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Introducing hep B
Hep B is a virus that is found in blood and other body fluids including vaginal fluid, semen and breast milk. It can cause problems with a person’s liver.
There are around 165 000 people living with hep B in Australia. The majority of those people belong to one or more of the following groups:
- people who have migrated from countries where hep B is endemic (especially North-East and South-East Asia, and sub-Saharan Africa)
- Aboriginal and Torres Strait Islander people
- people who inject drugs
- men who have sex with men
Yes, there is a safe and effective vaccine available for hep B. Getting vaccinated is the best way to make sure you don’t get hep B.
Hep B is most commonly passed on:
- at birth (from mother to child) or in early childhood (from family members or other close contacts)
- through sharing drug injecting equipment
- through vaginal, anal or oral sex without a condom/dental dam
- through unsterile tattooing or piercing
There is also a chance that it can be passed on through:
- blood-to-blood contact through open wounds
- getting pricked by a needle at work
- sharing toothbrushes, razor blades or anything else that might come into contact with blood
- accidentally getting pricked by a needle in public (very rare)
- blood transfusions/products (particularly rare in Australia)
- unsterilised medical equipment (particularly rare in Australia)
You cannot get hep B from:
- hugging, kissing, another person’s tears or sneezes
- sharing cups, plates, clothes, food, showers or toilets
- mosquito bites
If a woman with hep B has a child, the best way to prevent hep B being passed on is to give the baby two injections soon after they’re born. One is hepatitis B immunoglobulin (HBIG) and the other is the first dose of hepatitis B vaccine. If the baby is given all injections (including all three follow-up doses), the risk of hep B being passed on from mother to child is around 10%. Without HBIG and vaccination, the risk of transmission could be as high as 90%.
It is fine for women with hep B to breastfeed if their baby is given HBIG and vaccination at birth (and completes all doses of the vaccination). There is no evidence that the risk of hep B being passed on in this case is increased: the benefits of breastfeeding outweigh any potential risk.
All newborn babies in Australia are now vaccinated against hep B, and adolescents are being offered catch-up doses (the national adolescent program is due to finish in 2012). The vaccination is also recommended for many other people, some of whom should be able to access vaccination for free.
Consider getting vaccinated if you are:
- a person who injects drugs
- a man who has sex with men
- a sexual contact of someone with hep B
- in household contact with someone who has hep B
- a sex worker
- on haemodialysis
- someone with HIV or impaired immunity
- someone with a clotting disorder
- living with hep C or other liver disease
- living or working in facilities for people with intellectual disabilities
- adopting children from overseas who have hep B
- waiting for a liver transplant
- an inmate or prison worker
- a healthcare worker, ambulance personnel, dentist, embalmer, tattooist or body-piercer
- a police officer, member of the armed forces or emergency services worker
- a funeral worker (or other worker who has regular contact with human tissue, blood or body fluids and/or uses needles or syringes)
- travelling to countries where hep B is endemic
- someone who plays contact sports (low risk)
NSW Health funds free vaccination for the following groups
Adults: Refugees, household contacts of acute and chronic hepatitis B carriers, sex workers, people living with HIV, men who have sex with men, injecting drug users, catch up of Aboriginal persons 20 years of age or older, clients of sexual health services, opioid programs and s100 prescribers.
Children: Refugees, catch up of Aboriginal children under 20 years of age, children in Year 7 only who missed out on vaccination at school, catch up of children less than 7 years of age born overseas.
If someone has hep B for less than six months it is called an acute infection. Most people who get hep B as adults will only have an acute infection and will recover from it.
If you have acute hep B, you might not experience any symptoms. If you do, they can take up to three months to appear, and are likely to make you sick for between 1-3 months. During that time you might experience symptoms like fatigue, weight loss, flu-like symptoms, dark urine and jaundice. Recovery might take several months. The older a person is when they get hep B, the better their chances of successfully fighting it off (‘clearing’ the virus). Around 95% of adults who contract hep B will only have an acute infection and are able to clear it naturally. On the other hand, up to 90% of babies and 30% of children who get the virus will go on to have chronic hep B.
If your body has naturally fought off (cleared) hep B, then you will be immune. This means you cannot get it again.
If the infection lasts for longer than six months it is called chronic hep B. Most people with chronic hep B contracted it as babies or young children. Many people with chronic hep B have no symptoms, but if they appear they are similar to the symptoms of acute hep B. Chronic hep B is a lifelong illness.
If someone has chronic hep B it is a lifelong illness. Each person’s experience of the illness will be different, and will depend on a number of factors like what stage their hep B is currently in and how long they’ve had the virus. However we do know that 20 to 30% of people with chronic hep B will develop advanced liver disease if the virus is left untreated. Advanced liver disease can lead to complications including liver failure and liver cancer, and unfortunately, can lead to death. Treatment for hep B aims to avoid these outcomes.
All of the tests given to diagnose hep B are blood tests, but might indicate different stages of the illness or immunity. The following list shows the different tests available, and what a positive result indicates for each of them.
What a positive result means
|Hepatitis B surface antigen|
|Shows whether the person has hepatitis B. It can be detected during acute and chronic infection. |
|Hepatitis B surface antibody|
(HBsAb or anti-HBs)
|Shows whether the person has developed immunity to hepatitis B. It can be detected in people who have recovered from acute hepatitis B or been vaccinated against it. |
|Hepatitis B e antigen|
|Shows whether hepatitis B virus is multiplying, and that it can be more easily passed on. |
|Hepatitis B e antibody|
(HBeAb or Anti-HBe)
|Shows whether the person’s immune system has responded to hepatitis B and (in some circumstances) whether the virus is actively replicating. |
|Hepatitis B core antibody|
(HBcAb or Anti-HBc)
|Shows whether a person has previously had hepatitis B. Could indicate past or present infection. (If someone has immunity through vaccination they will not test positive.) |
|Hepatitis B virus DNA|
|Measures the amount of hepatitis B virus in the bloodstream and indicates how actively the virus is multiplying. |
Not everyone with hep B needs treatment. The treatments for hep B aim to stop the virus being active and multiplying in the liver. A good outcome on treatment is to lower the viral load (how much of the virus is in a person’s blood) so that the immune system can make the virus inactive. Treatment cannot cure hepatitis B though: the goal is to try and control the virus by making it inactive. In Australia there are a number of drugs used to treat hep B:
- Pegylated interferon boosts the body’s immune system and changes the virus’ ability to multiply. It is a synthetic version of a protein our bodies naturally produce (interferon). Pegylated interferon is injected under the skin once a week for up to twelve months.
- Lamivudine (Zeffix®) is an antiviral drug that stops the virus from multiplying. It is taken orally (as a tablet) every day for at least a year. Not many people are given lamivudine in Australia because the risk of the virus becoming resistant to this drug is high. It is still used in particular circumstances, though.
- Telbivudine (Sebivo®) is in the same class of drugs as lamivudine. It is not commonly used in Australia..
- Adefovir (Hepsera®) is an antiviral drug similar to lamivudine. It is usually only given when the hep B virus has become resistant to lamivudine, and is usually added on to the lamivudine (to protect against the development of resistance to adefovir also).
- Entecavir (Baraclude®) and Tenofovir (Viread®) are two newer antiviral medications which are generally more potent (stronger). They are also taken orally, usually very well-tolerated (unlikely to cause side effects), and the virus is much less likely to become resistant to them with prolonged use than any of the other drugs mentioned (except pegylated interferon).
- It’s a good idea for people with hep B to be in regular contact with a GP and a liver specialist.
- The Hepatitis Helpline (ph: 1800 803 990) can provide you with more information, and can also direct you towards GPs and specialists in your area. You can call the Helpline through the Telephone Interpreter Service (ph: 131 450). Workers can send printed information, including information in community languages.
- Hep B Help has information for doctors and people with hep B.
- HBV Advocate has information for people living with hep B, including information in community languages.
- ASHM has information for doctors and policy information on hep B.
This page provides an overview of hepatitis B (hep B) and was developed with assistance from Dr Ben Cowie of the Victorian Infectious Diseases Reference Laboratory (VIDRL). Click here to see the referenced version of this page.
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Stock photos used. People shown may have no actual connection with hepatitis C.
Top image by E>mar, via www.flickr.com
This page last updated 24 Jan 2011