Hepatitis B

Viral hepatitis strikes thousands of Canadians resulting in short-term illness, chronic infections and even life-threatening consequences. One of the three most common forms of viral hepatitis is hepatitis B.

Hepatitis B is a type of liver disease caused by the hepatitis B virus and is one of the most common strains of viral hepatitis (the others are the hepatitis A virus and the hepatitis C virus). Many people who become infected with hepatitis B never feel sick and recover completely. Others get a brief, acute illness with fatigue and loss of appetite and their skin and eyes turn yellow (a condition called “jaundice”). Less than 5% of adults who get acute hepatitis B develop chronic hepatitis, which can lead to cirrhosis (liver scarring) and/or liver cancer later in life. Chronic hepatitis B is a “silent” disease because often no symptoms appear until your liver is severely damaged. Infants and children infected with hepatitis B have a much greater likelihood of developing a chronic infection than adults.

Canadian Liver Foundation is the first organization in the world to endorse a declaration calling for global strategies to eliminate viral hepatitis B and C.

How do I get hepatitis B?

A person who has acute or chronic hepatitis B can spread the infection to other people through his/her blood and other body fluids or by sexual contact. The hepatitis B virus is found mainly in the blood, semen, and vaginal fluid of an infected person. Saliva is also a body fluid but the virus concentration is 1,000 to 10,000 times less than what is found in the blood.

You may risk exposure to hepatitis B through unprotected sex, tattoos, piercings, pedicures, manicures or medical procedures with improperly sterilized equipment, sharing personal hygiene items with an infected person (e.g. razors, toothbrushes, nail clippers) or providing emergency first aid in which you come in contact with blood or other body fluids.

Who is most at risk of getting hepatitis B?

Hepatitis B is common worldwide. In regions where hepatitis B is most common such as countries in Asia and Africa, at least one in five people may be infected with this virus.

You have a high risk of contracting hepatitis B if you:

• have unprotected sex with an infected person; 
• have unprotected sex with multiple sexual partners; 
• have a sexually transmitted infection (STI); 
• were born to a hepatitis B infected mother;  
• use injection drugs and share contaminated drug preparation/injection materials; or 
• receive a tattoo or piercing with unsterilized needles or contaminated ink. 

You have a moderate risk of contracting hepatitis B if you:

• have siblings or other family members who have hepatitis B; 
• share a household with someone who has hepatitis B; 
• live or travel to regions where hepatitis B is more common; 
• are exposed to blood and body fluids because of your job; or 
• receive bite wounds containing blood from an infected person.

Hepatitis B is NOT passed from person to person by:

• coughing, sneezing;  
• touching or shaking hands with an infected person; 
• sharing food, drinks or eating utensils; 
• using toilet seats; 
• hugging and kissing; or 
• other casual contact.

What are the symptoms?

What happens to you when you contract hepatitis B depends largely on the age at which you first become infected and how well your immune system copes with the virus. If you are infected as an adult, you may have a brief illness with mild or moderate symptoms such as jaundice, dark urine, fatigue, abdominal discomfort, and loss of appetite.  As an adult, you have a 95% chance of clearing the infection completely and developing lifelong protection against this virus. The acute infection rarely (in less than 1% of cases) leads to severe illness that requires a liver transplant.

Most babies and children exposed to this virus never have signs and symptoms. Unfortunately, they are more likely to become carriers of hepatitis B for life because their immune system is unable to fight and clear the virus from their body.  In these cases, chronic infections are often not detected or “picked up” until much later in life when the person becomes seriously ill with liver disease.

Chronic hepatitis B infection goes through different phases that also show how well your body is coping with the virus. Although most people with chronic hepatitis B have an inactive disease and will remain healthy, about one in four will have active disease that may lead to cirrhosis (scarring of the liver), liver failure, and liver cancer.

People who are healthy with an inactive disease may still be at risk of virus reactivation, especially when their immune system is weakened by medicines such as chemotherapy or by other viral infections.

You will need treatment if you have an ongoing active disease that causes a lot of damage to your liver, or if you are going to take medicines that will weaken your immune system.

If I have no symptoms, how would I know if I have hepatitis B?

To confirm whether or not you have hepatitis B, you will need blood tests.

If you have at least one risk factor (see sections above ‘How do I get hepatitis B?’ and ‘Who is most at risk’), you should ask your health care provider to be tested for hepatitis B.  Also, you should be tested for hepatitis B if:

• you were born in a region where hepatitis B is more common, including Asia, Africa, southern and eastern Europe, the Pacific Islands, the Middle East, and the Arctic; 
• one or both of your parents immigrated from a region where hepatitis B is more common; 
• you live or travel to regions where hepatitis B is more common; 
• you have a family history of liver disease or liver cancer; 
• you have been in prison; 
• you are pregnant; 
• you are a man who has sex with men; 
• you have HIV; 
• you have chronic hepatitis C; 
• you receive kidney dialysis; 
• you have ever used injection drugs, even just once;  
• you have unexplained abnormal liver enzymes; or if 
• you receive medicines that suppress the immune system.

How can I avoid getting hepatitis B?

There is a safe and effective vaccine that can protect you from getting hepatitis B. The vaccine is usually given in three doses over a six month period.  The vaccine will give you long-lasting protection. A combined vaccine for hepatitis A and hepatitis B is also available.

Other ways to protect yourself or your loved ones include:

• Adopt safe sex practices. 
• Avoid sharing personal hygiene items (e.g. razors, toothbrushes, nail clippers) 
• If you have been exposed to the hepatitis B virus (within the previous seven days or less), an injection of hepatitis B immune globulin may help protect you. 
• If you are pregnant, make sure you are screened for hepatitis B. If the test result shows that you have the virus, make sure your baby receives the free hepatitis B vaccine. If you have hepatitis B, breastfeeding is safe if the baby has received both protective antibody called immune globulin, and the first dose of hepatitis B vaccine within the first 12 hours of life. Talk to your doctor about having your newborn immunized (some provinces have universal neonatal hepatitis B immunization while others only immunize babies of mothers infected with hepatitis B). 
• If you decide to have a tattoo, piercing, manicure or pedicure, ensure that the facility uses single-use needles and inks and/or follows proper sterilization procedures.

Can hepatitis B be treated?

If you know you have been exposed to the hepatitis B virus in the previous seven days or less, you can receive an injection of hepatitis B immune globulin that may prevent you from developing the disease. Besides this, there is no treatment for acute hepatitis B.

If you have chronic hepatitis B, two types of treatment exist; interferon which is a medication administered by a needle, and antiviral medicines that are taken by mouth.  Current approved hepatitis B oral medications include lamivudine, adefovir, telbivudine, tenofovir, and entecavir. These treatments do not provide a cure, but they offer control of the virus so that further damage to your liver can be prevented.   When and how to treat your hepatitis B is a decision between you and your doctor. Availability of the medications listed above may vary from province to province based on provincial government drug plans and individual insurance plans.

How can I pay for my medication?

Private health insurance or drug plans
If you have private health insurance or a drug plan at work, you may be able to have the medication paid through your plan. Please consult your private health insurance or drug plan provider to see if your drug is covered.

Publicly funded drug plans
Each province and territory has their own rules.  Some provincial drug plans provide coverage for individuals 65 and older, or those on social assistance.  Some provinces (e.g. Ontario) provide special support to low-income individuals. Please call your Provincial Ministry or Department of Health to get more information about the terms of the publicly funded drug plan in your province. (see links on page 13 of the “How To Health Guide”)

Quebec public drug program
In Quebec, everyone must be covered by prescription drug insurance either through private or publicly funded plans.

Each provincial and territorial government offers a drug benefit plan for eligible groups. Some are income-based universal programs. Most have specific programs for population groups that may require more enhanced coverage for high drug costs. These groups include seniors, recipients of social assistance, and individuals with diseases or conditions that are associated with high drug costs. For more details, please contact your provincial or territorial health care ministry, or click on the appropriate link below.

• Alberta (Prescription Drug Programs)
• British Columbia (Pharmacare)
• Manitoba (Pharmacare Program)
• New Brunswick (Prescription Drug Program)
• Newfoundland (Pharmaceutical Services)
• Northwest Territories (Drug coverage)
• Nova Scotia (Pharmacare)
• Nunavut (Drug coverage)
• Ontario (Drug Benefit Program)
• Prince Edward Island (Drug Cost Assistance Programs)
• Quebec (Prescription Drug Insurance)
• Saskatchewan (Drug Plan)
• Yukon (Insured Health)

Pharmaceutical companies
Some pharmaceutical companies provide medications to patients who cannot afford them or who do not have government or private insurance under the Compassionate Use Programs. Each program has its own terms for eligibility. Please talk to your doctor to see if you are eligible for such a program.

Available Patient Assistance Program for Hepatitis B treatment
• Gilead Momentum HBV Support Program 1 (888) 453-8885
– VEMLIDY (Tenofovir Alafenamide)

Can hepatitis B be controlled by eating right and exercising?

It is important that people with liver disease follow a healthy, nutritious diet as outlined by Health Canada in Eating Well with Canada’s Food Guide.

Alcohol can also damage the liver so it is best that people with hepatitis B do not drink. Following a healthy lifestyle may also prevent fatty liver disease, another liver disease highly prevalent in Canada.

However, hepatitis B cannot be controlled by healthy eating and exercise alone. Hepatitis B can only be controlled by currently available treatment as prescribed by your doctor. Your doctor will need to do regular blood tests to know how much of the active virus is in your blood (the viral load). The viral load test is used to monitor and manage hepatitis B patients. Viral load can tell your doctor if you need treatment for hepatitis B and how well you are responding to treatment.

If I have hepatitis B and feel healthy, do I need to keep going to my doctor?

Chronic hepatitis B is a “silent” disease because often no symptoms appear until your liver is severely damaged. Although many people with chronic hepatitis B have an inactive disease and will remain healthy, about one in four will have an active disease that may lead to cirrhosis, liver failure, and liver cancer.

Because hepatitis B has no symptoms until your liver is badly damaged, a blood test is the only way for your doctor to find out if your hepatitis B is active or inactive, and to offer treatment, if needed. To help your doctor monitor how your disease behaves over time, you will need lifelong repeat blood tests every six to 12 months. Some tests, such as HBV DNA (viral load) may need to be done more frequently (every three to six months). No treatment is required while the virus is inactive, but you should continue to get regular blood tests from your doctor to monitor your liver disease.

Where can I get more detailed information on how to live with hepatitis B?

More detailed information can be found in the Canadian Liver Foundation’s Healthy Living with Viral Hepatitis booklet, including:

• What to expect if you have hepatitis B;
• The different types of blood tests and what they measure;
• How to prepare for an appointment with your doctor;
• What choices to make to prevent additional damage to your liver;
• Who needs to know if you have hepatitis B and how to tell them;
• How to recognize and deal with symptoms;
• How to find financial assistance;
• What questions to ask when considering alternative therapies.

Support

National Help Line:
This support resource gives you and your loved one somewhere to turn for answers after diagnosis, helps you understand your disease, and provides you with the resources you need.  You can call 1 (800) 563-5483 Monday to Friday from 9 AM to 5 PM EST.

The Peer Support Network:
This is a national network of people living with liver disease that have offered to share their experiences with others. It was developed by the Canadian Liver Foundation as a means to link Canadians like you who have a family member who has liver disease, who care for someone who suffers from liver disease, or who have been diagnosed with a liver disease, to talk about your concerns with a peer in a similar situation.

If you would like to be connected with a Peer Supporter in your area, or would like to join the Peer Support Network, please fill out the Peer Support Network Sign-up Form.