born. Vaccination is strongly recommended for all travellers to countries where hepatitis B is common.
How do I reduce the risk of catching Hepatitis B?
Practicing safer sex reduces the risk of infection with Hepatitis B.
HBV is not spread by contaminated food or water, and cannot be spread casually in the workplace
* Male and female condoms, when used correctly, can help protect against STIs
* Avoid contact with other peoples blood or body fluids where possible
* People in high risk groups should also be vaccinated, including: persons with high-risk sexual behaviour; partners and household contacts of HBV infected persons; injecting drug users; persons who frequently require blood or blood products; recipients of solid organ transplantation; those at occupational risk of HBV infection, including health care workers; and international travellers to countries with high rates of HBV. The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.
What are the Symptoms of Hepatitis B?
Men and women may experience:
* Nothing – infection may be silent
* Hepatitis B virus can cause an acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. People can take several months to a year to recover from the symptoms.
What happens if Hepatitis B infection isn’t treated?
There is no treatment for the acute virus infection itself but chronic hepatitis B can be treated with drugs, including interferon and anti-viral agents, which can help some patients. The virus incubation period is 90 days on average, but can vary from about 30 to 180 days. HBV may be detected 30 to 60 days after infection and persist for widely variable periods of time About 90% of healthy adults who are infected with HBV will recover and be completely rid of the virus within six months..
HBV can however cause a chronic liver infection that can later develop into cirrhosis of the liver or liver cancer.
Liver cancer is almost always fatal, and often develops in people at an age when they are most productive and have family responsibilities. In developing countries, most people with liver cancer die within months of diagnosis. In higher income countries, surgery and chemotherapy can prolong life for up to a few years in some patients.
Patients with cirrhosis are sometimes given liver transplants, with varying success
How do I reduce the risk of passing Hepatitis B on to others?
Your sexual partner and infants of infected mothers will benefit from vaccination.
Practicing safer sex reduces the risk of infection to others with Hepatitis B.
How do I get testing or treatment for Hepatitis B?
NHS:Testing is free on the NHS from genitourinary medicine clinics, sexual health clinics, many contraception clinics, your GP and pharmacies. You can find an clinic to help with Hepatitis B by phoning directory enquiries and asking for genitourinary medicine, sexually transmitted disease or venereal disease or locate one using our NHS Genitourinary Medicine Clinic page in the Sexual Health Section of our website.
PRIVATE:Alternatively you can have confidential private testing based on an internet ordered home sample blood test kit. Telephone 0345 2303386 or use the Confidential Text Service 07786202070
How is Hepatitis B treated?
There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.
Chronic hepatitis B can be treated with drugs, including interferon and anti-viral agents, which can help some patients.
Where can I get more information about Hepatitis B?
The British Liver Trust have excellent further information on Hepatitis B