Hepatitis B (serum hepatitis)

Last Reviewed: January 2023

What is hepatitis B?

Hepatitis B is a liver disease caused by the hepatitis B virus (HBV). The virus can cause an acute (short-term) or chronic (long-term) infection, cirrhosis (scarring) of the liver, liver cancer, liver failure and death.

Who gets hepatitis B?

Anyone can get hepatitis B, but those at greater risk are:

  • Infants born to mothers with hepatitis B
  • People who inject drugs or share needles, syringes, and other types of drug equipment
  • Sex partners of people with hepatitis B
  • Men who have sex with men
  • People who live with someone who has hepatitis B
  • Health care and public safety workers exposed to blood on the job
  • People on dialysis

How is the virus spread?

Hepatitis B is spread when blood, semen, or other body fluid infected with the hepatitis B virus enters the body of someone who is not infected or has not been vaccinated. People can become infected with the virus from:

  • Birth (spread from a mother who has hepatitis B to her baby during birth)
  • Sex with a partner who has hepatitis B
  • Sharing needles, syringes, or drug preparation equipment
  • Sharing items such as toothbrushes, razors, or medical equipment (like a glucose monitor) with a person who has hepatitis B
  • Direct contact with the blood or open sores of a person who has hepatitis B
  • Exposure to the blood from a person who has hepatitis B through needlesticks or other sharp instruments

You can spread hepatitis B without knowing you are infected.

What are the symptoms of acute (short-term) hepatitis B?

The symptoms of hepatitis B include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored bowel movements
  • Joint pain
  • Jaundice (yellow color in the skin or the eyes)

Adults are more likely than children to develop symptoms; however, up to 50 percent of adults who have acute infection do not have any symptoms. However, most infants who become infected progress to chronic infection. 1-2% of acutely infected adults develop "fulminant" hepatitis, which can lead to liver failure or death.

What are the symptoms of chronic (long-term) hepatitis B?

Most people with chronic hepatitis B do not have any symptoms, do not feel ill, and remain symptom-free for decades. When and if symptoms do appear, they are similar to the symptoms of new infection but can be a sign of advanced liver disease.

About one (1) in four (4) people who become chronically infected during childhood and about 15% of those who become chronically infected after childhood will eventually die from serious liver conditions, like cirrhosis (scarring of the liver) or liver cancer. Some people still do not have symptoms even after their liver becomes diseased, although certain blood tests for liver function might show some abnormalities.

How soon do symptoms appear?

If symptoms occur, they begin an average of 90 days (3 months) after exposure to the virus, but they can appear any time between eight (8) weeks and five (5) months after exposure.

For how long is a person able to spread the virus?

The virus can be found in blood and other body fluids several weeks before symptoms appear and generally persists for several months afterward. Approximately five (5) percent of infected adults may become long-term (chronic) carriers of the virus. Infants infected at birth have a 90 percent chance of becoming chronically infected.

How is acute (short-term) hepatitis B treated?

There is no medication available to treat acute hepatitis B. For people with mild symptoms, health care providers usually recommend rest, adequate nutrition, and fluids. Those with more severe symptoms may need to be hospitalized.

How is chronic (long-term) hepatitis B treated?

Several medications have been approved to treat people who have chronic hepatitis B, and new drugs are in development. However, not every person with chronic hepatitis B needs medication, and the drugs may cause side effects in some patients. People who start hepatitis B treatment may need to take medication indefinitely because these medications do not lead to a cure.

Chronic carriers of HBV should avoid drinking alcohol, using illicit drugs or taking medications which are harmful to the liver, as these substances can make the liver disease worse.

What precautions should hepatitis B carriers take?

Chronic hepatitis B carriers should follow standard hygienic practices to ensure that close contacts are not directly contaminated by his or her blood or other body fluids. Carriers must not share razors, toothbrushes or any other object that may become contaminated with blood. In addition, susceptible household members, particularly sexual partners, should be immunized with hepatitis B vaccine. It is important for carriers to inform their dentist and health care providers of their condition.

How can hepatitis B be prevented?

A safe and effective vaccine to prevent hepatitis B is available. It is recommended that all children, adolescents, and adults 19 – 59 years be vaccinated against hepatitis B. The hepatitis B vaccine is also recommended for people age ≥ 60 years at increased risk. Persons ≥ 60 years without risk factors may also be vaccinated. A special hepatitis B immune globulin is available for people who are exposed to the virus. In the event of exposure to hepatitis B, consult a doctor or the local health department.

Hepatitis B Vaccination Schedule

  • Infants: See Hepatitis B vaccine schedule for infants
  • Adolescents: All children and adolescents through age 18 years not previously vaccinated
    • 3-dose series at 0, 1, 6 months
    • Adolescents ages 11 through 15 years may use 2-dose series of Recombivax HB separated by 4 to 6 months
  • Adults ages 19 through 59 years: complete a 2- or 3-, or 4-dose series
    • 2-dose series only applies when 2 doses of Heplisav-B* are used at least 4 weeks apart
    • 3-dose series Engerix-B or Recombivax HB at 0, 1, 6 months [minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 8 weeks / dose 1 to dose 3: 16 weeks])
    • 3-dose series hepatitis A-hepatitis B (Twinrix at 0, 1, 6 months [minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 5 months])
    • 4-dose series hepatitis A-hepatitis B (Twinrix) accelerated schedule of 3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months
    • 4-dose series Engerix-B at 0, 1, 2, and 6 months for persons on adult hemodialysis (note: each dosage is double that of normal adult dose, i.e., 2 mL instead of 1 mL)
  • Adults ages 60 years or older and at risk for hepatitis B virus infection (those 60 years and older without risk factors may also be vaccinated): 2-dose (Heplisav-B) or 3-dose (Engerix-B, Recombivax HB) series or 3-dose series hepatitis A-hepatitis B (Twinrix):
    • Chronic liver disease (e.g., persons with hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice upper limit of normal)
    • HIV infection
    • Sexual exposure risk (e.g., sex partners of hepatitis B surface antigen [HBsAg]-positive persons; sexually active persons not in mutually monogamous relationships; persons seeking evaluation or treatment for a sexually transmitted infection; men who have sex with men)
    • Current or recent injection drug use
    • Percutaneous or mucosal risk for exposure to blood (e.g., household contacts of HBsAg-positive persons; residents and staff of facilities for developmentally disabled persons; health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids; hemodialysis, peritoneal dialysis, home dialysis, and predialysis patients; patients with diabetes)
    • Incarcerated persons
    • Travel to countries with high or intermediate endemic hepatitis B

Combined and special products:

  • DTaP-HepB-IPV (Pediarix)
  • DTaP-IPV-Hib-HepB (Vaxelis)
  • HepA-HepB (Twinrix)
  • Engerix-B
  • Recombivax HB