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Symptoms of Hepatitis B
Many people do not have any symptoms if they contract hepatitis B, although they can still pass the virus on to others. Other people will have some symptoms similar to those of hepatitis A. Common symptoms include:

• flu-like symptoms, such as tiredness, general aches and pains, headaches and fever,
• loss of appetite, nausea or vomiting, and diarrhoea, abdominal pains, and
• jaundice - this occurs because your inflamed liver is unable to remove bilirubin, a substance in the blood that causes your skin and the whites of your eyes to become yellow. It may also turn your urine very dark and your stools (faeces) may become pale. Jaundice can also cause itching.

Very rarely, a serious acute hepatitis called fulminant hepatitis B occurs. Symptoms include collapsing, severe yellowing of the skin and eyes (jaundice), and swelling of your abdomen. It can be fatal if not treated quickly.

Many people who have hepatitis B as adults will clear the infection and become immune. However, the disease is said to be chronic when you have been infected for longer than six months. Some people are carriers and have no symptoms, remaining healthy while clearing the virus from their bodies. They may not even know they have been affected.

Others, especially babies and children, will have symptoms that come and go. This is similar to the acute stage, symptoms such as fatigue, nausea, abdominal pain, weight loss, and jaundice. These people may then go on to develop irreversible scarring of the liver, called cirrhosis, and may eventually develop liver cancer.

Causes of Hepatitis B
Hepatitis B is spread when blood or body fluids from someone who has the virus infects someone who is not immune. Many people with hepatitis B do not even realise that they are infected.

The spread of the virus can happen in several different ways. You are at particularly high risk if:

• you are sexually active and have unprotected sex with several different partners,
• you have an open wound, cut or scratch, and come into contact with the blood of someone with hepatitis B,
• you use drugs and share equipment, such as needles, spoons and filters,
• you work closely with blood and bodily fluids, for example health care workers, nurses and laboratory technicians are at increased risk of needlestick injury when the skin is accidentally punctured by a used needle, and
• you have hepatitis B and are pregnant. Mothers can pass the virus to their babies during pregnancy, when giving birth or during breastfeeding. All pregnant women in the UK are tested for hepatitis B. If they are infected, the baby is given a course of injections of immunoglobulin and immunised immediately after birth to help prevent infection from developing.

There is a small risk of contracting the hepatitis B virus from sharing toothbrushes, razors and towels, which may be contaminated with blood. Unsafe tattooing and body piercing practices also risk potentially spreading the virus.

The viral infection is also more likely to be passed on in countries where equipment for medical and dental treatment is not sterilised properly. This can also be the case in countries where blood is not tested for hepatitis B, and blood transfusions may still result in infection. All blood donations in the UK are tested for hepatitis B. Travellers are advised to vaccinate themselves against hepatitis B before setting off on their trip.

Chronic hepatitis (persistent liver inflammation) can also be caused by the body attacking its own organs as if they were a foreign bacteria or infection. This is known as autoimmune hepatitis and is a rare cause of chronic hepatitis.
Hepatitis B cannot be spread through sneezing, coughing or hugging someone who is infected with the viral infection.

Diagnosing Hepatitis B
Hepatitis B is detected by a blood test that will show a positive reaction to antibodies. This reveals that your body is making antibodies to try and fight the hepatitis B virus. Your GP may also request a liver function test. These are blood tests that measure certain enzymes and proteins in your bloodstream, which indicate whether your liver is damaged or inflamed. These will often show raised levels if you are infected with the hepatitis B virus.

The amount of liver damage can only be assessed by taking a liver biopsy. This involves a hollow fine needle being passed through the skin into your liver, to take a sample of tissue. The cells are then examined under a microscope to assess the amount of liver damage, inflammation, and cirrhosis (scarring).

Treating Hepatitis B
There is often no specific treatment for acute hepatitis B. Pain relief for your symptoms, rest, a healthy diet, and no alcohol will most certainly be advised. Most people tend to be symptom free, or recover completely within a couple of months, never going on to develop chronic hepatitis. If you are diagnosed as having an active infection, you will be advised to have regular blood tests and physical check-ups.

However, if you develop chronic hepatitis, treatment may involve an antiviral medication called interferon. This will help to prevent the virus causing more liver damage. Interferon is given by injection three times a week for around six months. You may be taught to inject yourself.

Interferon often produces side effects, such as flu-like symptoms, especially in the early stages of treatment. You will need to be monitored regularly for these potential side effects by your GP.

Autoimmune hepatitis (where the body attacks its own organs) is treated with steroid medication which helps to reduce the inflammation that causes cirrhosis (scarring of the liver), which can be fatal.

For some people with cirrhosis and other life-threatening complications, having a liver transplant is an option. However, the virus may infect the new liver and can sometimes cause disease again some time later.

Preventing Hepatitis B
Anyone who is at increased risk of being infected with the hepatitis B virus should consider being immunised. People at risk include:

• those who come into close contact with blood products for example, nurses, healthcare workers, doctors, dentists, medical laboratory workers, and prison wardens,sexual partners and close family members of an infected person,
• injecting drug users who share needles and other equipment, such as spoons and filters,
• people who have unprotected sex and change sexual partners frequently,
• travellers to countries where hepatitis B is common, and
• people with haemophilia (inability to clot blood).
• You can ask your GP or go to your nearest sexual health GUM (genito-urinary medicine) clinic for the immunisation.

You will need three injections of hepatitis B vaccine over a period of 4-6 months for full protection. A blood test is then taken one month after the third dose to check that the immunisations have worked. You should then be immune for at least 5 years. A booster injection is usually given 5 years after the initial injection.
Before your trip, you should arrange to see your GP to receive the hepatitis B vaccination if you are planning to travel to countries where the condition is particularly common - for example, south east Asia, sub-Saharan Africa, or the Pacific Islands, such as the Hawaiian Islands, the Solomon Islands, and Fiji.
Some GP surgeries, and sexual health, or GUM (genito-urinary medicine) clinics, provide the hepatitis B vaccination free-of-charge to people who are in high risks groups. If you are not thought to be at risk, you may have to pay a small fee for the vaccination.

Anyone exposed to the virus should be given an injection of immunoglobulin immediately as well as the vaccine.