Patient Resources

Marina Suarez, Multicultural HIV and Hepatitis Service, Sydney, NSW

What is hepatitis B?

Hepatitis B is a liver infection caused by the hepatitis B virus. Your liver is very important for your wellbeing. When your liver is inflamed or damaged, it may not work properly and this can affect your health.

Hepatitis B can be ‘acute’ or ‘chronic’

Most adults who get infected with hepatitis B will get rid of the virus (clear it) within 6 months and develop protection against it. This short-term illness is called ‘acute hepatitis B’. Once they clear the virus, they cannot be infected with the hepatitis B virus again, and cannot pass it on to others. When the infection lasts for more than six months, the person has developed ‘chronic hepatitis B’. This happens to 90% of people who are infected at birth or before one year of age. Chronic hepatitis B can cause liver damage, liver scarring (cirrhosis) and liver cancer; however, there are effective medicines that can greatly reduce liver damage and prevent cancer. There is also a lot you can do to help your liver. The most important thing is to have regular checks with your doctor every six to twelve months.

How do you get hepatitis B?

Hepatitis B is found in body fluids such as the blood, semen and vaginal fluids of an infected person. The virus is passed on (transmitted) when body fluids from an infected person enter another person’s bloodstream. Even amounts of fluid too small to be seen can transmit the virus.

In babies and young children transmission occurs:

• From a mother with hepatitis B to her baby around the time of birth if the baby is not vaccinated. This is the most common way the virus is spread in many developing countries.
• From a child with hepatitis B to another child who is not vaccinated against hepatitis B, through cuts and sores that are not covered.

In adults transmission occurs through:

• Vaginal, anal or oral sex without a condom.
• Sharing needles, syringes or any other equipment to inject drugs.
• Tattooing or body piercing done with equipment that has not been sterilised properly.
• Sharing toothbrushes, razors, nail files or other personal items that may carry blood, including dry blood.
• Blood transfusions in some parts of the world, particularly in developing countries. In most developed countries, including Australia, donated blood is checked for hepatitis B and other viruses, so the risk of infection is extremely low.
• Medical and dental procedures in some developing countries may put people aout risk, but they are safe in Australia.
• Accidental injury with a needle or splashing of infected blood or body fluids, especially for health-care workers.
• Contact sports.

Hepatitis B CANNOT be transmitted through:

• hugging
• kissing
• sharing food and utensils for eating
• insect bites
• coughing
• sharing bathroom and toilet facilities
• swimming pools.

Regular checks with your doctor

Having chronic hepatitis B means you will need to think of your health a little differently. With many illnesses, you can tell if you are getting worse and need to see your doctor, because the illness makes you feel unwell. However, hepatitis B is different, and you cannot rely on how you feel to know how the illness is affecting your liver. In fact, it is often the case that by the time you feel unwell, there is already liver damage.

Not every person with chronic hepatitis B will need treatment, but you will need to see your doctor every six to twelve months for regular checks, even if you feel well and have no symptoms. This is called ‘monitoring’.

Chronic hepatitis B is a complex disease that changes over time, and it is only through regular monitoring that you can know what the disease is doing to your liver, and when to get treatment if you need it.

As well as blood tests, your doctor may order tests such as a Fibroscan®, a liver ultrasound or a liver scan. The tests allow your doctor to see whether there have been any changes in the disease; whether there is liver damage, scarring of the liver (cirrhosis) or cancer; and decide if and when you may need treatment. If you need treatment, your doctor will refer you to a liver clinic or a liver specialist.

Seeing your doctor for regular monitoring is the most important thing you can do to look after yourself and your liver when you have chronic hepatitis B, because treatment at the right time can prevent scarring of the liver and cancer.

Treatment for hepatitis B

There are effective medications available that can control the virus. They can reduce the damage to your liver and the risk of liver cancer, and also help the liver repair itself.

The most common treatment consists of taking one pill a day, and it is usually a lifelong treatment.

There is another type of treatment that is offered to some patients. It consists of a weekly injection, for up to twelve months. This treatment can be very effective for certain patients, but can have serious side effects.

Each treatment has different benefits and your specialist will discuss with you which one is best for you.

Reducing the risk of liver damage

There are a number of things you can do to reduce the risk of liver damage:

• drink less alcohol or none at all
• eat a balanced healthy diet, avoiding too much fat
• maintain a healthy body weight
• stop or reduce smoking
• exercise regularly
• manage your stress and get support
• tell your doctor if you are taking any medicines or herbal remedies, including Chinese medicines; some medications and herbs can be harmful to the liver, especially if taken in high doses or for a long time
• protect yourself from other infections such as HIV and other hepatitis viruses, because they can severely affect your health and cause further liver damage:
  – get vaccinated for hepatitis A if you are not already protected against it
  – do not share equipment for injecting drugs, to avoid getting hepatitis C
  – practice safe sex (using condoms and lubricant), to avoid getting HIV.

Your doctor can refer you to services that can help you with these.

Protecting others from hepatitis B

You need to prevent passing hepatitis B on to others by taking the following precautions:

• Make sure that people you have close contact with are vaccinated against hepatitis B.
• Practice safe sex: use condoms and lubricant during vaginal, anal and oral sex.
• Avoid blood-to-blood contact: do not share toothbrushes, razors or other personal items that may contain blood, including dry blood.
• Cover any open wounds and clean blood spills with bleach. Do not allow other people to touch your wounds or blood unless they are wearing gloves.
• Throw away personal items such as tissues, sanitary pads, tampons and bandages in a sealed plastic bag.
• Do not share needles, syringes or other equipment used to inject drugs.
• Do not donate blood, sperm, organs or body tissue.
• If you are pregnant or planning to have a baby, talk to you doctor about the vaccinations your baby will need to be protected. You will be able to breastfeed.
• If you are a health-care worker who performs invasive procedures (such as a surgeon or dentist), you should seek expert medical advice, and expert occupational health and safety advice.

Vaccination

The hepatitis B vaccine is very safe and provides immunity (protection against the virus) more than 95% of the time. The vaccine is usually given in two or three injections over six months, depending on the age of the person. In Australia, all mothers are offered free vaccination for their babies when they are born. To be fully protected, the baby will need additional doses in the first twelve months. All children younger than one year old are provided with hepatitis B vaccination for free. Vaccination is recommended for adolescents aged ten to thirteen years who have not already been vaccinated.

A baby born to a mother with hepatitis B will receive an extra shot of hepatitis B immunoglobulin (HBIG) within twelve hours of birth. This can offer the baby the best available protection against hepatitis B. Once they are nine months old, babies need to be tested to check whether they have become immune to hepatitis B.

Other people at high risk of contracting hepatitis B, such as health-care workers, should also be tested one month after the final dose of vaccine, to show whether they have developed immunity or not.

Do I need to tell others that I have hepatitis B?

While you don’t have to tell everyone that you have hepatitis B, you need to tell the people who live in your house and your sexual partner or partners, so that they can be tested and vaccinated. If you need help telling them, talk to your doctor to get some advice.

There are also some situations in which you have to tell other people you have chronic hepatitis B. These include if:

• you are applying to join the Australian Defence Force
• your insurance company requires information about infections and illnesses
• you are a health-care worker who performs invasive procedures (such as a surgeon or dentist)

You may want to tell your family so they can also be tested, especially if you come from a country where hepatitis B is common, or you are Aboriginal or Torres Strait Islander.

Telling health-care workers, such as your dentist or other doctors, can help them give you the best medical care, but this is your choice. If you decide to tell them, they have a responsibility to protect your privacy and keep your information confidential, and they cannot discriminate against you.

You may find it helpful to talk to other people who can understand and support you, but should take your time to decide who you feel you can trust.

Interpreters

Hepatitis B can be complex and difficult to understand. If you do not speak or understand English well and you need help to communicate with your doctor, you can ask for an interpreter. An interpreter may help you to:

• understand everything you are being told
• ensure everything you say is understood
• ask questions and get answers
• give permission for tests or treatment.

Interpreters must protect your confidentiality.

Telephone interpreters can help you connect with services in your own language. Call TIS on 131 450 for the cost of a local call and ask to speak to someone in your language.

This information sheet was developed specifically to be given by health professionals to people living with hepatitis B.