Hepatitis B

Hepatitis means inflammation of the liver. The liver is an organ which carries out lots of important jobs in the body. If the liver is inflamed or damaged it may not work properly.

*This website provides general information but does not replace medical advice. It is important to contact your/your child’s medical team if you have any worries or concerns
Download our Hepatitis B leaflet for full information and diagramsDownload our young people with Hepatitis B leaflet for full information and diagrams

Hepatitis B is a virus that causes an infection. The virus is present in blood and bodily fluids. The body’s immune system responds to the virus and this response can damage the liver cells.

Acute hepatitis B

It can occur in both adults and children, although it is less common in children. Sometimes there may be no symptoms but in other cases it can cause someone to become very ill.

Symptoms of acute hepatitis B:

  • Tiredness
  • General aches and pains
  • A high temperature (fever)
  • A general sense of feeling unwell
  • Loss of appetite
  • Feeling and being sick
  • Diarrhoea
  • Tummy (abdominal) pain
  • Yellowing of the skin and eyes (jaundice)
  • Dark urine and pale, grey-coloured stools

Chronic hepatitis B

This is when the hepatitis B virus does not clear from the body within six months. This is more common in children but can occur in adults as well. When hepatitis B is acquired at a younger age, it is more likely to become chronic (long-term).

Symptoms of chronic hepatitis B:

Most children with chronic hepatitis B have no symptoms. However, some children may experience symptoms if they have a ‘flare’ of the hepatitis B infection. A flare can occur when the liver enzymes become raised (See leaflet an Introduction to Liver Disease). Symptoms may be the same as those for acute hepatitis B but they are milder and tend to come and go.

It’s important that children are referred to a specialist children’s liver centre where their liver function and hepatitis B virus can be closely monitored, assessed and treatment provided if necessary.

How did my child get hepatitis B?

Hepatitis B is spread when blood from an infected person enters another person’s body. The virus can be spread even if the person doesn’t have any symptoms.

It cannot be spread by casual contact such as sharing utensils, cups, cuddling, hand holding or by breastfeeding (unless nipples are cracked or bleeding). Hepatitis B cannot be spread through casual kissing but there may be a risk if there are cold sores, ulcers, bleeding gums, cuts or abrasions in the mouth of the infected person.

Hepatitis B can be transmitted from mother to child or by person-to-person transmission.

Mother to child (vertical transmission)

The main way children in the UK contract hepatitis B is at birth from their mothers who have hepatitis B infection. Pregnant women in the UK are tested for hepatitis B as part of their antenatal routine during pregnancy. If a pregnant woman tests positive for hepatitis B and she has been told that she is at high risk of transmitting the infection, she should receive oral antiviral treatment in the 28th week of the pregnancy. This helps to reduce the risk of her child also contracting the infection. Babies born to mothers who have hepatitis B are considered high risk infants. These babies should receive the accelerated hepatitis B vaccination course as stated below.

Person to person (horizontal transmission)

Hepatitis B is highly infectious and can be spread when blood from an infected person enters another person’s body. Ways this can happen include, contact with open wounds or a bite that breaks the skin, sharing toothbrushes, razors, shavers and equipment for cutting hair, injecting drugs and sharing drug taking equipment and sexual intercourse. Hepatitis B can also be spread through receiving contaminated blood during a medical procedure. Blood donations in the UK are screened for hepatitis B to remove the risk but it is possible to receive contaminated blood in other countries.

You may not see any blood on an item but this doesn’t mean there isn’t any blood or virus present. The hepatitis B virus can last up to a week on dry surfaces.

How can I prevent my child passing the infection to other people?

Ensure your child knows what they need to do:

  • Cover cuts and any wounds with a waterproof dressing
  • Don’t let anyone touch your blood if you cut yourself or have a nosebleed
  • Do not share toothbrushes with others
  • Clean up any blood spills you may have
  • Do not share razors or hair clippers
  • Do not share any equipment used to inject, snort or smoke drugs e.g. needles, syringes, spoons, water, filters, straws, notes, crack pipes.

What do the blood test results mean?

Blood tests will be done to find out if someone has hepatitis B. If a child is found to be positive for hepatitis B their condition will be assessed and monitored by undertaking blood tests and other investigations. Download the leaflet to view diagrams explaining the different blood tests.

What treatment is available?

At the moment, there is no cure for hepatitis B but more research is taking place. Treatment is aimed at controlling the hepatitis B virus by reducing the amount of virus in the blood and improving the immune system response. This will minimise the risk of spreading the infection and prevent damage to the liver cells.

Prevention and vaccination for hepatitis B in low risk newborns

All babies born to mothers who have had a negative hepatitis B surface antigen blood test result during antenatal care are known as low risk babies.

From 1st August 2017 all babies born in the UK are offered the hepatitis B vaccine as part of the universal vaccination which is given at 8, 12 and 16 weeks of age.

Prevention and vaccination for hepatitis B in high risk newborns

There are different vaccines available to try to stop hepatitis B developing in babies born to mothers with hepatitis B. These differ from the routine vaccinations given to all babies when they are born. Babies who are born to mothers with hepatitis B have an accelerated course (see below).

These babies should receive the first vaccine as soon as possible after birth, and definitely within the first 24 hours of life. Sometimes the blood test can show that a mother is highly infectious. If this is the case the child may be given another injection of specific hepatitis B immunoglobulin (HBIG) at birth, as well as the vaccine, to help them to fight the infection. This provides temporary immunity whilst waiting for the vaccine to work. HBIG should be given at the same time as the first vaccine or as close as possible to the vaccine within 24 hours of birth.

Vaccination timings for a child at risk of hepatitis B:

  • At birth – within 24 hours of birth
  • 4 weeks
  • 8 weeks
  • 12 weeks
  • 16 weeks
  • One year of age
Children require ALL of these vaccinations on time and as scheduled in order to give the infant the best chance of being protected. Babies born to mothers with hepatitis B should have a blood test at 12 months old to find out if the vaccine has worked and whether the child has developed immunity against the virus. This can be done at your GP surgery, local community clinic and, in some cases, at home.

Vaccination is more than 95% effective in protecting babies from long-term hepatitis B infection.

All mothers in the UK are offered hepatitis B screening during antenatal care. It’s important to speak to a midwife so that the appropriate vaccinations can be organised.
Breastfeeding is not thought to have an effect on passing hepatitis B onto a child. It is recommended that mothers can breastfeed once the infant is vaccinated as long as they don’t have bleeding or cracked nipples.

Other individuals who require hepatitis B vaccination:

  • Family members, siblings and carers living in the same house as a person who has been diagnosed with acute or chronic hepatitis B
  • All household contacts
  • Sexual partners of people with hepatitis B
  • Those involved in fostering or adoption

Fostering and adoption

Families adopting from countries where hepatitis B infection is common or at high levels are advised to have the hepatitis B vaccination. The vaccine will reduce their risk of contracting the virus.

A baby born to a mother with hepatitis B won’t be tested for hepatitis B until they have completed all vaccinations for hepatitis B at 12 months old.

If you adopt or foster an infant whose mother has or may have had hepatitis B you will need to make sure they receive their hepatitis B vaccinations as scheduled (see previous page).

Foster carers, and their families, should also be immunised against hepatitis B if they are looking after children with hepatitis B. When a child is fostered there should be a medical exam and a health assessment of the child during the process. Carers should be advised about any infection risks and whether they need to be immunised.

Carers should check the child’s red book (if available) to see if the hepatitis B vaccination has been given and to check whether the child has had a blood test for the hepatitis B surface antigen, hepatitis B core antibody and hepatitis B surface antibody. These results will inform the doctor or nurse if the child has a good response to the vaccinations (immunity) or not

Who should I tell about my child’s hepatitis B infection?

You should inform healthcare professionals treating your child including their dentist. Choosing whether to tell people about your/your child’s hepatitis B status is a very personal decision and there is no right or wrong answer. There can be a stigma associated with hepatitis B and sometimes family and friends don’t fully understand what it is.

Some people, however, find that support from family and friends is important and helps them to cope with the diagnosis better.

It is also up to parents when to tell children about their health. It is helpful that even young children receive some information about what they can do to prevent passing the infection on to others.

Whether or not to tell a child’s school is also a difficult decision for some parents. There is a worry that the school may stigmatise or treat a child with hepatitis B differently but they should ensure confidentiality at all times. It is your choice.

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    If you have any questions about this resource, or if you would like information on the evidence used to produce it, please email: info@childliverdisease.org