What is Hepatitis B And How Do You Get It?

Dr Ravi Gowda
Jul 27
7 min read

Dr Ravi Gowda vaccinating a patient for Hepatitis B at Health Klinix

What is hepatitis B? Well, it's probably one of the most underestimated infections in the world. Many people may have heard of hepatitis B but the magnitude of effects is less well known. The World Health Organisation, (WHO) estimates that about 240 million people are living with chronic hepatitis B infection with nearly 1 million new infections every year. Unfortunately, about 1 million people also die from the complications of the infection such as liver cancer and cirrhosis.

In this article we'll explore:

What is Hepatitis B
How Hepatitis B is Transmitted from Person to Person
Hepatitis B Transmission Myths
Symptoms of Hepatitis B
Chronic Hepatitis B Complications and Liver Health
Hepatitis B Testing and Diagnosis Process
Is Hepatitis B Curable
Hepatitis B Vaccine Effectiveness and Schedule
Who Should Receive the Hepatitis B Vaccine?

What is Hepatitis B

Hepatitis B is a viral infection of the liver that leads to chronic liver inflammation and eventually scarring that leads to various complications.

The first stage is the acute infection which occurs as soon as you become infected. You may or may not experience symptoms (see below) but the crucial bit is what happens afterwards. This partly depends on your age because 85% to 90% of young adults will clear hepatitis B infection spontaneously. However, the remaining 5 to 10%, and most young children and babies (90%) will progress to chronic hepatitis B infection. We define this as having a positive hepatitis surface antigen blood test, HbsAg, (a test that detects current hepatitis B infection) for longer than six months.

It's during this chronic phase that the virus continues to multiply in the liver, often silently causing inflammation, and ultimately scarring and damage.

Worse still, you’ll remain infectious and can infect other people but may be completely unaware of the infection.

How is Hepatitis B Transmitted from Person to Person?

You might be wondering how hepatitis B is actually transmitted. Interestingly, it's much more infectious than HIV and is easily passed on from person to person through bodily fluids and blood. Here are some common ways:

Blood-to-blood contact
Unprotected sexual contact
Sharing needles
Use of contaminated medical equipment
Mother-to-baby transmission during birth
Exposure in healthcare or tattoo settings (if unsterile)

Hepatitis B Transmission Myths

Hepatitis B is not usually transmitted by casual contact like shaking hands, sharing food and drinks etc. but the truth versus the myth is much more ambiguous than we might think.

Studies in the United States in the late 1970s showed the presence of hepatitis B virus by environmental sampling on school lunch room table tops, on walls, toys and even baby bottles in homes where people with hepatitis B infection were living. Partly based on this type of evidence, universal childhood vaccination was first introduced in 1991, as well as targeted vaccination for high-risk groups such as household contacts of people living with hepatitis B. This led to a drastic reduction of hepatitis B cases.

So, it’s quite possible that the virus may be shed from cuts, wounds, scratches etc onto environmental services from people living with hepatitis B, that can then infect others with cuts and scratches.

Impact of vaccination on the Incidence of Hepatitis B in USA

HBIG= Hepatitis B immunoglobulin, Hep BsAg =hepatitis B surface Antigen Source: Adapted from cdc.gov

What are the Symptoms of Hepatitis B?

Hepatitis B has an incubation period of about 1 to 6 months (so that means from the time of infection to showing symptoms)

Common symptoms include:

Fatigue
Nausea
Vomiting
Loss of appetite and jaundice (yellowing of the skin and the whites of your eyes)

But symptoms can be vague, mild and non-specific, like just feeling tired, or even completely absent, meaning it can be missed.

Younger people's immune system is much more tolerant to the virus and so they don't often have any symptoms. However, people with weakened immune systems, the elderly, and anyone with multiple medical problems can experience a much more severe disease, sometimes leading to life-threatening acute liver failure.

Chronic Hepatitis B Complications and Liver Health

Most adults with acute hepatitis B will clear the virus and recover spontaneously. However, a small number of adults and many children are unable to clear the virus which then continues to replicate and be active in the liver.

This is chronic hepatitis B. It’s often silent and most people are able to carry on their lives without being aware of it. Unfortunately, the continual activity and replication of the virus leads to chronic active inflammation of the liver tissue. This leads to scarring, and ultimately to a liver condition called cirrhosis.

This is serious as the liver is slowly filled by scar tissue and gradually loses its function, leading to liver failure. The liver cirrhosis also increases the risk of liver cancer. In fact, hepatitis B is a leading cause of liver cancer worldwide.

We feel that it's absolutely vital that hepatitis is B detected early by screening high risk groups. This will allow us to monitor the infection so that treatment can be offered if there’s any active inflammation of the liver.

Hepatitis B Testing and Diagnosis Process

But who should get tested?

Well, both national and international guidelines recommend the following high-risk groups should be offered hepatitis B testing:

Anyone in a country where the hepatitis B prevalence in the population is 2% or more (See our map of world with high and intermediate prevalent countries)
Any person suspected of liver disease
Any person with abnormal liver function test
All pregnant women
All household contacts of people living with chronic hepatitis B
Anyone attending an STI clinic
Immigrants who have come from countries with a hepatitis B prevalence of 2% or more
People who inject drugs
People in prison or care/correctional facilities
Men who have sex with men and commercial sex workers
People living with HIV or hepatitis C
Anyone with cirrhosis, liver cancer or on kidney dialysis
People who may have chemotherapy or immunosuppressive drugs

Diagnosis is easy with a simple blood test called hepatitis B surface antigen, Hep BsAg which basically looks for current infection. We can offer a simple test at our clinic which can detect Hep B.

Hepatitis B testing

Test	What the test looks for
Hep B surface Antigen	Current infection
Hep B core Antibody	Previous infection
Antibody to-Hep B Surface antigen	Hepatitis B immunity
Liver function tests	Ongoing, active liver inflammation
Hep B surface Antigen, HIV, Hep C, Syphilis	STI testing

Hepatitis B prevalence: Intermediate/high (≥ 2%) vs (<2%) countries

If you’d like to explore country specific data on prevalence of hepatitis B, take a look at the WHO Viral Hepatitis Country Profiles.

Source: World Health Organisation, Global Health Observatory. Licensed under CC BY 4.0.

Is Hepatitis B Curable?

Acute hep B is not usually treatable but most people clear the infection spontaneously. As we know, a small number of people will progress to chronic hepatitis B and they will need careful monitoring and follow up with hepatitis B specialists, like Health Klinix.

We can monitor your liver function, the viral load (the amount of virus in your body) as well as offering you a liver ultrasound and a fibro-scan, looking for inflammation and scarring. Depending on what we find we may offer you treatment with medications such as tenofovir or entecavir.

However, prevention is much more important. Simple ways of reducing your risk of catching hepatitis B include:

Practising safe sex by using condoms
Avoiding sharing needles or equipment for injecting drugs, piercing or tattooing
Making sure to wash your hands thoroughly after coming into contact with blood or bodily fluids
And importantly, get a hepatitis B vaccine

Hepatitis B Vaccine Effectiveness and Schedule

Hepatitis B vaccine is a safe and very effective vaccine that usually gives you lifelong immunity. You'll normally require three doses over six months but this can be done quicker.

Hepatitis B Vaccine Schedules

Schedule	Dosing intervals	No. of doses required
Standard	0, 1 and 6 months	3
Accelerated	0, 1, 2 and 12 months	4
Super-accelerated	0, 7, 21 and 365 days	4

Who Should Receive the Hepatitis B Vaccine?

Actually, many of the groups that require testing also require vaccination. Again people like:

Migrants from countries where there's a hepatitis B prevalence of 2% or more
Household contacts of people living with hepatitis B
Healthcare and laboratory staff
Anyone who is in contact with blood or bodily fluids as part of their work. People like the police, prison officers, funeral workers, tattoo artists and firefighters, etc
Workers and residents in psychiatric facilities or learning disability care homes
People who inject drugs
People living with HIV or hepatitis C
Men who have sex with men
Commercial sex workers
Anyone receiving chemotherapy immunosuppressive drugs or is having dialysis
International travellers thought to be at risk

Book a Hepatitis B vaccination service with Health Klinix

Hepatitis B Safety for New Parents and Newborns

Hepatitis B is most commonly transmitted from mother to baby during pregnancy and delivery, accounting for up to 52% of all cases of new hep B infections around the world. For this reason, there’s been a major push to break this chain of transmission with a worldwide policy implementation consisting of the following:

Screening for hep B of all pregnant women
Anti-viral treatment for all women with high hepatitis B viral loads
Infant hep B vaccination within 12 hours of birth, with Hepatitis Immunoglobulin in high-risk cases

I’ll finish this article with the following key messages that you can take away:

Hepatitis B is a serious liver infection but is largely preventable and manageable with modern preventative healthcare and treatment
Early detection through testing and protection through vaccination not only prevents the serious long-term complications of hepatitis B, but also transmission to other people
Increasing awareness also helps reduce stigma and improves long-term health outcomes
If you think you might be at risk, why not get in touch with us and ask about hep B testing and vaccination.