What are the symptoms of Hepatitis B?

The early symptoms of hepatitis B can include:

• loss of appetite
• feeling and being sick
• tiredness or fatigue
• fever

Later symptoms of hepatitis B include:

• stomach pain
• bloated stomach
• yellowing of eyes and skin (jaundice)
• itchy skin
• dark yellow urine
• pale or “clay-coloured” faeces (poo)

How long does it take for the symptoms of hepatitis B to appear?

Symptoms of hepatitis B typically appear between 8 weeks to 5 months after being exposed to the hepatitis B virus, with an average incubation period of 90 days (3 months).

Most people who are infected with hepatitis B won’t develop any symptoms at all, and will actually fight off the virus without even realising that they’ve been infected. However, this also means that those infected with hepatitis B can carry and spread the disease without being aware. Some people with hepatitis B will not be able to fight off the virus and develop a chronic infection, so they can potentially carry and spread the virus for years without it being detected.

How long do the symptoms of hepatitis B last?

If you do get symptoms of hepatitis B, most people can expect the infection to last for between one to three months. In some cases, the symptoms of hepatitis B can last for six months or even longer. Long-lasting (chronic) hepatitis B is more common in younger children and babies, though it can still affect a small number of adults.

Acute hepatitis B – over 90% of adults diagnosed with hepatitis B are able to fight off the virus within six months. These short-term infections are known as an “acute hepatitis B infection”. While it can take anywhere between one to six months to recover from an acute infection of hepatitis B, most people will make a full recovery in four to twelve weeks.

Chronic hepatitis B – around 10% of adults who are infected with hepatitis B will still have the virus over six months later.This occurs when the immune system is not able to effectively fight off the virus. These long term infections, which can be lifelong, are known as a “chronic hepatitis B infection”.

Chronic hepatitis B in children – young children and babies are at a higher risk of developing chronic hepatitis B after they are infected with the virus. This is because their immune systems have not had time to completely develop, so they are unable to effectively fight off the virus and clear it from their body. Around 90% of babies under the age of 1 that are infected with hepatitis B will develop a chronic infection, which falls to around 50% of children under the age of 6.

What are the complications of Hepatitis B?

Scarring of the liver (cirrhosis) – around 20% of people with chronic hepatitis B will experience cirrhosis during their lifetime. Cirrhosis is when liver tissue becomes damaged and forms scar tissue, reducing the liver’s ability to function properly. If the liver is severely damaged by cirrhosis, it may cause liver failure and a liver transplant may be necessary. This damage and scarring occurs over a long period of time, usually caused by a chronic infection or long term substance abuse (such as alcohol). Generally, it doesn’t cause any symptoms until this damage and scarring is quite widespread throughout the liver. While cirrhosis cannot be cured, the symptoms can be managed and progression can be slowed.

Signs and symptoms of cirrhosis include:

• feeling tired or fatigued
• weakness
• stomach pain and swelling, particularly in the upper right area (where the liver is)
• loss of appetite
• weight loss
• feeling generally unwell and nauseous
• itchy skin

Liver cancer – people with a chronic hepatitis B infection have a 25% – 40% chance of developing liver cancer during their lifetime. Hepatitis B is the leading cause of liver cancer worldwide, causing between 60% to 80% of all primary liver cancers. While most hepatitis-associated liver cancers are a consequence of liver damage and cirrhosis, a chronic infection of the hepatitis B virus can also cause changes to the cells in the liver that can develop into cancer.

Signs and symptoms of liver cancer include:

• feeling generally unwell
• loss of appetite
• feeling tired and weak
• feeling and being sick
• weight loss, that you can’t account for
• stomach discomfort or pain, particularly in the upper right area (where the liver is)
• yellowing of the skin and eyes (jaundice)
• itchy skin
• darker urine than normal
• slightly pale or clay-colour faeces (poo)

Fulminant hepatitis B –  in fewer than 1% of cases, a short-term (acute) hepatitis B infection can lead to a serious liver condition called fulminant hepatitis B. Fulminant hepatitis B is a severe type of hepatitis that causes sudden liver failure, sometimes within days, and requires immediate medical attention in hospital – if it’s not treated quickly it can be fatal.

Signs and symptoms of fulminant hepatitis B includes:

• feeling very sick and nauseous
• severe vomiting
• severe yellowing of the eyes and skin (jaundice)
• stomach becomes swollen and bloated (due to fluid building up)
• becoming confused and disorientated
• collapsing

How are the symptoms of Hepatitis B treated?

Currently there is no treatment that’s a cure for hepatitis B. Treatment for hepatitis B depends on how long you’ve been infected, though it typically focuses on managing the system and supporting the body’s functions. If you are infected, your GP will typically refer you to a liver specialist who will be able to provide expert advice and offer treatment based on the severity of your symptoms.

Post-exposure hepatitis B treatment

Hepatitis B Immunoglobulin (HBIG) – while there isn’t a cure for hepatitis B after you have been infected, if you have been recently exposed to the virus then you may be able to prevent  getting infected with a shot of hepatitis B immunoglobulin (HBIG). HBIG is a medicine that is made from blood containing high numbers of antibodies, which can boost your immune system to help fight off the virus before it can infect you. The HBIG only provides short-term protection against hepatitis B, so you should also get the hepatitis B vaccine to avoid future infections. If you think you have been exposed to hepatitis B, seek medical attention as soon as possible – the post exposure treatment is more effective if you have it within 48 hours.

Acute hepatitis B treatment

The symptoms of hepatitis B are typically quite mild, so they can normally be recovered from at home without needing any specific treatment. Treatment for a short-term hepatitis B infection is supportive care that revolves around relieving the symptoms and helping your immune system to effectively fight off the infection. Some methods to help relieve the symptoms of hepatitis B include:

Over-the-counter painkillers – over-the-counter medicines, such as paracetamol or ibuprofen, can help to relieve any stomach pain caused by hepatitis B. Speak with your doctor before taking any medication, even over-the-counter painkillers, as some can have a negative effect on your liver which could cause complications with hepatitis B.

Antiemetics – if you are feeling and being sick then a doctor may prescribe you an antiemetic. Antiemetics are a type of medication that help to relieve feelings of nausea, and can reduce the urge to vomit.

Wear soft and loose clothing – one of the symptoms of hepatitis B is itchy skin, which can be very disruptive – especially at night when you’re trying to sleep. Wearing comfortable clothing that doesn’t irritate the skin can help to reduce the feeling for itchy skin.

Antihistamines – if hepatitis B is causing your skin to feel itchy all the time, and the symptoms are particularly difficult to live with, a doctor may prescribe antihistamines such benadryl to help relieve the itch.

Get plenty of bed-rest – sleep is necessary for the body to repair itself, especially when you are feeling sick. Taking it easy and getting some rest means that your body has more energy to spend on getting better, giving your immune system a better chance of fighting off the infection and helping you to recover faster.

Chronic hepatitis B treatment

Peginterferon alfa-2a – interferons are a type of protein that occur naturally in the human body, which communicate with other cells to alert them of a viral infection. Peginterferon alfa-2a is a genetically engineered interferon that helps the body attack the hepatitis B virus and protect itself from the infection, and is usually given as a weekly injection over the course of 48 weeks.

Antiviral medication – some people may not react well to peginterferon alfa-2a or their liver may already not be working well, so may be prescribed antiviral treatment instead to help manage a chronic hepatitis B infection to help slow down to stop the progression of symptoms.

How can I prevent the symptoms of hepatitis B?

Get the hepatitis B vaccine – the most effective way to protect yourself against hepatitis B is to get the hepatitis B vaccine, which offers lifelong immunity to the virus after you have 3 doses. The hepatitis B vaccine doesn’t contain any of the live hepatitis B virus, meaning that it can help your immune system produce the antibodies needed to defend itself from a future infection without risking you developing the condition. You can get the hepatitis B vaccine from any Superdrug Health Clinic in the UK.

Use protection when having sex – hepatitis B can spread during sex, so it’s important to use a condom when having sex, especially if you don’t know the sexual health status of your partner. Condoms help to reduce the risk of getting hepatitis B during sex, but are not 100% effective.

Don’t share needles – using unsterilised needles to inject substances into your body, or sharing the same needle with another person, can infect you with the hepatitis B virus, which can spread through contaminated blood being introduced directly to the bloodstream.

Be careful with piercings and tattoos – if you are going to get a tattoo or a piercing, making sure that the shop has high hygiene standards and use sterilised equipment that is properly cleaned between uses. If you have doubts about how clean the establishment is, get it done elsewhere – it’s better to be safe than sorry.