Questions Frequently Asked About Hepatitis B

What is hepatitis B? How is hepatitis B spread? • loss of appetite • nausea, vomiting Hepatitis B is a serious public health prob- Hepatitis B is found in the blood of people • fever lem that affects people of all ages in the infected with the virus and certain of their • weakness, fatigue, inability to work for U.S. and around the world. Hepatitis B is body fluids, such as serum, semen, and weeks or months caused by a highly infectious virus that vaginal secretions. Hepatitis B has not been • abdominal pain attacks the liver and can lead to severe ill- shown to be spread from sweat, tears, urine, • yellowing of skin and eyes (jaundice) ness, liver damage, and in some cases, death. or respiratory secretions. Contact with • joint pain An estimated 850,000 people in the U.S. microscopic amounts of infected blood can • cola-colored urine are currently infected and about 350 million cause infection. • clay-colored stools people worldwide. Hepatitis B virus can be spread by The best way to be protected from hepa- I’m not in a risk group. How did titis B is to be vaccinated with hepatitis • unprotected sexual contact I get hepatitis B infection? B vaccine, a vaccine used in the U.S. for • sharing needles and “works” • a hepatitis B-infected mother to her baby Many people don’t know when or how they more than three decades that has proven during birth got the infection. When they get the results to be safe and effective. • contact with blood or open sores of a of a blood test indicating they’ve been infected with hepatitis B, they are taken by Who is at risk for hepatitis B infection? hepatitis B-infected person • human bites from a hepatitis B-infected surprise. Studies have demonstrated that Anyone who is not vaccinated is at risk for person about 15% of people who get infected with hepatitis B infection. If you engage in certain • sharing a household with a person with hepatitis B are unable to identify a risk fac- activities, your risk might be much higher. chronic (lifelong) hepatitis B infection tor that explains why they have the disease. You might be at risk if you • sharing personal-care items such as razors Do people usually recover from • have a job that exposes you to human or toothbrushes hepatitis B infection? blood • pre-chewing food for babies or sharing • share a household with someone who chewing gum The vast majority of adults recover after has chronic (lifelong) hepatitis B infection • using unsterilized needles in ear- or body- several months. They clear the infection from • inject illegal drugs piercing, tattooing, or acupuncture their bodies and become immune. This • have sex with a person infected with • needle sticks or sharps injuries on the job means they won’t get infected with hepatitis hepatitis B • poor infection control practices in medi- B again. They are no longer contagious and • are sexually active but not in a long-term, cal settings cannot pass hepatitis B to others. mutually monogamous relationship Unfortunately, about 2% of adults and more • are a man who has sex with men Hepatitis B IS NOT spread by than 90% of children under age 1 year are • are a person who was born, or who has a • casual contact, like holding hands unable to clear the infection from their bodies parent born, in Asia, Africa, the Amazon • eating food prepared by an infected person and develop chronic hepatitis B infection. River Basin in South America, the Pacific • kissing or hugging Islands, Eastern Europe, or the Middle • sharing silverware, plates, or cups How do I know if I have or have had East • visiting an infected person’s home hepatitis B infection? • were adopted from Asia, Africa, the • sneezing or coughing The only way to know if you are currently Amazon River Basin in South America, • breastfeeding the Pacific Islands, Eastern Europe, or infected with hepatitis B, have recovered, the Middle East What are the symptoms of hepatitis are chronically infected, or could become • are a patient or worker in an institution B infection? infected, is by having blood tests. The three for developmentally challenged people standard blood tests are the following: Most babies and young children who get • are an inmate of a correctional facility ■ HBsAg (hepatitis B surface antigen): hepatitis B infection don’t look or feel sick • travel internationally to areas with moder- when this is “positive” or “reactive,” it at all. About half of adults who get infected ate or high rates of hepatitis B infection means the person is currently infected with don’t have any symptoms or signs of the • are receiving dialysis now or will be in hepatitis B and is able to pass the infection disease. If people do have signs or symp- the future on to others. toms, they might experience any or all of the • have diabetes continued on the next page ▶ following:

immunization action coalition

Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4090.pdf • Item #P4090 (8/18) IimmAunize.orgC Questions Frequently Asked About Hepatitis B (continued) page 2 of 4

■ Anti-HBs [sometimes written as HBsAb] (antibody to hepatitis B surface antigen): Interpretation of the hepatitis B blood test results when this is “positive” or “reactive,” it means the person is immune to hepatitis B infec- vaccination tion, either from vaccination or from past tests results interpretation needed infection. (This test is not done routinely by * Postvaccination blood HBsAg negative susceptible Yes, for all most blood banks on donated blood.) testing, when it is rec- anti-HBc negative people who ■ ommended, should be Anti-HBc [sometimes written as HBcAb] anti-HBs negative want done 1–2 months after (antibody to hepatitis B core antigen): when protection the final vaccine dose. this is “positive” or “reactive,” it might mean the person has had contact with hep- HBsAg negative immune no † 1. May be distantly atitis B. This is a very complicated test to anti-HBc negative due to immune, but the test explain because the “anti-HBc” can possibly anti-HBs positive with vaccination may not be sensitive be a “false-positive” test result. Blood banks ≥10mIU/mL* enough to detect a very low level of anti- routinely run an “anti-HBc” on donated HBs in serum. blood. The interpretation of this test result, HBsAg negative immune due no anti-HBc positive to natural 2. May be susceptible if it is positive, depends on the results of the with a false positive anti-HBs positive infection other two blood tests previously described. anti-HBc. ■ A fourth blood test that is sometimes done HBsAg positive newly no 3. May be chronically anti-HBc positive infected infected and have an is IgM anti-HBc (IgM class antibody to hep- undetectable level of atitis B core antigen). When this is positive IgM anti-HBc positive HBsAg present in the or “reactive,” it means that the person anti-HBs negative serum has had hepatitis B infection in the past six 4. May be passive HBsAg positive chronically no months, indicating acute (recently acquired) transfer of anti-HBc anti-HBc positive infected (may need hepatitis B infection. to infant born to IgM anti-HBc negative treatment) an HBsAg-positive mother. What does it mean if my blood bank anti-HBs negative 5. May be recovering said I tested positive for hepatitis B HBsAg negative five possibly† from acute HBV infec- and can no longer donate blood? anti-HBc positive interpretations tion and detectable anti-HBs negative possible† anti-HBs has not yet If the blood bank told you your test was appeared “positive,” it is important to find out which test was positive. If the “HBsAg” was tion sheet along with you on your visit to your positive, this means that you are either has had hepatitis B in her/his blood for healthcare provider. The blood bank does chronically infected with hepatitis B or were more than 6 months. While approximately not usually test for anti-HBs or IgM anti-HBc. recently infected. If only the “anti-HBc” was 2% of adults who acquire hepatitis B infec- positive, it is most likely that you either had And remember, you cannot get hepatitis tion become chronically infected, children a “false-positive” test or are immune to B from donating blood because the equip- younger than age 1 year have a much greater hepatitis B infection (had hepatitis B infec- ment used during blood donation is sterile. risk (more than 90%). The younger the tion sometime in the past). It is important child is at the time of infection, the greater that you understand the full meaning of the risk that the child will develop chronic your test results. If you are not sure how to Chronic Hepatitis B Virus infection. Many babies born to chronically interpret these test results, call your blood Infection infected mothers will also become chronically bank for an explanation or have the blood infected with hepatitis B unless the babies bank send the test results to your healthcare What does it mean to be chronically are given two shots in the hospital immedi- provider. You may need to provide written infected with hepatitis B? ately after birth – the first dose of hepatitis permission for the blood bank to release B vaccine and a dose of hepatitis B immune People who do not recover from hepatitis B these results to your healthcare provider. globulin (HBIG) – and at least two doses infection are chronically infected, often for Your healthcare provider may want to repeat of hepatitis B vaccine during the 6 months life. There are an estimated 850,000 chroni- the blood tests or perform additional tests after birth to protect them from the infection. cally infected people in the U.S. today. A such as an “anti-HBs.” Bring this informa- The final dose should not be given before chronically infected person is someone who 24 weeks of age.

continued on the next page ▶ immunization action coalition

A chronically infected person might have no can hurt the liver. If the result of any liver • Clean up blood spills. Then reclean the signs or symptoms of hepatitis B infection test is abnormal, it’s important that you con- area with a bleach solution (one part house- but usually remains infected for years or for sult a liver specialist. hold chlorine bleach to 10 parts water). a lifetime and is capable of passing hepa- • Tell your sex partner(s) you have hepatitis titis B on to others. Sometimes chronically If your liver disease has progressed... B so they can be tested and vaccinated (if infected people will spontaneously clear If your physician tells you your liver disease not already infected). Sex partners should the infection from their bodies, but most has progressed, read the following for be tested for anti- HBs 1–2 months after will not. Although most chronically infected some extra precautions you should take. the three doses are completed to be sure people have no serious problems with hep- the vaccine worked. • Avoid alcohol and medicine that has not atitis B and lead normal, healthy lives, some • Use condoms (rubbers) during sex unless been prescribed by your doctor – even develop liver problems later. Chronically your sex partner has had hepatitis B or over-the-counter medicines. infected people are at significantly higher risk has been vaccinated and has had the anti- • Get vaccinated against hepatitis A. Hepa- than the general population for liver failure HBs blood test demonstrating immunity. titis A virus infection can further damage or liver cancer. (Condoms may also protect you from other your liver. sexually transmitted diseases.) • Get a yearly influenza (flu) vaccination. Is there a cure for hepatitis B? • Tell household members to see their health- • Patients with severe liver disease (cirrhosis) care providers for testing and vaccination There are several medicines used for the should also receive pneumococcal vaccine. for hepatitis B. treatment of people with chronic hepatitis • Don’t eat raw oysters. They may carry the • Tell your healthcare providers that you are B. These drugs usually don’t get rid of the bacteria Vibrio vulnificus, which can cause chronically infected with hepatitis B. virus completely, but may reduce your risk serious blood infections in people with • See your healthcare provider every 6–12 for serious liver disease such as cirrhosis liver disease. Approximately 50% of people months to check the health of your liver and liver cancer. Check with your doctor to with this blood infection die from it. find out if treatment with medication is with blood tests and liver scanning. • the right choice for you. Researchers con- What can I do to protect others from If you are pregnant, tell your healthcare provider that you have hepatitis B infec- tinue to find additional treatments and look hepatitis B infection? for cures for hepatitis B. tion. It is critical that your baby is started People with hepatitis B infection might feel on the hepatitis B shots (both vaccine What are the long-term effects healthy but are still capable of passing the and HBIG) within 12 hours of birth. of hepatitis B infection? infection on to other people. To protect others from getting hepatitis B infection, it don’t: Each year, approximately 3,000 people in the is important to protect them from contact • Don’t share chewing gum, toothbrushes, U.S. die of hepatitis B-related chronic liver with your infected blood and other infectious razors, needles for ear or body piercing, or disease. Hepatitis B virus infection is the body fluids, including semen and vaginal anything that might have come in contact most common cause of liver cancer world- secretions. Sweat, tears, urine, and respira- with your blood or infectious body fluids wide and ranks second only to tobacco as tory secretions do not contain hepatitis B. • Don’t pre-chew food for babies. the world’s leading cause of cancer. Transmission of hepatitis B by saliva has only • Don’t share syringes and needles. been documented through biting. How can I take care of myself if I am • Don’t donate blood, plasma, body organs, tissue, or sperm. chronically infected with hepatitis B? Important dos and don’ts for • Don’t take any medicines not prescribed A person with hepatitis B infection should people with chronic hepatitis B by your doctor, even over-the-counter see a physician knowledgeable about the infection medicines. management of liver disease every 6–12 months. The physician will do blood tests do: Why is hepatitis B so serious in to check the health of the liver, as well as • Cover all cuts and open sores with a pregnant women? test for evidence of liver cancer. It is best for bandage. Pregnant women who are infected with chronically infected people to avoid alcohol • Wrap up and discard used items such as hepatitis B can transmit the disease to their because alcohol can injure the liver. Addi- band aids and menstrual pads carefully babies. If babies aren’t protected with vacci- tionally, your physician should know about so no one is accidentally exposed to your nations, many of them develop lifelong hep- all the medicines you are taking, even over- blood. atitis B infections, and up to 25% of those the counter drugs, because some medicines • Wash your hands well after touching your who become infected will develop liver failure blood or infectious body fluids. continued on the next page ▶ immunization action coalition

or liver cancer later in life. All pregnant national level by the Centers for Disease contaminated with the virus. Hepatitis C women should be tested early in every preg- Control and Prevention (CDC), which is caused by the hepatitis C virus and is nancy to determine if they are infected with contracts with vaccine manufacturers to spread through hepatitis C-infected blood. hepatitis B. If the blood test is positive, the buy vaccines at reduced rates. For adults, Both hepatitis C and hepatitis B infections baby should be vaccinated within 12 hours contact your healthcare provider to find out are spread by blood through some of the of birth with two shots, one of HBIG and the if the vaccine is available and how much it same activities (e.g., injection drug use). other the first dose of hepatitis B vaccine. costs. If you are uninsured or don’t have a Both hepatitis B and hepatitis C infections The infant will need at least two more doses healthcare provider, call your local health can cause lifelong liver problems. Hepatitis of hepatitis B vaccine by age 6 months. The department for advice. A infection does not. Vaccines to prevent final dose should not be given before age hepatitis A infection are also available. 24 weeks. How many doses of vaccine are Hepatitis A vaccine won’t protect you from needed? hepatitis B or hepatitis C infection, nor will How can hepatitis B be prevented? hepatitis B vaccine protect you from hepa- Two or three doses (depending on vac- titis A or hepatitis C infection. There is no Hepatitis B vaccination is the best protec- cine brand) are needed usually for the best vaccine yet for hepatitis C. If you’ve been tion. The vaccine can be given safely to protection against hepatitis B infection, infected with hepatitis A or hepatitis C in infants, children, and adults and is usually but protection is sometimes provided from the past, it is still possible to get infected given as two or three doses depending on receiving as little as one dose. The vaccine with hepatitis B. the brand of vaccine. Other flexible sched- series can be completed in from 1 to 6 ules are available. Pregnant women can be months, depending on vaccine brand. As Where can I receive more information given this vaccine as well. Hepatitis B vac- with all other vaccines, if you fall behind on about hepatitis B? cine is very safe, and side effects are rare. the schedule, you just continue from where This vaccine was the first vaccine that pre- you left off.Hepatitis B vaccine will not help Contact your local and state health depart- vents cancer; it prevents liver cancer caused or cure a person who is already infected with ments for more information. You can also by hepatitis B infection. hepatitis B. contact the following organizations:

At what age are hepatitis B vaccines How do I protect myself if I’m in Immunization Action Coalition (651) 647-9009 given routinely? a risk group for hepatitis B? www.immunize.org The hepatitis B vaccine series can begin at If you are in a risk group for hepatitis B, www.vaccineinformation.org any age. For newborns, it’s recommended be sure to get vaccinated! All people in risk American Liver Foundation that the first dose be given in the hospital at groups (risk groups are listed in the sec- (212) 668-1000 birth. Hepatitis B vaccine is recommended ond question on this question-and-answer www.liverfoundation.org routinely for all children age 0–18 years series) should protect themselves from hep- living in the U.S. Older children and teens atitis B infection. You don’t have to “admit” Asian Liver Center who haven’t been vaccinated yet should get that you have a risk factor to be vaccinated. (888) 311-3331 vaccinated at the earliest opportunity. Any You simply need to ask to be vaccinated. http://liver.stanford.edu adult who is at risk for hepatitis B infection Every day you delay getting vaccinated Centers for Disease Control or who simply wants to be protected from increases your chances of being in contact and Prevention hepatitis B infection should start the vaccine with this highly contagious liver disease. (800) CDC-INFO series right away. The problems caused by hepatitis B – liver www.cdc.gov/hepatitis cancer and liver failure – are too great to www.cdc.gov/vaccines Where can I get hepatitis B vaccine? take a chance. See your healthcare provider or visit your health department. Hepatitis B Foundation Check with your healthcare provider’s office (215) 489-4900 first. Children’s health insurance usually www.hepb.org covers the cost of this vaccine since it is How does hepatitis B differ from routinely recommended for all children in hepatitis A and C? Parents of Kids with Infectious Diseases (PKIDS) the U.S. If your child is uninsured, ask your Hepatitis A, B, and C are all different viruses (360) 695-0293 local health department for assistance. The that attack and injure the liver, and all can www.pkids.org federal Vaccines For Children (VFC) pro- cause similar symptoms. Usually, people gram helps families by providing free vac- get hepatitis A virus infection from close cines to healthcare providers who serve contact with a person who has the infec- eligible children. VFC is administered at the tion or from ingestion of food or water immunization action coalition

Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4090.pdf • Item #P4090 (8/18) IimmAunize.orgC