Hepatitis B is a very common virus. Worldwide, an estimated two billion people have been infected with hepatitis B virus (HBV), and more than 350 million are chronic carriers of the virus, mostly in Asia, Africa and China. HBV infects the liver and can cause hepatitis. Hepatitis simply means “inflammation of the liver”.
Transmission
HBV is transmitted between people by contact with the blood or other body fluids (i.e. sem*n or vagin*l fluid) of an infected person. Common modes of transmission in developing countries are:
Perinatal (from mother to baby at birth)
Early childhood infections (unapparent infection through close interpersonal contact with infected household contacts)
Sexual contact
Unsafe injection practices
Blood transfusions.
In many developed countries (e.g. those in Western Europe and North America), patterns of transmission are different from those mentioned above. Today, the majority of infections in these countries are transmitted during young adulthood by sexual activity and injecting drug use.
HBV infection cannot be spread through ordinary day-to-day activities such as eating and drinking with friends or family; sharing washing or toilet facilities and hugs and kisses are all safe. There is no risk of infection from shared cooking and eating utensils, or baths, showers or swimming pools. HBV cannot be passed on by tears, sweat, coughs, sneezes or insect bites. HBV is not spread by contaminated food or water, and cannot be spread casually in the workplace.
Signs and symptoms
There are usually no symptoms from hepatitis B virus infection unless there is liver damage, but even then the symptoms may be vague. Persistent tiredness is a common symptom and there may be a short flu-like illness, feeling generally unwell and loss of appetite. There may also be jaundice, which might make the whites of the eyes look yellow and the urine become darker than usual. Severe liver damage can cause bleeding, usually from the gut, fluid retention in the abdomen and even jaundice. Having hepatitis B virus infection does not necessarily mean that the liver will be permanently damaged, but it is very important that the person has a full medical check-up, including liver function tests.
Most (95%) adults who become infected with hepatitis B virus recover completely from the infection and develop antibodies which make them immune to further infection. Babies or small children, or people whose immune system is depressed for some other reason, may not be able to overcome the virus and get rid of it. They may become persistently infected with hepatitis B virus, and will have the virus in their liver for most of their lives. Persistent infection with hepatitis B virus can lead to inflammation of the liver in the long term. This may result in liver damage and cirrhosis of the liver. People who develop cirrhosis have an increased risk of developing liver cancer.
Important information about your test results
The tests performed on your donation have given positive results for HBV. This means that you are infected with HBV and that the virus is in your bloodstream. Because the virus is also in the blood, it can be passed on to the recipient of blood transfusion. The tests do not give any information about when or how you became infected, or whether your liver is inflamed or not. Other tests should be performed which will give much more information about your health.
Your test results are regarded as strictly confidential and will not be disclosed to anyone without your consent. Being infected with HBV does not necessarily mean that your liver is inflamed or that you will become ill in the future. However, we could refer you to a specialist in liver disease for further medical care and treatment. Furthermore, you are infectious to your sexual partner and should seek treatment for both yourself and your partner. If you do not want to, or are unable to inform your partner, the specialist centre may be able to help you with that.
We advise you to think very carefully before sharing your result with others. Most people do not need to know. You should tell those with whom you recently or regularly had sexual contact. You should also tell your doctor (GP) and any other doctor who may look after you, particularly for females who are planning a pregnancy. You should also inform your dentist of the possible infection risk.
If you are a health care worker, you will need to inform your occupational health adviser. If you are engaged in exposure-prone procedures with patients, you should not work until you have taken advice. For most people there are no occupational health issues and other people do not need to know.
Having someone to talk to may help, especially in the first few days after you hear the news. You can contact the doctor or nurse at the BTS again. The specialist centre that we refer you to will also have people who can help you. There are helplines which offer counselling and support as well as information leaflets on a wide range of topics.
Medical care and treatment
It is very important to have a full medical check-up. This should be arranged with a specialist in liver disease. The specialist will arrange a full medical assessment of your liver which will give much more information about your health. You will also be advised if any treatment is necessary.
There is no cure for hepatitis B virus infection, but medications are available which can reduce the harmful effects of the virus. Whether or not you need treatment will depend on how the virus is affecting your liver. There is no special diet that should be followed, but it is important to avoid alcohol as this also causes hepatitis and liver damage.
How to prevent HBV from being transmitted to others
Blood donation: Unfortunately, you will no longer be able to give blood. Any current sexual partner cannot be a donor either.
Sexual contact: Any sexual contact, where infected body fluids enter the body of another person, carries the risk of infection. The degree of risk varies with the activity. The sexual activities most likely to pass on the virus are:
Unprotected anal intercourse (that is, without a condom)
Unprotected vagin*l intercourse (that is, without a condom)
Any activity which draws blood – this would include sexual intercourse during the menstrual period.
The infection is passed more easily from a man to a woman than from a woman to a man, but it is recommended that:
A regular partner is immunized against hepatitis B virus to protect against the risk of transmission; this can be arranged by your doctor
Condoms are used with other partners to reduce both the risk of passing on HBV and the risk of acquiring some other infection.
Pregnancy and breastfeeding: There is a risk of the virus being passed from mother to baby at the time of birth. Throughout the world this is probably the most common way for the infection to be passed on, but it can be prevented if the baby is given protective injections at birth. There is also a risk from breastfeeding, but this is prevented if the baby has been protected.
Accidents which involve blood spillage could expose other people to risk, so it is recommended that you:
Wipe up spillages yourself, using disposable paper towels and then swab the area with household bleach or detergent
Cover cuts or open wounds
Dispose carefully of soiled dressings and used sanitary towels or tampons, by flushing them down the toilet, or by packing them carefully in waterproof wrapping (plastic) before disposal
Wash blood-stained linen or clothing in the usual way using a domestic washing machine
Do not share razors, toothbrushes or nail scissors since traces of blood may be left on them after use
Do not play contact sports if you have a cut or other injury which is likely to bleed.
