Can Hepatitis B Cause Injury and/or Death?
For most people hepatitis B is not a deadly disease. Symptoms of acute hepatitis B disease usually begin within one to four months of exposure and include nausea, vomiting, fatigue, low grade fever, pain and swelling in joints, headache, cough and jaundice (yellowing of the skin or eyes). Fatigue and malaise may persist for weeks or months during recovery, as symptoms subside.1 Fifty percent of adults infected with hepatitis B have will have no symptoms.2 Hospitalization for acute hepatitis B is low and limited to the elderly, individuals with pre-existing medical conditions and those who require treatment for dehydration from severe nausea and vomiting.3 On very rare occasions, acute hepatitis B infections can lead to liver failure and death.
During 2016, of the 1,651 acute hepatitis B cases containing information about death, 44 deaths were reported.4
There is no recommended medicine for the treatment of acute infections5 and 95 percent of adults recover fully from acute hepatitis B infection and acquire life-long immunity.6 Eating well, drinking plenty of fluids and avoiding alcohol and drugs assist in recovery.7
Of the approximately five percent who do not recover completely and become chronic carriers of the virus, only 20 to 30 percent will develop life threatening liver disease such as cirrhosis or liver cancer.8, 9 Chronic infection requires monitoring and avoidance of alcohol to avoid liver damage.10
In 1988, the Advisory Committee on Immunization Practices (ACIP) recommended that all pregnant women be screened to identify hepatitis B positive expectant mothers and allow for immediate treatment of their newborns with hepatitis B immune globulin (HBIG) and the hepatitis B vaccine. This recommendation was put forth due to the high rate of transmission from hepatitis B positive mothers to their newborns. All pregnant women are now routinely screened early in pregnancy for both hepatitis B surface antigen (HBsAg) and Hepatitis B "e" antigen (HBeAg).11
Studies indicate that 90 percent of infants born to a mother who is both positive for HBsAg and HBeAg and between five percent and 20 percent of infants born to a mother who is HBsAg positive but HBeAg negative, will become infected without treatment at birth. Treatment with hepatitis B immune globulin (HBIG) and the hepatitis B vaccine within 24 hours of birth is estimated to be 85 to 95 percent effective in preventing chronic hepatitis B infection in infants born to hepatitis B positive mothers.12
Although much attention is focused on the risk of perinatal transmission, a 1996 report issued by the U.S. Preventative Services Task Force, an organization comprised of nationally recognized experts in prevention, evidence-based medicine, and primary care, stated infections during infancy were “estimated to represent only one to three percent of all hepatitis B cases.13
Those who recover completely from hepatitis B infection acquire life-long immunity. Of those who do not recover completely, fewer than five percent become chronic carriers of the virus with only 20 to 30 percent developing liver cancer or cirrhosis.14
IMPORTANT NOTE: NVIC encourages you to become fully informed about Hepatitis B and the Hepatitis B vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.
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1 Nettleman MD, Mortada ME Hepatitis B (HBV, Hep B). MedicineNet Revised Aug. 14, 2018
2 CDC. Hepatitis B – Clinical Features Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.
3 University of Maryland Medical Center. Viral Hepatitis. Revised Oct. 19, 2015.
4 CDC. Table 3.2. Select Clinical Characteristics of Acute Hepatitis B Cases* Reported in the United States, 2016. Apr. 16, 2018
5 CDC. 2015 Sexually Transmitted Diseases Treatment Guidelines – Viral Hepatitis – Hepatitis B. Revised Jun 4, 2015.
6 Chou H-H. et al (2015), Age-related immune clearance of hepatitis B virus infection requires the establishment of gut microbiota. Proc Natl Acad Sci U S A, Feb 2015; 112(7): 2175–2180.
7 CDC. Viral Hepatitis – Hepatitis B – Hepatitis B FAQs for the Public. Revised May 22, 2018.
8 CDC Hepatitis B – Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.
9 WHO. Media Centre Fact Sheets. Hepatitis B. Revised July 18, 2018.
10 CDC. Viral Hepatitis – Hepatitis B information. Revised May 22, 2018.
11 CDC. Recommendations of the Immunization Practices Advisory Committee Prevention of Perinatal Transmission of Hepatitis B Virus: Prenatal Screening of all Pregnant Women for Hepatitis B Surface Antigen, MMWR. June 10, 1988; 37(22);341-6,351.
12 Nelson, N. P., Jamieson, D. J., & Murphy, T. V. Prevention of Perinatal Hepatitis B Virus Transmission. J Pediatric Infect Dis Soc. 2014 Sep; 3(Suppl 1): S7–S12
13 Guide to Clinical Preventive Services: Report of the U. S. Preventive Services Task Force, Part D – Infectious Disease. Chapter 24 – Screening for Hepatitis B Viral Infection, 1996.
14 WHO. Media Centre Fact Sheets. Hepatitis B. Revised July 18, 2018