The hepatitis B virus can survive outside the body for around 7 days and can cause infection if it enters the body of a person who is not protected by the vaccine. The incubation period of the hepatitis B virus is between 30 to 180 days. The virus may be detected in the body within 30 to 60 days after infection and can persist and develop into chronic hepatitis B

Click to view WA Health video on Hepatitis B

Symptoms & Signs

Symptoms of acute hepatitis B (such as fever, fatigue, loss or appetite and jaundice with dark urine) normally show quickly although the symptoms of chronic hepatitis generally do not show until significant liver damage occurs.  By the time these symptoms appear, the liver may have suffered advanced damage.  Approximately 15-25% of people with chronic Hepatitis B develop serious liver damage with symptoms such as

• Jaundice due to liver failure
• Bleeding disorders
• Fluid build-up in the abdomen (known as ascites) and legs (known as ankle oedema)
• High pressure in the portal veins of the liver (known as varices)
• Liver cancer

Click to view Demystifying Medicine video on Hepatitis B

Who is at risk of Chronic Disease?

The chances that HBV infection becomes chronic depends on the age at which a person becomes infected. The younger the person gets infected, the higher the chances of getting chronic disease.

• Infants and children.  80-90% of infants infected during the 1st year of life and 30-50% of children infected before the age of 6 years will develop chronic infection
• Adults. Less than 5% of healthy adults develop chronic infection but there is a 15-25% chance of developing liver cirrhosis and/or liver cancer later on in life

Diagnostic & Follow-up Tests

Blood tests

• Liver Function Blood Test to determine how efficiently the liver is functioning by looking at the levels of bilirubin, protein and liver enzymes such as AST, ALT and ALP
• Hepatitis Blood Test can determine the presence of hepatitis virus antigens & antibodies and most importantly, which type of hepatitis virus is in the body. 

Abdominal Ultrasound

The ultrasound scan is used to measure the liver size and to view the texture of the liver.  A liver biopsy may be done at the same time if cancer is suspected

MRI Scan

MRI scan is used to view and measure any liver lesion, extent of liver damage or cirrhosis (scarring of the liver)

Treatment for Hepatitis

Treatment of hepatitis depends on whether the disease is acute or chronic.

1. Acute Hepatitis B.  Patients with acute hepatitis B (defined as first 6 months of infection) do not require specific treatment but need supportive medical attention.

2. Chronic Hepatitis B.  Patients with chronic disease (defined as illness which occurs when the virus remains active in the body) may need antiviral medications and requires regular life-long monitoring to see if the virus is still under control.  These patients need REGULAR CHECK-UP of their liver function to look out for liver damage, cirrhosis or liver cancer which can occur in 15-25% of patients infected with Hepatitis B.

WHO recommends the use of oral antiviral medications (such as Tenofovir or Entecavir) to suppress the Hepatitis B Virus replication.  As it is not a cure, the treatment may be required for life long.  Treatment decisions are based on the basis of serology, viral load, liver function tests, stage of liver disease, age of patient and patient’s health amongst other factors.

Blood Test Monitoring

• The presence of HbsAg means the patient has had exposure to Hepatitis B infection
• In acute infection, there is the presence of HBsAg and IgM antibody to the core antigen (HBcAg) as well as HBeAg.  The presence of HBeAg is a marker of high levels of virus replication and that the person is HIGHLY CONTAGIOUS
• In chronic infection, there may be persistence of HBsAg which suggests risk of developing chronic liver disease later in life
• Susceptible people who have NO antibodies should consider to have HBV vaccination
• You will also need other blood tests to check for liver function tests (AST, ALT, ALP & bilirubin), blood clotting tests as well as albumin levels

Blood Serology results	Susceptible person	Immune due to natural infection	Immune due to HBV vaccine	Acute infection 6 months	Chronic infection
HbsAg	–	–	–	+	+
anti HbcAg	–	+	–	+	+
anti HbsAg	–	+	+	–	–
IgM to anti HbcAg	–	–	–	+	–

Remember to keep your follow-up appointments and do your blood tests regularly to help monitor your condition

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