What is hepatitis B?
Hepatitis B is a liver disease caused by a virus.
The liver is an organ in our abdomen (belly). It helps our bodies remove toxins and waste. It also helps us digest food and stores the energy we get from food.
The word hepatitis means that there is inflammation of the liver. Inflammation of the liver can affect the liver's ability to work properly. Hepatitis can be caused by infections (virus, bacteria or parasites), drugs or toxins (including alcohol). There are several types of viruses that can cause hepatitis. One of these viruses is the hepatitis B virus. Over time, hepatitis B may cause irritation and scarring in the liver, making it difficult for your liver to work properly.
How do people get hepatitis B?
The hepatitis B virus may be spread from person to person by blood contact, by sexual contact, and during pregnancy or delivery from mother to baby.
- Most children with hepatitis B were born to mothers who are also infected with the virus, which is passed to the baby either during pregnancy or delivery.
- Rarely, people can get hepatitis B if they share personal items that may have the blood of someone with hepatitis B on them (such as toothbrushes, nail clippers or razors).
- It is possible to get the virus from a blood transfusion, from other blood products, or from improperly cleaned medical equipment. This almost never happens in Canada.
- Anyone can get hepatitis B from unprotected sex or from sharing needles, such as the needles used for body piercing, tattooing, acupuncture or intravenous drug use.
Hepatitis B cannot be spread to other people by hugging, kissing, sneezing, coughing or breastfeeding. Because the amount of virus in saliva is low, it is unnecessary to have two sets of eating utensils or dishes at home. You and your family can safely use the same sets.
How can I protect others from hepatitis B?
The risk of spreading hepatitis B infection is very low in regular day-to-day activity. If you or someone in your home has hepatitis B then all other people living there should be immunized against it with the vaccine against the hepatitis B virus. If you have hepatitis B you should not share your toothbrush or other personal items that may have traces of blood on them (razors and nail clippers). You should not let other people touch your blood, and you should not touch the blood of others.
Hepatitis B is also spread through unprotected sexual contact. To avoid spreading hepatitis B, and also to protect yourself and your partner from other sexually transmitted infections, you should practice safe sex. You should prevent any bodily fluid exchange between your body and your partner's by using barrier protection such as condoms.
It is unclear whether you can get hepatitis B from oral sex; for the best protection, you should always use condoms or other barrier protection devices such as dental dams. For more information on safe sex practices, please visit sexandu.ca.
To prevent infecting your partner you should make sure they are immunized against the hepatitis B virus. If they have not been immunized against hepatitis B, they should ask for the vaccine at their doctor's office. If they have been immunized before or cannot remember if they have been immunized, they should have a blood test to make sure the immunization worked.
What tests can tell me how I am doing with hepatitis B?
Blood work can tell many things about the hepatitis B virus and how it is affecting your liver. Common tests that are helpful include:
- Liver enzymes (ALT and AST): The levels of these enzymes in the blood indicate how much inflammation is occurring in your liver. High levels mean there is more liver inflammation. A lot of inflammation over time can lead to scarring of the liver.
- Hepatitis B viral load: This test tells how much hepatitis B virus is in your blood.
What do liver enzymes in the blood and viral load mean?
Many young people have a high viral load because their immune system does not recognize and control the hepatitis B virus. As long as the liver enzyme levels are normal and you have regular checkups, a high viral load is common and does not mean you will be unwell.
Higher than normal levels of liver enzymes in your blood usually mean that your immune system has recognized the virus and is trying to fight it. In many people, the immune system will be able to reduce the amount of hepatitis B virus in the blood. This is good because it means the risk of scarring in the liver because of hepatitis B is reduced. In some people, this inflammation may go away on its own over a short period of time. For people with liver enzymes that are high for a long time (six to 12 months), your health-care provider may recommend treatment to help control the inflammation in the liver before scarring can develop.
What happens if I get scarring in my liver?
Many people live their whole lives with hepatitis B without significant damage to their liver. However, as people age the risk of scarring in the liver increases. Mild scarring in the liver does not usually affect the way the liver works. Severe scarring (cirrhosis) may make it difficult for the liver to work properly. Cirrhosis only rarely happens in children and teenagers with hepatitis B. Chronic hepatitis B infection also increases the risk for liver cancer, especially if it has caused bad liver scarring. However, liver cancer is very rare in children and teenagers with hepatitis B.
Regular medical follow-up throughout your life is important. This should allow problems in your liver to be identified and treated early, which may prevent you from becoming sick.
Will my hepatitis B infection disappear?
It is most likely you will keep the infection throughout your life. This is called chronic hepatitis B infection. Only very rarely do people get rid of the virus completely.
Can people tell I have hepatitis B?
Most young people with hepatitis B look completely well and do not have any symptoms or signs that they have the virus. Most people with hepatitis B usually feel well and participate in school, work and other activities.
How can I keep my liver healthy?
There are many things that help your liver stay healthy.
- A healthy diet with plenty of fresh vegetables and fruit helps provide antioxidants that protect the liver from the bad effects of inflammation.
- Regular physical activity when combined with a healthy diet keeps weight under control. Being overweight will often cause extra difficulty for the liver.
- Be careful with herbal, natural or other alternative or complimentary treatments. Check with your doctor before taking any herbal medications as some of these may be harmful to the liver.
- Be careful about other medications because some medications are processed by the liver. If you need medication for other health conditions, it is important to follow the instructions carefully, or to ask your health-care provider or pharmacist for advice.
- Get immunized. You should have all of the recommended immunizations available and should be immunized against hepatitis A.
- Avoid alcohol and other types of drugs which may cause damage to the liver.
Does drinking alcohol or taking drugs hurt my liver?
Drinking alcohol often or drinking alcohol in large amounts can cause irritation in your liver and may lead to scarring over time. When you have hepatitis B, this scarring may happen sooner and be worse than in a person who does not have hepatitis B. It is unknown how much alcohol you can drink safely before it starts to damage your liver. The best thing to do is to either drink no alcohol, or as little as possible.
Taking street drugs may also cause damage to your liver or other organs, even smoking marijuana. Some drugs may cause severe liver damage the first time you try them. Avoid street drugs if you do not want to further damage your liver.
Who do I have to tell about my hepatitis B status?
People who should know about your hepatitis B are your health-care providers, such as your doctors, nurses and dentist. Not everyone needs to know about hepatitis B. It is up to you who you tell about your hepatitis B infection. Friends, family and teachers do not have to be told unless you feel comfortable doing so.
It is important to talk about hepatitis B with your sexual partners as they should be immunized against hepatitis B to protect themselves from getting the virus.
Some university courses and jobs, like medical school and being a doctor or dentist, require you to share information about your hepatitis B status with them. If you are unsure about the need to tell someone about your hepatitis B infection, discuss this with your parents, caregiver and your health-care provider.
If I have children someday, will they have hepatitis B?
There are many things that can be done to help prevent your children from getting hepatitis B.
If you are pregnant, you may be given medication during pregnancy that will help reduce the amount of hepatitis B in your blood (your viral load). On the day of birth, your baby should be given the first dose of the hepatitis B vaccine and given another medicine, hepatitis B immunoglobulin, that helps their immune system fight hepatitis B. Your child will then need at least two additional doses of the hepatitis B vaccine at one month and six months of age.
If you are a father-to-be, your baby will not be at risk for hepatitis B before they are born, unless the mother is also infected. All children who have a parent with hepatitis B should be immunized against the virus as soon as possible. Before having a child, it is important to discuss your hepatitis B status with your health-care provider and with the health-care provider looking after the pregnancy.
