The Center for Acute Disease Epidemiology (CADE)

It is important to know that many people who are infected with hepatitis B may never know it. Many infected people have very mild symptoms or no symptoms at all. However, if symptoms do present, they may show up in many different phases.

Prodromal phase. The time period from the initial onset of symptoms up to the onset of jaundice. Symptoms commonly appear between two to three months after infection. This phase of the disease usually lasts from 3 to 10 days and symptoms can include:

• Depression
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Fever
• Headache
• Muscle and joint aches
• Skin rashes

Icteric Phase. Follows the prodromal phase, usually lasts one to three weeks, and is characterized by:

• Yellowing of the skin and eyes (jaundice)
• Tea-colored urine
• Light or gray stools
• Tenderness of the liver
• Enlarged liver and spleen

Recovery Period. During the recovery period, depression and fatigue may last for weeks or months, while other symptoms usually disappear. After recovery, about 10 percent of adults will become lifelong carriers of the virus. Between 30 to 50 percent of children ages one to five years old who become infected with hepatitis B will become carriers. This means that they will probably never get rid of the virus and are still capable of spreading it even without symptoms.

Fulminant Hepatitis. About 1 to 2 percent of infected people will progress to fulminant hepatitis. This final phase of disease may lead to death of the patient and is characterized by:

• Severe symptoms listed above
• Liver disease (cirrhosis)
• Liver cancer (hepatocellular carcinoma)

Humans are the only known reservoir for the hepatitis B virus. The virus can be found in the bodily fluids of an infected person. These fluids include, but are not limited to:

• Blood
• Saliva
• Cerebral spinal fluid
• Amniotic fluid
• Semen

All of these fluids are capable of spreading the virus from one person to another. There are many ways that the virus can spread from one person to another including:

• Person-to-person. The main route of transmission in the U.S. is by sexual contact with an infected person. Infection can also occur if a person comes into contact with any of the infected fluids listed above.
• Needle sticks. Contaminated needles used during recreational drug use or in health care facilities can spread disease. Contaminated needles used for tattooing have also been implicated in the spread of disease.
• Mother-to-infant. If a pregnant woman is infected with the hepatitis B virus, there is a very high chance that the infant will become infected in the absence of preventative measures.

Anyone can become infected with hepatitis B. However, people with the following chronic conditions are more likely to develop a chronic infection:

• Down syndrome
• Lymphoproliferative disease
• HIV/AIDS
• Compromised immune system

Other actions or characteristics that put people at greater risk for a hepatitis B infection include:

• Having unprotected sex with more than one partner
• Having a sexually transmitted disease such as gonorrhea or Chlamydia
• Men who have sex with men
• Sharing needles for recreational intravenous drug use
• Living with someone who has a chronic hepatitis B infection
• Having a job that exposes you to human blood
• Traveling to regions of the world where hepatitis B infection is common. These regions include Africa, Central and South Asia, and Eastern Europe

One of the best ways to prevent hepatitis B infection is to get vaccinated. Vaccination is typically recommended for children, adolescents, all newborns before they leave the hospital, and people who are at high risk for infection.

Other recommended methods for preventing infection include:

• Do not share needles for drug use, ear piercing, tattooing, or any other purpose
• Avoid contact with blood or wound drainage of any person
• Use condoms when having sex
• Consider getting vaccinated before traveling to a region of the world where hepatitis B is common

Treatment immediately after exposure. If you know you’ve been exposed to hepatitis B, you can receive an injection of hepatitis B immune globulin within 24 hours of the exposure.

Treatment for acute (short-lived) hepatitis B infection. There is no specific treatment for acute hepatitis B infection. People who are sick with hepatitis B should see a doctor for advice about how to control their symptoms.

Treatment for chronic hepatitis B infection. Antiviral treatment has been developed for people with chronic hepatitis B infection. This treatment leads to remission of the disease in 25 to 40 percent of adults suffering from chronic hepatitis B infection and liver disease. In severe cases where the liver is damaged, a liver transplant may be considered.