Hepatitis B - Get the Facts

What You Need to Know

You Can Have It and Not Know It

What is hepatitis B?

Hepatitis B is a liver disease caused by the hepatitis B virus (HBV). HBV is far more infectious than HIV and can be prevented by a vaccine. People who have not been vaccinated may be at risk of getting infected.

About 95 percent of adults will recover within 6 months of becoming infected (acute hepatitis B) and as a result will develop lifelong protection against it. The remaining 5 percent are unable to clear the virus and will become chronically infected. Chronic hepatitis B infection is treatable.

It is estimated that less than 1 percent of Canada's population is infected with either acute or chronic HBV. People who are infected before the age of 7 are at a higher risk of developing chronic infection. In 2011, the overall reported rate of acute hepatitis B infection in Canada was 0.6 reported cases per 100,000 people living in Canada.

Why is hepatitis B a health concern?

Many people infected with HBV do not know they have the virus because symptoms can take two to six months to appear and only about 50 percent of people develop symptoms. During this time, they can spread the infection to others. You may not know you have this infection until damage has already been done to your liver. Potential complications from chronic HBV infection include cirrhosis of the liver, liver failure, liver cancer and premature death.

Why do I need my liver?

It's important to keep your liver healthy because it plays a key role in your overall health. It helps digest food and stores vitamins and minerals. Most importantly, the liver acts as a filter for chemicals and other substances that enter the body. It is also important in the production of your blood and many of the proteins that keep your body working.

How is hepatitis B spread?

HBV is spread through contact with infected blood and body fluids including semen and vaginal fluid.

The most common risk factors for HBV infection include:

• Injection drug use (past and/or present) and intranasal drug use (snorting) when sharing contaminated drug-using equipment (e.g., needles, straws pipes, spoons and cookers);
• High-risk sexual activities (e.g., unprotected sex, multiple sexual partners);
• Being born or living in a region where HBV is widespread;
• Being born to a mother with HBV;
• Exposure to blood/blood products in endemic regions without routine infection control measures;
• Use of shared or contaminated medical or dental devices;
• Sharing personal care articles such as razors, scissors, nail clippers or toothbrushes with an infected person;
• Exposure in the workplace by getting pricked by a needle or sharp equipment that had infected blood or body fluids on it;
• Tattooing, body piercing or acupuncture when unsterile equipment or techniques are used; and
• Exposure to blood, blood products or organ transplantation in Canada prior to 1970.

Hepatitis B is NOT spread by casual contact such as hugging, kissing or shaking hands or by being around someone who is sneezing or coughing. It cannot be spread by breastfeeding unless the nipples are cracked and bleeding. The hepatitis B virus is not found in food or water.

Transmission through saliva not visibly contaminated with blood is uncommon.

What are the symptoms of hepatitis B?

You may have hepatitis B and not have any signs or symptoms. Symptoms of HBV infection can include some or all of the following: fatigue, loss of appetite, fever, nausea, vomiting, dark urine, pale stools, stomach pain, joint pain and jaundice (yellowing of the skin and eyes). About half of the people infected with HBV don't develop any symptoms until their liver has already been damaged - that's why it's important to take precautions against HBV, and to get tested if you think you might be infected.

How can I protect myself and others against HBV?

There is a safe and effective vaccine available to prevent you and others from getting hepatitis B. In Canada, all provinces and territories have free immunization programs for children and certain groups of adults.

If you are pregnant and infected with hepatitis B, it is important for you to know that your infant is at a high risk of developing chronic HBV infection. In Canada, it is recommended that infants born to infected mothers receive a special injection immediately after birth, as well as, the first dose of vaccine within 12 hours of birth to help prevent infection.

Hepatitis B vaccination is the best way to protect yourself against becoming infected. You can also reduce the risk of hepatitis B infection by taking the following precautions:

• Avoid sharing needles/syringes, spoons, drug solutions or water, filters, cookers, pipes, straws used for snorting drugs, and other drug related equipment. Cleaning with bleach may not kill HBV;
• Practice safer sex. Use condoms/dental dams to reduce the risk of acquiring sexually transmitted and blood borne infections (STBBIs) including HBV;
• Avoid dental, medical or cosmetic procedures that penetrate the skin (e.g., transfusions, acupuncture, piercing or tattooing) unless you are certain that the needles, materials and equipment are sterile;
• Wear latex gloves if you are likely to be in contact with someone else's blood or bodily fluids;
• Don't share personal items like razors, scissors, nail clippers or toothbrushes; and
• Be especially careful when travelling abroad in countries where HBV is widespread.

How can I find out if I have acute or chronic hepatitis B?

If you think you are at risk, or may be infected with hepatitis B, talk to your healthcare provider about testing for hepatitis B, and the hepatitis B vaccination.

What if I have hepatitis B?

Most adults with hepatitis B infection will clear the virus on their own within 6 months. If you clear the virus, you will no longer be infected and will not be able to transmit the virus to others. You will also have antibodies that protect you from getting hepatitis B again. Until your health care provider tells you that you have cleared the virus, you are still infectious and can transmit the virus to others. Management and care of acute HBV infection is focused on relief of symptoms, preventing complications and further transmission.

If you have a chronic HBV infection your healthcare provider will monitor you closely with blood tests to keep an eye on your liver health and may recommend treatment. Not all people with chronic HBV infection need to be treated. A combination of medications can be used to treat hepatitis B. Talk to your health care provider to see if treatment is right for you.

To prevent further damage to your liver, your health care provider may advise vaccination against hepatitis A. Many provinces and territories provide this vaccination at no direct cost to you. In addition, you may want to limit or avoid alcohol consumption to decrease your risk of liver damage.

If you have either an acute or chronic infection, you should advise anyone who may have been exposed to your blood or bodily fluids (e.g., sexual partners, people you live with, and health care workers). These people should consult a health care provider right away as there are ways to prevent them from getting the infection.

If you have acute or chronic hepatitis B, you may infect others. You can prevent spreading the virus by following the same safe sex, drug behaviour and personal hygiene precautions outlined to reduce your risk of infection. Additionally:

• Never donate blood, tissue, organs or semen;
• Ensure that family members living with you, sexual partners and drug use partners are tested for HBV and immunized if at risk;
• If you are pregnant, inform your health care provider so that all the necessary precautions for the baby are taken at or soon after birth; and
• Cover open sores or breaks in your skin.

Remember

Hepatitis B is a vaccine-preventable disease.

Chronic hepatitis B is treatable. If you think you may be infected with hepatitis B, it is important to find out if you have the virus so that you can take the necessary steps to protect yourself and others.