Hepatitis B: symptoms, how it spreads, vaccine and treatment

Hepatitis B is inflammation of the liver caused by the hepatitis B virus, which is spread through blood and body fluids. The NHS says you can be vaccinated against it, the chance of getting it in the UK is low, and the infection usually lasts only a few months, though some people have it long term.

The dividing line is time. The NHS says the infection usually lasts 1 to 3 months, and that infection lasting longer than 6 months is called chronic hepatitis B. Liver UK adds that most adults fight off the virus within 6 months (acute hepatitis B), that most people with chronic hepatitis B caught the virus at birth or as a small child, and that the UK is not a country with higher levels of the virus.

The NHS says babies, children and people with a weakened immune system are more likely to get chronic hepatitis. The NHS vaccine page adds that hepatitis B can be very serious: it can make the liver suddenly stop working or cause gradual damage to the liver over time, and it can increase the chance of liver cancer.

Most people with hepatitis B have no symptoms or only mild ones. When symptoms occur, the NHS lists:

• a high temperature and tiredness

• pain in the upper tummy

• feeling sick or being sick

• a raised, itchy rash (hives)

• yellowing of the skin and whites of the eyes, which may be less noticeable on brown or black skin

• darker urine than usual and pale poo

Acute hepatitis B usually clears without treatment, and the NHS says you may be offered medicine for symptoms such as painkillers or anti-sickness tablets. Your GP will refer you to a liver specialist who will check how well your liver is working.

For chronic hepatitis B, the NHS says there is no known cure. It is usually treated with antivirals, which control the virus, and with medicine to relieve symptoms such as itchiness, pain and sickness. Regular check-ups with a liver specialist are part of long-term care, and the NHS stresses taking any prescribed medicine and attending those check-ups.

Day-to-day measures from the NHS include resting and staying hydrated, asking a doctor about safe painkiller doses, keeping the room ventilated, wearing loose clothing and avoiding hot showers if itchy. Things to avoid are alcohol, sex without a condom or dam, and sharing razors, toothbrushes or needles.

The NHS lists several routes of infection. The ones in the list are vaginal, anal or oral sex without a condom or dam; sharing needles to inject drugs; being injured by a used needle; having a tattoo, piercing, or medical or dental procedure with unsterilised equipment; and having a blood transfusion in a country that does not check blood for hepatitis B. Blood transfusions in the UK are checked, and donated blood has been tested for hepatitis B since 1972.

A mother with hepatitis B can pass it to her baby when giving birth. The NHS vaccine page says that if you have hepatitis B in pregnancy there is a much higher chance your baby could get the infection, so the baby is given extra vaccine doses, the first within 24 hours of birth.

The NHS names areas where the risk is higher: sub-Saharan Africa, Asia and the Pacific islands, the Middle East, parts of South America and southern parts of central and eastern Europe. To reduce risk further, it suggests condoms or dams and avoiding sharing razors, toothbrushes and needles.

Yes, hepatitis B can be passed to other people. The NHS vaccine page says it is spread through blood, semen and vaginal fluids. The NHS hepatitis B page lists the ways of getting it (see the section on how it is caught), and does not list kissing or sharing food.

To help stop the infection spreading, the NHS advises people with hepatitis B not to have sex without a condom or dam, and not to share razors, toothbrushes or needles. People who may be exposed, for example through a bite or being injured by a used needle, may be recommended the vaccine.

The NHS says that if you are pregnant and have hepatitis B, you can pass it on to your baby when giving birth. The NHS vaccine page says there is a much higher chance your baby could get the infection, so the baby is given extra doses of hepatitis B vaccine: within 24 hours of being born, at 4 weeks old, and then at 12 months (or a fourth dose of the 6-in-1 vaccine at 18 months for babies born on or after 1 July 2024), making 6 doses in total.

The NHS says most people who need the hepatitis B vaccine can have it, including if they are pregnant or breastfeeding. The only reason you cannot have it is a previous serious allergic reaction (anaphylaxis) to a dose or an ingredient.

All UK babies are offered three doses of the 6-in-1 vaccine, given at 8, 12 and 16 weeks old, which protects against hepatitis B and other illnesses. The NHS adds that babies born on or after 1 July 2024 get a fourth 6-in-1 dose at 18 months; babies born to mothers with hepatitis B have 6 doses in total.

For adults, the NHS recommends the vaccine for groups at higher risk, including people who inject drugs or live with someone who does, people who change sexual partners often, gay, bisexual and other men who have sex with men, sex workers, close contacts of someone with hepatitis B, people who have regular blood transfusions or blood products, people with chronic liver disease or kidney failure, healthcare workers and some laboratory staff, prison staff and prisoners, and travellers to higher-risk regions.

The only reason you cannot have the vaccine, says the NHS, is a previous serious allergic reaction (anaphylaxis) to a dose or an ingredient. You usually need at least 3 doses, typically a month apart, though an accelerated schedule within 21 days with a fourth dose at 12 months exists if faster protection is needed. Pregnancy and breastfeeding are not barriers. The vaccines in the UK use a killed version of the virus, so they cannot cause the infection.

Booster doses are usually only needed by healthcare workers whose blood tests show inadequate protection, people with kidney failure, and people exposed to the virus through a bite or needlestick.

Most adults do not have any lasting problems after a short-term hepatitis B infection, according to the NHS, but some develop long-term (chronic) hepatitis. If left untreated, the NHS says chronic hepatitis B can cause liver damage (cirrhosis) and increase the risk of liver cancer.

Liver UK says living with hepatitis B can lead to liver damage, but that most people with hepatitis B do not get cirrhosis or liver cancer, and that treatments can help control the virus and stop or slow down any liver damage. Whether you have treatment depends on how active the virus is. The NHS stresses that it is important to take any prescribed medicine and go for regular check-ups to make sure your liver is working properly.

The NHS advises seeing a GP if you think you might have hepatitis B or are at high risk of getting it. For hepatitis B, the NHS says your GP will refer you to a liver specialist, who checks how well your liver is working, and that chronic infection needs regular specialist check-ups.

Seeing a private specialist is an option for some people, for example for quicker access to appointments or scans. Your NHS GP can share records either way. On vaccination, the NHS says babies are usually contacted by the GP surgery, people travelling to higher-risk areas can use travel clinics or pharmacies with travel health services (and usually have to pay), people at risk through work should speak to their employer, and people at risk through sexual activity can visit a sexual health clinic.