What are the symptoms of acute hepatitis B infection?

Most people who get hepatitis B as babies or children do not look or feel sick at all. Similarly, over half of the adults who get hepatitis B never have any symptoms of the disease. Once you get hepatitis B infection, it may take from six weeks to six months for signs or symptoms to appear. If people do have signs or symptoms, they may include:

• Loss of appetite
• Yellow skin and eyes (jaundice)
• Nausea, vomiting
• Fever
• Weakness, tiredness, inability to work for weeks or months
• Abdominal pain
• Dark urine

Most people recover from acute hepatitis B infection in about six months. About 10 percent of adults will become chronic carriers after they recover. Approximately 90 percent of infants infected with hepatitis B virus will become carriers. Hepatitis B carriers continue to have the hepatitis B virus and can infect others, even though their symptoms diminish.

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Who is at risk for hepatitis B infection?

About 5 percent (1 in 20) people in the United States will get hepatitis B infection sometime during their lives. Engaging in certain behaviors increases your chances of coming in contact with body fluids infected with hepatitis B. You may be at risk for hepatitis B if you:

• Have a job that exposes you to human blood (health care workers)
• Share a household with someone who has chronic hepatitis infection
• Are an injecting drug user or share needles to inject drugs
• Have sex with a person infected with hepatitis B virus
• Have sex with more than one partner during a six-month period
• Individuals with a history of sexually transmitted disease are at risk
• Are a homosexual or bisexual male
• Were born in Asia, Africa, the Amazon Basin in South America, the Pacific Islands, Eastern Europe, or the Middle East
• Are an adopted child from Asia, Africa, the Amazon Basin in South America, the Pacific Islands, Eastern Europe, or the Middle East
• Are an Alaskan native
• Are a patient or worker in an institution for the developmentally disabled
• Have hemophilia
• Are an inmate of a long-term correctional facility
• Travel internationally to areas with a high prevalence of hepatitis B
• Are on kidney dialysis or have lived with someone on kidney dialysis

These behaviors may put you at higher risk by increasing your chances of coming in contact with body fluids infected with hepatitis B virus.

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HEPATITIS B CARRIERS

What does it mean to be a hepatitis B carrier?

People who do not recover from hepatitis B are called carriers. Today, an estimated 1-1.25 million people are carriers in the United States with over 10,000 more people becoming chronic carriers each year. A hepatitis B virus (HBV) carrier is someone who has had hepatitis B in his/her blood for more than six months. Five to ten percent of adults who acquire HBV become carriers. Children who are infected under age 5 have a 20-90 percent chance of becoming lifelong carriers. Many babies born to carrier mothers also will become carriers of hepatitis B unless the babies are given special shots at birth and during their first six months of life.

A carrier usually has no signs or symptoms of HBV, but remains infected with the virus for many years or a lifetime, and is capable of passing the disease onto others. Sometimes HBV carriers will spontaneously clear the infection from their bodies, but most will not. Most carriers have no serious problems with hepatitis B and lead normal, healthy lives. However, other carriers become sick because they are at significantly higher risk than the general population for liver failure or liver cancer.

How can I protect others from hepatitis B?

People can get hepatitis B from a carrier by coming in contact with his/her blood, serum or other body fluids like saliva, semen and vaginal fluids. People with hepatitis B virus may feel healthy, but are still capable of passing the hepatitis B infection to other people. Fortunately, hepatitis B virus is not spread by sneezing or coughing, or from such casual contact such as holding hands. The following are important guidelines for you to follow so that others are protected:

Protect Your Family/Friends:

• Make sure all household members see their physicians or go to the local health department for hepatitis B testing and vaccination.
• Tell your sex partner(s) you are infected with the hepatitis B virus. Sexual partner(s) must see a physician or go to the health department for hepatitis B blood testing. If the blood tests show that the partner has never had hepatitis B, he or she should be vaccinated with the hepatitis B series. Use condoms until your partner is proven to be protected from hepatitis B.
• Know that if someone is exposed to your blood — a family member, friend or even a stranger — preventive treatment is available for that person. Notify the local health department or your health care provider, so a health care professional can notify the individual. If the exposed person receives hepatitis B immune globulin (HBIG) and starts the hepatitis B vaccine series within a few days, that person has an excellent chance of being protected from hepatitis B infection.

General Hygenie Guidelines:

• Wash your hands well after touching your blood or infectious body fluids.
• Cover all cuts and open sores with bandages. Do not allow others to come in contact with your blood. Place soiled bandages in a plastic bag, tie securely and place in the trash can.
• Place personal items such as tissues, menstrual pads and tampons in a plastic bag, tie securely and place in the trash can.
• Clean up your blood spills, then clean the area again with a bleach solution of one part household bleach to 10 parts water.
• Do not share items such as toothbrushes, razors, needles for tattoos, needles for ear or body piercing, nail files, clippers, scissors, or anything that may come in contact with your blood or body fluids.
• Do not share food or chewing gum and do not pre-chew food for babies.
• Do not share syringes and needles.
• Do not donate blood, plasma, body organs, tissue or sperm.

Regular Doctor's Visits:

• Tell your health care providers you are infected with hepatitis B virus.
• See your doctor every six to 12 months to have your liver checked for injury or cancer, and for ongoing education about hepatitis B.

Educate Yourself:

• Learn more about hepatitis B so you can make the best decisions for yourself and provide the best protection for your family and friends.

Why is hepatitis B so serious in pregnant women?

Pregnant women who are infected with HBV frequently transmit the disease to their babies. Up to 90 percent of these babies may develop lifelong HBV infections, and as many as 25 percent will develop liver failure or liver cancer. All pregnant women should be tested early in pregnancy to determine if they are infected with hepatitis B virus. If the blood test is positive, the baby should be vaccinated at birth with two shots — one HBIG and one hepatitis B vaccine. The infants will need additional doses of hepatitis B vaccine at age 1-2 months and age 6 months. Completing the scheduled hepatitis B vaccination series on time has shown to be 85-95 percent effective in preventing mother-to-infant transmission of hepatitis B infection. It also is important for the infant to have a blood test at age 9-15 months of age to ensure the hepatitis B vaccine provided complete protection against the hepatitis B virus.

What can I do to take care of myself?

A person with hepatitis B should see a doctor regularly. About six months after the acute illness, the doctor will repeat the hepatitis B test to determine if the infection has subsided. The doctor can order tests to determine how the liver is working and to check for early signs of liver cancer. If liver disease develops, the doctor may recommend hepatitis A vaccine to protect the liver from yet another threatening liver disease.

People with hepatitis B infection should ask the doctor about alcoholic beverages; alcohol may worsen your liver condition. Tell your doctor and dentist you have hepatitis B infection. Be sure your doctor knows about all medicines you are taking. Some medications may have a harmful effect on your liver.

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How do I know if I have hepatitis?

The symptoms of hepatitis B usually include yellow coloring of the skin and eyes (jaundice), dark urine and fever. Many people lose their appetites, feel tired or feel like they have flu. Many people are severely ill for months. If you have these symptoms, check with your doctor. He or she can tell if you have hepatitis B infection. However, some people who are carriers of the infection never feel sick.

If you have ever had hepatitis B, it is possible you did not fully recover and are now a carrier. Your doctor can give you a simple blood test to determine if you have hepatitis B or are a carrier.

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Where can I go for help?

To learn more about hepatitis B, talk with your family doctor or visit your local health department.

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Adapted from materials developed by the Hepatitis B Coalition, the Hepatitis B Branch of the Centers for Disease Control and Prevention and the Perinatal Hepatitis B Program of the North Carolina Immunization Branch.