Ways you can’t catch hepatitis B

Hepatitis B is not spread through:

• Food or water
• Sharing eating utensils
• Hugging
• Kissing
• Coughing or sneezing
• Casual contact, such as in an office or factory setting.

People with chronic hepatitis B infection should not be excluded from work, school, play, childcare, or other settings.

How does hepatitis B spread?

The spread of hepatitis B occurs when blood from an infected person enters the body of a person who is not infected. Hepatitis B is spread in the following ways:

• Unprotected sex
• Sharing needles or getting a tattoo or piercing with an infected needle
• Needlesticks
• During childbirth when the mother is infected
• During childhood, when an infected person’s blood comes in contact with a break in a child’s skin
• The bite of an infected person
• Sharing personal care items (i.e., razors or toothbrushes)

Sexual transmission
Sexual contact is the most common reason for the spread of hepatitis B infection in the United States. The spread of hepatitis B as a result of heterosexual sex (vaginal intercourse) makes up about one-third of new infections in adults. The risk of spreading hepatitis B increases if either person has multiple sex partners, a history of a sexually transmitted disease, or has sex with an HBV-infected person. About one-quarter of new infections occur among men who have sex with men.

Drug use and needles
Hepatitis B is also easily spread by sharing drugs, needles, or “works” when “shooting” drugs. The risk of infection from contaminated needlesticks is much greater than the risk of spreading HIV by this method. In the United States, illegal drug use injection accounts for about 16 percent of new hepatitis B infections.

Other types of percutaneous (through the skin) exposures, including tattooing and body piercing, have also been reported to result in the spread of hepatitis B. Unsafe injections in medical settings are a major source of hepatitis B infection in many developing countries and might be a risk for United States residents traveling abroad, if medical care is required in settings that do not have good systems in place to prevent transmission.  Hepatitis B is also spread through needlesticks or sharps exposures among healthcare workers and others.

Early childhood and contact with bodily fluids
Although hepatitis B can spread from an infected mother to her baby during birth, breastfeeding has not been associated with transmission.

Hepatitis B can also be spread during childhood. Most early childhood spread occurs in households of people with chronic (life-long) hepatitis B infection, but transmission has also been seen in daycare centers and schools. The most likely way that the spread of HBV occurs during early childhood involves contact between an infected person’s body fluids (e.g., blood from cuts or wounds) and breaks in the child’s skin.

Hepatitis B can be spread also when an infected person bites another person who is not infected. Hepatitis B can be spread also by an infected person pre-chewing food for babies, and through contact with infected personal-care items, such as razors or toothbrushes. The virus remains infectious and capable of spreading infection for at least seven days outside the body, even if blood or other fluids is not visible

Hepatitis B as a chronic disease

Hepatitis B is very serious.

• About 90 percent of infants (who do not receive treatment at birth) become chronically infected
• One-third of children younger than age 5 become chronically infected
• About 2 of 100 adults who are infected are unable to clear the virus from their bodies and become chronically infected

This serious condition is discussed below. Even though people might eventually recover from their acute infection, a feeling of tiredness and poor health might last for months.

Living with chronic hepatitis B

People with chronic hepatitis B infection are infectious and can transmit the virus to others. Usually, chronically infected people do not feel sick and do not realize they are infected. They generally have the hepatitis B infection for their entire lives. They are also at high risk of developing chronic liver disease, including cirrhosis (scarring of the liver), liver failure, and liver cancer.

An estimated 15-25 percent of people with chronic hepatitis B infection eventually develop serious liver disease. Chronic infection is responsible for most hepatitis B-related sickness and death, including cirrhosis, liver failure, and liver cancer. When people are infected at a very young age, these forms of liver disease do not appear usually until young adulthood or middle age.

How common is hepatitis B?

About 5 out of 100 unvaccinated people in the United States will contract hepatitis B infection sometime in their lifetime. Approximately 1 million people have a chronic infection. Most of these people do not know they are infected.

In the United States, an estimated 3,000-4,000 people die each year of hepatitis B-related liver disease, and another 1,000-1,500 die each year of liver cancer as a result of infection. Worldwide, the medical consequences of chronic infections are a huge problem. Approximately 350 million people around the world are chronically infected and approximately 1 million of these people die each year from cirrhosis leading to liver failure or liver cancer. Overall, hepatitis B is the 10^th leading cause of death worldwide.

Between 1990 and 2005, the overall occurrence of reported cases of acute hepatitis B declined. In 2006, the estimated number of new hepatitis B infections was about 46,000–a decrease from an estimated 232,000 new infections in 1990.

The overall decrease in the occurrence of acute hepatitis B in the United States is most likely due to the increased use of hepatitis B vaccine and changes in behaviors among at-risk populations in response to the HIV/AIDS epidemic. The greatest decline in cases was among children and adolescents, the group with the largest increase in hepatitis B vaccination coverage. Reporting of hepatitis B still remains a problem as many people do not exhibit recognizable symptoms.

Despite the dramatic decrease in the number of new HBV infections in the United States, chronic hepatitis B infection remains a major problem. About 1 million people have chronic infection currently and most of these people do not know they are infected because they haven’t been tested. Most cases of chronic infection in the U.S. are found in immigrants or refugees from areas of the world with moderate or high rates of hepatitis B. Some of these areas of the world include Asia, Africa, the Pacific Islands, and Eastern Europe. People from these areas of the world should be tested to find out if they are chronically infected.

How to protect yourself

Hepatitis B diagnosis

A blood test called is needed to diagnose acute hepatitis B. There are additional blood tests for hepatitis B that determine other aspects of infection. These other blood tests can tell whether or not a person is currently infected and whether or not a person has been infected in the past.

If the tests indicate a person has been infected in the past, testing will also determine whether the person has developed protective antibodies to the virus (i.e., they have gotten over the infection and will not get infected again [this is called immunity]) or whether they still have virus in their blood, indicating they might have a chronic infection.

Treatment, prevention and exposure

There are several Food and Drug Administration (FDA)-approved medications that might help a person who has chronic infection. These medications don’t usually get rid of the virus, but they might decrease the chance of the infected person developing severe liver disease. Not everyone is a candidate for these medications. Researchers continue to seek additional cures for hepatitis B. There is no treatment (other than supportive care) for people with acute hepatitis B.

If you’ve been diagnosed with chronic hepatitis B, there are some simple measures you can take to protect your friends and loved ones.

DO

• Cover all cuts and open sores with a bandage.
• Discard used items such as bandages and menstrual pads carefully so no one is accidentally exposed to your blood.
• Wash hands well after touching your blood or infectious body fluids.
• Clean up blood spills; then clean the area again with a bleach solution (one part household chlorine bleach to 10 parts of water).
• Tell your sex partner(s) you have hepatitis B so they can be tested and vaccinated (if not already infected or vaccinated). Partners should have their blood tested 1-2 months after three doses of vaccine are completed to be sure the vaccine worked.
• Use condoms during sex unless your sex partner has had hepatitis B or has been immunized and has had a blood test demonstrating immunity to hepatitis B. (Condoms can also protect you from other sexually transmitted diseases).
• Tell household members to see their doctors for testing and vaccination for hepatitis B.
• Tell your doctors that you are chronically infected.
• See your doctor every 6-12 months to check your liver for abnormalities, including cancer.
• If you are pregnant, tell your doctor that you have hepatitis B. It is critical that your baby is started on hepatitis B shots within a few hours of birth.

DON’T

• Don’t share chewing gum, toothbrushes, razors, washcloths, needles for ear or body piercing, or anything that might have come in contact with your blood or infectious body fluids.
• Don’t pre-chew food for babies.
• Don’t share syringes and needles.
• Don’t donate blood, plasma, body organs, tissue, or sperm.

What should you do if you have been exposed to hepatitis B?

If you think you’ve been exposed, don’t delay. Contact your doctor or clinic. If you have not been vaccinated, it is recommended that you receive treatment with hepatitis B immune globulin (HBIG), a blood product containing protective hepatitis B antibodies. You should also get the first dose of hepatitis B vaccine as soon as possible, preferably at the same time as the HBIG is given, but at a different site on your body. Following this, you will need to complete the full hepatitis B vaccine series (usually a total of three doses over a six-month period).

Vaccination

The hepatitis B vaccines (Recombivax HB^® and Engerix-B^®) used in the United States are recombinant DNA vaccines, which means they are produced by inserting the gene for hepatitis B into a medium from which it is grown, harvested, and purified. Hepatitis B infection cannot occur from receiving the vaccine.

The Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and American College of Obstetricians and Gynecologists (ACOG) recommend this vaccine.

Vaccine administration

Hepatitis B vaccine should be given to infants (12 months of age and younger) in the thigh muscle. Either the thigh or the upper arm muscle may be used for young children. The upper arm muscle is the preferred site of administration for adolescents and adults. Hepatitis B vaccine should always be given into the muscle regardless of the age of the patient.

Who should get the vaccine?

Infants and children

Hepatitis B vaccine, usually a three-dose series, is recommended for all children 0-18 years of age. It is recommended for infants beginning at birth in the hospital. All older children who did not get all the recommended doses of hepatitis B vaccine as an infant should complete their vaccine series as soon as possible. Most states require hepatitis B vaccine for school entry. Adolescents who are just starting their series will need two or three doses, depending on their age and the brand of vaccine used.

Adults

Adults at increased risk of acquiring hepatitis B infection should also be vaccinated. In addition, the vaccine can be given to any person who desires protection from hepatitis B.

Who is at increased risk of hepatitis B infection?

• Healthcare workers and public safety workers with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids
• Men who have sex with men
• Sexually active people who are not in long-term, mutually monogamous relationships
• People seeking evaluation or treatment for a sexually transmitted disease
• Current or recent injection drug users
• Inmates of long-term correctional facilities
• People with end-stage kidney disease, including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
• Staff and residents of institutions or group homes for the developmentally challenged
• Household members and sex partners of people with chronic hepatitis B infection
• People from United States populations known to previously or currently have high rates of childhood hepatitis B infection, including Alaska Natives, Pacific Islanders, and immigrants or refugees from countries with intermediate or high rates of chronic HBV infection.
• International travelers to regions with high or intermediate rates of HBV infection

Any adult who wishes to be protected from hepatitis B infection should be vaccinated without having to acknowledge a specific risk factor.

Risk to travelers

Short-term travelers to regions (Asia, Sub-Saharan Africa, Amazon Basin, Eastern Europe, and the Middle East) in which there are moderate to high rates of hepatitis B are typically at risk for infection only through:

• Exposure to blood in medical, healthcare or disaster-relief activities
• Receiving medical care that involves blood exposures
• Sexual activity
• Drug use

The Centers for Disease Control and Prevention recommends hepatitis B vaccination for travel to any of these places, regardless of the length of stay.

Is the hepatitis B vaccine safe?

Yes. Hepatitis B vaccines have been demonstrated to be safe when administered to infants, children, adolescents, and adults. Since 1982, more than an estimated 70 million adolescents and adults and more than 50 million infants and children have received at least one dose of hepatitis B vaccine in the United States. The majority of children who receive this vaccine have no side effects. Serious reactions are rare.