Hepatitis B

What is hepatitis B?

Hepatitis B is a viral infection of the liver spread by direct contact with the blood or body fluids of an infected person.

It often does not cause any obvious symptoms in adults, and typically passes in a few months without treatment. In children, it often persists for years and may eventually cause serious liver damage.1

Hepatitis B is less common in the UK than other parts of the world, but certain groups are at an increased risk. This includes people originally from high-risk countries, people who inject drugs, and people who have unprotected sex with multiple sexual partners.2

A hepatitis B vaccine is available for people who are considered to be at high risk.

The following is a summary about the disease. For further details speak to your local pharmacist or GP.

How is hepatitis B spread?

Risk for travellers is low although certain behaviours or activities put individuals at higher risk, particularly when these occur in areas where hepatitis B is more common. These behaviours and activities include:

  • Unprotected sex
  • Exposure to blood or blood products
  • Exposure to contaminated needles through injecting drug use, or as a result of accessing medical or dental
  • Participation in contact sports
  • Adoption of children from risk countries
  • Long stay travel1

The virus is able to survive outside the body for at least a week which means objects and surfaces contaminated with dried blood also can pose a risk.3

Hepatitis B in other countries

Hepatitis B is found worldwide with highest rates reported in parts of:

  • East Asia
  • Sub Saharan Africa
  • Amazon,
  • Southern parts of Eastern and Central Europe
  • The Middle East
  • The Indian subcontinent.

The rates of infection in Western Europe and North America are low.1 In the UK, approximately 180,000 people are thought to be chronically infected with hepatitis B.3

A map showing the countries and areas where hepatitis B is a high risk can be found here.4

What are the signs and symptoms of hepatitis B?

In majority of cases of hepatitis B symptoms do not occur. Symptoms more commonly occur in adults than children and may include:

  • Jaundice (yellowing of the skin and eyes)
  • Loss of appetite
  • Fever
  • Abdominal pain

Persistent hepatitis B infection develops in 80-90% of those who are infected in the first year of life and in only 5% of those infected in adult years. Persistent infection may lead to liver failure or liver cancer.1

What are the complications of hepatitis B?

Some people may develop a serious illness and need to be treated in hospital. More severe symptoms may include:

  • Diarrhoea
  • Bowel motions may become pale
  • Urine may turn dark
  • Jaundice (a condition in which the whites of the eyes go yellow and in more severe cases the skin also turns yellow)3

If chronic infection of hepatitis B is left untreated people can sometimes develop serious liver problems often requiring a liver transplant. This can include:

  • Cirrhosis (scarring of the liver)
  • Liver cancer2

What treatment is available for hepatitis B?

See the GP as soon as possible if exposure to hepatitis B virus is suspected.

Emergency hepatitis B treatment:

Treatment is most effective within 48 hours of possible exposure (but can be given up to a week after exposure to help stop infection). Treatment includes:

  • A dose of the hepatitis B vaccine (2 further doses over the next few months will be required to provide long-term protection)
  • Hepatitis B immunoglobulin (a preparation of antibodies that work against the hepatitis B virus and can offer immediate but short-term protection until the vaccine starts to take effect)

Acute phase:

This does not require hospital treatment and the infection resolves within a few months. The GP may recommend:

  • Rest
  • Over-the-counter painkillers for stomach aches
  • Maintain a cool, well-ventilated environment, wear loose clothing, and avoid hot baths or showers if itching is a problem
  • Anti-sickness medication
  • Antihistamine to reduce itching

Blood tests are recommended to ensure the infection has cleared and not developed into chronic hepatitis B.

Chronic Phase:

This often requires antiviral medication to stop or reduce the activity of the virus from damaging the liver. Treatment is recommended if:

  • The immune system is unable to control the hepatitis B by itself
  • There is evidence of on-going liver damage2

What advice is there for those travelling to high risk countries?

All travellers should avoid contact with blood and bodily fluids by:

  • Avoiding unprotected sexual intercourse
  • Using appropriate protective precautions where contact is unavoidable
  • Avoiding tattooing, piercing and acupuncture (unless sterile equipment is used)
  • Not sharing needles or other injection equipment
  • Not sharing shaving equipment

Any traveller can be at risk of an accident or require emergency treatment. Travellers should be aware that using precautions will also help protect against other blood and body fluid-borne viruses, such as HIV and hepatitis C, for which there are currently no vaccines. A sterile medical equipment kit may be helpful when travelling to resource poor areas.1

When to consider vaccination

Vaccination is recommended for all travellers considering visiting high risk areas. Country specific recommendation for hepatitis B vaccinations can be found here.5

Hepatitis B vaccination is routinely available as part of the NHS vaccination schedule to all babies at 8, 12 and 16 weeks of age.6

The vaccination is also available to people who are considered at risk of getting hepatitis B or developing serious complications from it. These groups include:

  • People who inject drugs or have a partner who injects drugs
  • People who change their sexual partners frequently
  • Men who have sex with men
  • Babies born to infected mothers
  • Close family or sexual partners of someone with hepatitis B
  • Anyone who receives regular blood transfusions or blood products, and their carers
  • People with any form of chronic liver disease
  • People with chronic kidney disease
  • People travelling to high-risk countries
  • Male and female sex workers
  • People whose work puts them at risk of contact with blood or body fluids, such as nurses, prison staff, doctors, dentists and laboratory staff
  • Prisoners
  • Families adopting or fostering children from high-risk countries2

Vaccination

Several well-tolerated inactivated hepatitis B vaccines are available as well as combined hepatitis A/B products.1

There are many different immunisation schedules for hepatitis B vaccine which depend on the vaccine product used and how quickly protection is needed for pre or post exposure.7 Speak to a travel clinic advisor or pharmacist for more information.

A blood test to check immunity (hepatitis B surface antibody levels) is only recommended for people with kidney failure or those at risk of occupational exposure particularly healthcare and laboratory workers.2

References

This information is taken from trusted third party websites, NaTHNaC (Travel Health Pro) and EMIS (Patient info) and use of all information has been licenced under the Open Government Licence http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

Although the materials are being used/replicated under the provisions of the Open Government Licence this in no way represents endorsement of Traveljab.co.uk by NaTHNaC, EMIS, Public Health England, the NHS or the Department of Health and Social Care.

  1. Travel Health Pro (NaTHNaC): Hepatitis B
  2. NHS: Hepatitis B
  3. British Liver Trust: Hepatitis B
  4. WHO maps: Hepatitis B, countries or areas at high risk
  5. Travel Health Pro (NatTHNaC): Country information
  6. NHS: Vaccination Schedule
  7. The Green Book: Chapter 18 – Hepatitis B

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