Frequently Asked Questions (FAQs)

Overview

What is hepatitis?
How common does chronic or life-long infection develop in one infected with hepatitis B?
Where we can find a specialist doctor for hepatitis?
What are the differences among Hepatitis A, Hepatitis B and Hepatitis C?

EPIDEMIOLOGY

How common is chronic hepatitis B in the world?
How common is hepatitis B in the Philippines?
How can one get Hepatitis B?
Can a person unknowingly spread hepatitis B?
Can one get hepatitis B with unprotected sex?
Can hepatitis B be spread through food?
What are ways hepatitis B is not spread?
Can the hepatitis B virus survive outside the body?
Who are considered to be at risk for hepatitis B infection?
If I have recovered from acute hepatitis B and develop the antibody can I still get it?
If I have hepatitis B, can I be a blood or organ donor? 
I am worried that I may have been exposed to the hepatitis B virus, what should I do?

Signs and Symptoms of Hepatitis B

What are the symptoms of acute hepatitis B infection?
How soon after exposure to hepatitis B will symptoms appear?
After infection, how long can acute hepatitis B symptoms last?
Can a person spread hepatitis B without having symptoms?
What are the symptoms of chronic hepatitis B?
How serious is chronic hepatitis B?

Tests and Diagnostics for Hepatitis B

How will I know if I have hepatitis B?
What are the common blood tests available to diagnose hepatitis B?

Treatment and Management 

How is acute hepatitis B treated?
How is chronic hepatitis B treated?
How can you help keep your liver stay healthy if you have hepatitis B?

Prevention / Vaccination

How can hepatitis B be prevented?
Who should get vaccinated against hepatitis B?
When should a person get the hepatitis B vaccine series?
Is the hepatitis B vaccine effective?
Is the hepatitis B vaccine safe?
I cannot remember how many doses of the hepatitis B vaccine I have received, is it bad to get extra doses of Hepatitis B vaccine?
Who should not receive the hepatitis B vaccine?
When are booster doses of hepatitis B vaccine necessary?

Pregnancy and Hepatitis B

Should all pregnant women be tested for hepatitis B?
How does a baby get hepatitis B?
What if a pregnant woman has hepatitis B?
What happens if a baby gets hepatitis B?
Do babies need the hepatitis B vaccine even if a pregnant woman does not have hepatitis B?
Why is the hepatitis B vaccine recommended for all babies?


Overview

What is hepatitis?
Hepatitis refers to inflammation or swelling of the cells of the Liver. It has several causes including: heavy alcohol intake, some toxins and drugs, other systemic diseases, and some infections. Of the infectious causes of Hepatitis, viral infections, namely Hepatitis A, B, and C are most common.

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How common does chronic or life-long infection develop in one infected with hepatitis B?
It depends on the age that one becomes exposed to/infected with the hepatitis B virus. The younger a person is when infected with the hepatitis B virus, the higher the chance that he or she will have chronic infection or life-long infection with the virus.
  • 90% of infected infants will develop chronic infection.
  • Approximately 25%–50% of children infected between the 1 -5 years of age will develop chronic infection.
  • The risk drops to 6%–10% when one is infected over 5 years of age. 

In the Philippines and worldwide, most people with chronic hepatitis B acquired the infection at birth or during early childhood

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Where we can find a specialist doctor for hepatitis?
You can find a specialist doctor by clicking on this link.

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What are the differences among Hepatitis A, Hepatitis B and
Hepatitis C?
Hepatitis A, Hepatitis B and Hepatitis C are three types of viral Hepatitis that may have similar symptoms and manifestations but are caused by three different viruses. 

Hepatitis A infection is acquired through intake of contaminated food and drink. It is self-limiting and usually resolves without specific treatment. It is an acute infection, meaning it is usually newly occurring and does not become a long term infection where people can become a long term carrier of the infection. 

On the other hand, Hepatitis B and Hepatitis C  are infections that can be acquired from infected blood/ body fluids. It can also begin as acute infections, but in some, the virus remains in the body, and there is lifelong infection that may cause complications in the liver namely, liver Cirrhosis (scarring of the liver) and liver cancer (tumor of the liver). 

Hepatitis A and B can be prevented thru effective and safe vaccines. While there is no vaccine for Hepatitis C, its spread can be prevented by avoiding contact with infected blood/body fluids. Although uncommon, it is possible for a person to to have multiple types of viral hepatitis at the same time.

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EPIDEMIOLOGY

How common is chronic hepatitis B in the world?
Globally, Hepatitis B affects approximately 350 million people and contributes to an estimated 780,000 deaths worldwide each year.

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How common is hepatitis B in the Philippines?
Hepatitis B is a major public health problem in the Philippines. An estimated 7.3 million adult Filipinos (16.7% of the adult population) are chronically infected with the hepatitis B virus (HBV) making our country hyperenedemic for hepatitis B. This rate is extremely high in comparison to other countries and is more than double the 8% average prevalence of HBV infection in the Western Pacific region. A 2003 survey showed the prevalence of hepatitis B to be highest in the 20-49 year age group, which comprise the workforce or those entering the workforce.

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How can one get Hepatitis B?
Hepatitis B is spread thru blood, semen, or other body fluids with the hepatitis B virus. A person may acquire the infection thru the following activities:

  • Birth (spread from a hepatitis B positive mother to her baby)
  • Sex with an infected partner
  • Sharing needles, syringes, or other drug-injection equipment with an infected person
  • Sharing razors, nail clippers/manicure or pedicure paraphernalia or toothbrushes with an infected person
  • Direct contact with the blood or open wounds of an infected person
  • Exposure to blood from needlesticks or other sharp instruments 
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Can a person unknowingly spread hepatitis B?
Yes, because many of those infected with Hepatitis B have no symptoms. An infected person may appear or feel normal.  Even if they have no symptoms, they may spread the infection thru the   above-mentioned activities or practices.

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Can one get hepatitis B with unprotected sex?
Yes. In fact, Hepatitis B is 50–100 times more infectious than HIV and can be passed through the body fluids, such as semen, vaginal fluids, and blood.

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Can hepatitis B be spread through food?
No.Unlike Hepatitis A, it is not spread routinely through food or water. 

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What are ways hepatitis B is not spread?
Hepatitis B virus is not spread by sharingutensils, sharing drinks,  breastfeeding, hugging, kissing, holding hands, coughing, or sneezing.

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Can the hepatitis B virus survive outside the body?
Hepatitis B virus can survive in the environment and cause infection for at least 7 days. 

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Who are considered to be at risk for hepatitis B infection?
Since the Philippines is considered a hyperendemic area for hepatitis B, almost everyone without the antibody or vaccine can become infected. Some people, however are at greater risk, such as the following :

  • Infants born to infected mothers
  • People who have sex with an infected partner
  • People who have multiple sex partners
  • People who have a sexually transmitted disease
  • Men who have sexual contact with other men
  • People who inject drugs or share needles, syringes, or other drug equipment
  • People who live in the household of one with chronic Hepatitis B
  • Those who work in occupations where they may be exposed to blood and infected body fluids
  • Hemodialysis patients
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If I have recovered from acute hepatitis B and develop the antibody can I still get it?
No, if you recover from acute hepatitis B, your immune system can make  antibodies that protect you from the virus for life. An antibody is a substance found in the blood made by our immune system upon exposure to a virus. Antibodies can protect us from infection by destroying the virus or rendering it ineffective. Unfortunately, many infected people, especially those who acquire the infection as newborn babies or children,  are not able to produce antibodies to clear the virus from their bodies and thus develop chronic infection or carry the virus for life.

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If I have hepatitis B, can I be a blood or organ donor? 
No, if you have ever tested positive for the Hepatitis B virus, it is recommend that you should not donate blood, organs, or even semen because this can put the recipient at great risk for getting hepatitis B

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I am worried that I may have been exposed to the hepatitis B virus, what should I do?
If you believe that you might have been exposed to the virus, see your doctor. Hepatitis B infection can be prevented by getting the hepatitis B vaccine with an additional shot called HBIG (Hepatitis B Immune globulin) within 24 hours of exposure.

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Signs and Symptoms of Hepatitis B

What are the symptoms of acute hepatitis B infection?
Not everyone develop symptoms after acute Hepatitis B infection. Although majority of adults develop symptoms from acute hepatitis B infection, many young children do not. Adults and children over the age of 5 years are more likely to have symptoms. Seventy percent (70%) of adults will have symptoms from an acute Hepatitis B infection.
Symptoms of acute Hepatitis B infection, if present, can include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored stool
  • Joint pains
  • Jaundice (yellow color in the skin or the eyes)
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How soon after exposure to hepatitis B will symptoms appear?
Symptoms can appear 90 days (or 3 months) after exposure, but they can also manifest between 6 weeks and 6 months after exposure.

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After infection, how long can acute hepatitis B symptoms last?
People usually have symptoms for a few weeks, but some people can feel ill for as long as 6 months.

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Can a person spread hepatitis B without having symptoms?
Yes. Many people with Hepatitis B look and feel healthy and have no symptoms, but they can still spread the virus.

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What are the symptoms of chronic hepatitis B?
Most people with chronic hepatitis B have no symptoms and may feel healthy for many years. About 15%–25% of people with chronic hepatitis B develop complications in the liver, such as cirrhosis or liver cancer.  In the early stages of liver cirrhosis and liver cancer, patients may remain to have no symptoms. However, tests for liver function or liver ultrasound might begin to show some abnormalities.

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How serious is chronic hepatitis B?
Chronic hepatitis B is a serious infection that can result in in liver damage, liver failure, liver cancer, or even death. It is estimated that liver cancer is the third leading cancer in the Philippines, affecting over 7,000 new people yearly. Liver cancer carries a poor prognosis, making it the second leading cause of cancer death locally.

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Tests and Diagnostics for Hepatitis B

How will I know if I have hepatitis B?
Talk to your doctor about testing for Hepatitis B. Doctors may order one or more blood tests to evaluate if you:

  • have acute or chronic infection
  • have recovered from infection
  • are immune to hepatitis B
  • could benefit from vaccination  
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What are the common blood tests available to diagnose hepatitis B?
There are many different  blood tests that your doctor can order to diagnose hepatitis B. They can be ordered as a single test or as a battery of tests. Below are some of the common tests and what they usually mean. It is important that you ask your doctor on the proper interprestation of your test results.

TESTS

INTERPRETATION

Hepatitis B Surface Antigen-
It is a protein on the surface of the Hepatitis B Virus. It can be detected in the blood of those who carry the virus.

POSITIVE- A person may have acute or chronic Hepatitis B infection and may transmit the disease to others
NEGATIVE- A person does not have Hepatitis B in his or her blood

AntiHBs-
Protective antibody to the Hepatitis B Virus

POSITIVE

  • person has received successful vaccination against Hepatitis B
  • Person has recovered from Hepatitis B infection and is protected from future infection

AntiHBc IgM- (IgM Antibody to Hepatitis B Core Antigen)

POSITIVE
This may mean that a person was infected with Hepatitis B within the past 6 months

AntiHBcIgG- (IgG Antibody to Hepatitis B Core Antigen)

POSITIVE
This may indicate exposure to the Hepatitis B virus and that a patient either has chronic Hepatitis B, or recovered from Hepatitis B

 HBeAg

POSITIVE
This may indicate high levels of the Hepatitis B Virus in the blood, which can mean that a person can more easily spread the virus to others

HBV DNA

Indicates the levels of virus in the blood. This test is used to determine the need for treatment of Hepatitis B with drugs as well as the effectiveness of drug treatment

Note: A positive or negative test for any of the markers above (except HBVDNA) is reported as REACTIVE or NON-REACTIVE, respectively in most reports from different laboratories

 

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Treatment and Management 

How is acute hepatitis B treated?
Treatment of acute hepatitis is mostly supportive i.e. in the form of rest, adequate nutrition and adequate hydration. In some cases, some patients might need hospitalization particularly those who are unable to have adequate food intake due to vomiting and anorexia. Some patients may develop signs of liver failure (e.g. disorientation, confusion or even coma as a result of liver encephalopathy) and will need hospitalization. These patients may be given antiviral drugs used to treat chronic hepatitis B and may need to be evaluated for liver transplantation as well.
 
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How is chronic hepatitis B treated?
There are several antiviral drugs available to treat chronic hepatitis B. The choice of antiviral drug may depend on the patient. However, not all patients with chronic hepatitis B need antiviral drugs. Patients should be evaluated by health professionals experienced in the management of hepatitis B. These doctors may include: internists, pediatricians, gastroenterologists, hepatologists, and infectious disease specialists.  You can click on this link to gain access to Hepatology Society of the Philippines (HSP) website. People with chronic hepatitis B, even those who are asymptomatic, need long term monitoring for the early detection of liver complications, like cirrhosis and liver cancer. 

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How can you help keep your liver stay healthy if you have hepatitis B?
People infected with hepatitis B will benefit from regular wellness checks and follow-ups with their doctors.  Alcohol intake should be avoided as this may aggravate liver damage. Patients with hepatitis B need to consult their doctor before intake of pills, herbal supplements, and other over-the-counter medication.  Obesity, diabetes mellitus (DM) and cholesterol level problems also need to be managed. Patients who do not have a prior exposure to hepatitis A and those without known history of vaccination against hepatitis A will need to receive the vaccine for hepatitis A.

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Prevention / Vaccination

How can hepatitis B be prevented?
There is a safe and effective vaccine for hepatitis B. The vaccine is given as a series of 3-4 shots over a period of 6 months. It stimulates  the body's immune system to produce the antibody that protects against hepatitis B. In the
Philippines, hepatitis B immunization is included in the Maternal, Newborn, Child Health and Nutrition (MNCHN) Package of services of the Department of Health. Republic Act 10152 (An Act Providing for Mandatory Basic Immunization Services for Infants and Children) provides mandatory free hepatitis B vaccination to all infants. To increase its effectiveness in preventing hepatitis B transmission, the first dose should be given to newborns within the first 24 hours of life.

For babies born to mothers infected with hepatitis B, an additional shot called HBIg (pre-formed antibodies against hepatitis B) may also be given shortly after birth.

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Who should get vaccinated against hepatitis B?
Because of the high rates of hepatitis B infection in the Philippines, universal vaccination is mandated.

Hepatitis B vaccination is especially recommended for:

  • All infants, starting with the first dose of Hepatitis B vaccine within 24 hrs of birth
  • All children and adolescents younger than 19 years of age who have not been vaccinated
  • People whose sexual partners have Hepatitis B
  • Sexually active persons who have multiple partners.
  • Persons undergoing management for sexually transmitted infections
  • Men who have sexual contact with other men
  • People who share needles, syringes, or other drug equipment
  • People who have close household contact with someone infected with the Hepatitis B virus
  • Health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job
  • People with end-stage renal disease, including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
  • Residents and staff of facilities for developmentally disabled persons
  • People with chronic liver disease  (not from Hepatitis B)
  • People with HIV infection
  • Anyone who wishes to be protected from hepatitis B virus infection  
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When should a person get the hepatitis B vaccine series?
Children and Adolescents

  • All children should get their first dose of Hepatitis B vaccine at birth ( or at least within 24 hrs of birth)  and complete the vaccine series by 6–18 months of age.
  • All children and adolescents younger than 19 years of age who have not yet gotten the vaccine should also be vaccinated. "Catch-up" vaccination is recommended for children and adolescents who were never vaccinated or who did not get the entire vaccine series.

Adults:

  • Any adult who wants to be vaccinated should talk to a health professional about getting the vaccine series.

  
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Is the hepatitis B vaccine effective?  
Once the prescribed vaccination series has been given, Hepatitis B vaccine gives greater than 90% protection to those immunized before being exposed to Hepatitis B.

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Is the hepatitis B vaccine safe?
The hepatitis B vaccine is safe. Pain at the injection site is the most common side effect reported. Over 1 billion doses of the Hepatitis B vaccine have been used worldwide. The safety of the Hepatitis B vaccine has been evaluated by the many leading health authorities including the WHO and United States Institute of Medicine.  

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I cannot remember how many doses of the hepatitis B vaccine I have received, is it bad to get extra doses of Hepatitis B vaccine?
No, getting extra doses of hepatitis B vaccine is not harmful.

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Who should not receive the hepatitis B vaccine?
The hepatitis B vaccine is not recommended for people who have had serious allergic reactions to a prior dose of hepatitis B vaccine or to any component of the vaccine. It is not recommended for people allergic to yeast because yeast is is used when the vaccine is made. Inform your doctor if you have any severe allergies.

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When are booster doses of hepatitis B vaccine necessary?
A "booster" dose of hepatitis B vaccine is given to increase or extend the effectiveness of the vaccine. They are particularly recommended for patients undergoing hemodialysis or other people with compromised or "weak" immune system.

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Pregnancy and Hepatitis B

Should all pregnant women be tested for hepatitis B?
Yes. Hepatitis B testing should be included in routine prenatal examinations. Knowing whether a pregnant mother has hepatitis B is important because transmission of the virus can be prevented by giving the newborn HBIG and the first hepatitis B vaccine dose within 12 to 24 hours of birth, and then completing the series.

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What if a pregnant woman has hepatitis B?
If a pregnant woman has hepatitis B, she can transmit the infection to her baby during birth. But this can be prevented through a series of vaccinations and HBIG for her baby beginning as soon as possible (within 12-24 hours) birth. Without vaccination, babies born to women with Hepatitis B virus infection can develop chronic infection, which can lead to serious liver complications.

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How does a baby get hepatitis B?
A baby can get hepatitis B from an infected mother during childbirth.

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What happens if a baby gets hepatitis B?
Most newborns who become infected with hepatitis B virus do not have signs or symptoms, but they  can have a 90% chance of developing chronic hepatitis B. This can eventually lead to other diseases  later on in life, including liver cirrhosis, liver cancer, and even death.

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Do babies need the hepatitis B vaccine even if a pregnant woman does not have hepatitis B?
Yes. The hepatitis B vaccine is recommended for all infants. Republic Act 10152 mandates the administration of the free hepatitis B vaccine for all infants.

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Why is the hepatitis B vaccine recommended for all babies?
Hepatitis B vaccine is recommended for all babies  because it protects them from hepatitis B infection and thus from serious complications when they get older. Compared to adults, babies and young children are more likely to develop life-long infection with hepatitis B if infected and  the vaccine can very effectively prevent this.

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