Infectious Diseases
Hepatitis B: Risks, Prevention, and Treatment
2025-09-04 • Updated 2025-12-10
Intro
Hepatitis B is a viral infection that attacks the liver and can cause both short-term (acute) and lifelong (chronic) illness. Around 300 million people worldwide live with chronic hepatitis B, making it one of the major causes of cirrhosis and liver cancer globally.
Vaccination—especially in infancy—is the most effective way to prevent infection.
If you want detailed guidance on the Hepatitis B birth dose, see:
👉 /guides/hepatitis-b-birth-dose-guide
If you want analysis of new US policy changes, see:
👉 /posts/cdc-hepb-birthdose-debate
Key Points
- Hepatitis B is transmitted through blood or bodily fluids.
- Newborns and infants are at the highest risk of developing chronic infection.
- Chronic HBV infection can lead to cirrhosis, liver failure, and liver cancer.
- The vaccine provides >95% long-term protection when the full series is completed.
- Many countries use a birth dose to protect infants immediately after birth.
- Antiviral medicines control chronic infection but do not usually cure it.
Hepatitis B by the Numbers
- ~300 million people worldwide live with chronic hepatitis B.
- Up to 90% of newborns infected at birth develop chronic infection.
- >95% vaccine effectiveness after completing the series.
- Dramatic falls in childhood liver cancer in countries using universal infant vaccination.
- Hepatitis B contributes to hundreds of thousands of deaths each year from liver disease.
Background
HBV is extremely infectious—more so than hepatitis C or HIV. It can survive on surfaces and in dried blood for days, making household transmission possible in early childhood.
Unlike hepatitis A, which is short-lived, hepatitis B can persist in the body for decades.
Causes and Transmission
HBV is spread through:
- Birth (mother-to-child)
- Household exposure (microscopic blood, shared grooming items)
- Sexual contact
- Injection drug use
- Medical procedures using unsterile equipment
- Needlestick injuries
Infants infected at or around birth face the highest risk of lifelong infection.
Symptoms
Most acute infections—especially in children—cause few or no symptoms. When symptoms do occur, they may include:
- Fatigue
- Nausea, vomiting
- Loss of appetite
- Fever
- Abdominal discomfort
- Dark urine, pale stools
- Jaundice (yellow eyes/skin)
Chronic hepatitis B is often silent until severe liver damage emerges.
Diagnosis
HBV is diagnosed and monitored through:
- HBsAg (surface antigen)
- Anti-HBs (surface antibody)
- Anti-HBc (core antibody)
- HBV DNA (viral load)
- Liver function tests
- Ultrasound or elastography for fibrosis
- Liver cancer surveillance in high-risk patients
Treatment
Acute hepatitis B
- Most healthy adults clear the virus naturally.
- Treatment is usually supportive.
Chronic hepatitis B
Aimed at reducing liver damage:
- Antiviral medicines (tenofovir, entecavir)
- Regular liver monitoring
- Cancer screening in higher-risk individuals
- Liver transplant for advanced cirrhosis
A complete cure is still being researched, but new therapies are in development.
Prevention
Vaccination
The safest and most effective strategy.
Infants:
- Many systems give a birth dose, then doses at 2, 4, and 6 months.
- Others begin at 6–8 weeks for low-risk infants.
For full birth-dose details, see:
👉 Hepatitis B Birth Dose Guide (/guides/hepatitis-b-birth-dose-guide)
Adults & adolescents:
- Two- or three-dose catch-up options
- Strongly recommended for healthcare workers, people who inject drugs, and other high-risk groups
Other strategies
- Screening pregnant women
- Antiviral therapy in pregnant women with high viral load
- Safe sex practices and condom use
- Testing and vaccination of household contacts
- Avoiding shared razors, toothbrushes
- Needle and syringe programs
Recent Developments
- WHO aims to eliminate hepatitis B as a public health threat by 2030.
- Debate has emerged around changes to the US birth-dose policy.
See the analysis here:
👉 /posts/cdc-hepb-birthdose-debate - Multiple curative therapies are in clinical trials, including capsid inhibitors, siRNA therapies, therapeutic vaccines, and immune modulators.
FAQ
Is hepatitis B curable?
Not usually. Chronic infection can be controlled with antiviral medicines.
Can hepatitis B come back after vaccination?
Breakthrough infection is extremely rare. The vaccine provides long-term immunity for most people.
Why do some countries give a birth dose?
To prevent early-life infection and provide a safety net when testing fails.
How dangerous is chronic hepatitis B?
Very. It significantly increases the risk of cirrhosis and liver cancer.
Do I need testing if I was vaccinated?
Most people do not, but certain high-risk groups (e.g., healthcare workers) may require titres.
Further Reading
Related Guides
- #hepatitis B
- #liver disease
- #vaccination
- #public health