Introduction

Hepatitis is the medical term for an inflammation of the liver. It is often caused by an infection with certain viruses. There are several types of hepatitis viruses, which are named using different letters: Hepatitis A, B, C, D and E.

The hepatitis B virus is mainly spread through blood, but also through other body fluids. It is rare for people to become infected with hepatitis B in countries like Germany. In adults, hepatitis B usually goes away on its own and doesn’t have any long-term effects. Many people don’t even notice that they have it. But it can sometimes become chronic and eventually lead to serious health problems.

Symptoms

Hepatitis B can cause various symptoms, including a lack of appetite, nausea and vomiting, yellowish skin and eyes (jaundice), generally feeling unwell, achy joints and fever.

Many people who become infected don’t have any symptoms, or they don’t have typical symptoms. And it can take 1 to 6 months for symptoms to occur after becoming infected. So a person may have hepatitis B for quite a while before it's diagnosed, and could unknowingly pass the virus on to other people during that time.

Risk factors

The virus is usually spread through unprotected sex – most commonly between men who have sex with each other. People who have different sexual partners have a higher risk of getting hepatitis B. Other routes of infection include using non-sterile syringes when consuming drugs or having a tattoo done with non-sterile needles. The risk of infection is also higher for people who live with someone who has hepatitis B, and for people who permanently live in a country with a high number of infected people.

If a pregnant woman has hepatitis B, she might pass it on to her baby while giving birth. In Germany and other countries, pregnant women are offered a hepatitis B test. If a woman is found to be infected with the virus, measures can be taken to prevent her baby from becoming infected during or after the birth.

Prevalence

According to data collected by the Robert Koch Institute (RKI), about 3,600 people were infected with the hepatitis B virus in Germany in 2017. About 260,000 of the 80 million people living in Germany have a chronic (permanent) hepatitis B infection.

Outlook

Hepatitis B infections can lead to inflammation in the liver. Acute infections in adults usually clear up on their own and don’t have to be treated. In very rare cases they can lead to sudden liver failure.

If someone has had hepatitis B in the past and recovered from it, it means that their immune system has made antibodies that will most likely keep the virus under control. In rare cases hepatitis B viruses can become active again – for instance, if the immune system is very weak due to chemotherapy.

In some people the infection becomes permanent. Over time, chronic hepatitis B can lead to serious complications such as liver cirrhosis, a build-up of fluid in the abdomen (ascites), bleeding and liver cancer.

If a baby gets hepatitis B from their mother during or after their birth, the infection usually becomes chronic. This happens in 90 out of 100 children in this situation.

Diagnosis

Hepatitis B can be diagnosed using a blood test to detect certain parts of the virus (such as virus antigens) or antibodies to parts of the virus.

The blood test can also be used to screen for hepatitis B – in other words, to detect hepatitis B in people who don’t have any symptoms yet. In Germany, pregnant women can have this test for free – statutory health insurers pay for it as part of their standard prenatal care.

Prevention

There is a vaccine for the prevention of hepatitis B. The German Standing Committee on Vaccination (STIKO) at the Robert Koch Institute (RKI) recommends that all babies and toddlers be vaccinated against hepatitis B. Whether or not the vaccine makes sense for adults will depend on their individual risk of infection, which depends on the risk factors mentioned above.

The vaccine is recommended for people who have a weakened immune system and for people who are planning to have medical treatment that suppresses the immune system. It is also recommended for those who are in close contact with people who have chronic hepatitis B or who are more likely to be exposed to the virus at work, such as healthcare professionals or cleaning staff at a hospital. It can be a good idea to have the vaccine before traveling to countries where hepatitis B is very common. You will find more information about travel vaccinations on the website of the World Health Organization.

Treatment

In most cases the body’s immune system is able to effectively fight a hepatitis B infection. Symptoms such as nausea and pain can be treated with suitable medication. Several months after hepatitis B is diagnosed, another blood test can be done to see whether any signs of the virus are still detectable. Sometimes small amounts of the virus remain in liver cells although there are no viruses in the blood. But the viruses in the liver cells rarely cause further problems.

Chronic hepatitis B infections are usually treated with tablets designed to fight the virus and prevent liver damage (nucleotide analogues / nucleoside analogues). Temporary treatment with interferon alpha may be considered too.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

Sources

• Cornberg M, Protzer U, Petersen J, Wedemeyer H, Berg T, Jilg W et al. Aktualisierung der S3-Leitlinie zur Prophylaxe, Diagnostik und Therapie der Hepatitis-B-Virusinfektion. AWMF-Register-Nr.: 021-011. Z Gastroenterol 2011; 49: 871–930. [PubMed: 21748700]
• Institute for Quality and Efficiecy in Healthcare (IQWiG, Germany). Screening for hepatitis B: Final report; Commission S16-03. November 14, 2018.
• Poethko-Müller C, Schmitz R. Impfstatus von Erwachsenen in Deutschland. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsbl 2013; 56: 845–857. [PubMed: 23703506]
• Robert Koch-Institut (RKI). Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut – 2017/2018. August 24, 2017. (Epidemiologisches Bulletin; Volume 34).
• Robert Koch-Institut (RKI). Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2016. Berlin: RKI; 2017.
• Robert Koch-Institut (RKI). Virushepatitis B und D im Jahr 2017. July 26, 2018. (Epidemiologisches Bulletin; Volume 30).
• Trepo C, Chan HL, Lok A. Hepatitis B virus infection. Lancet 2014; 384(9959): 2053-2063. [PubMed: 24954675]

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.