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Hepatitis B (HepB)

What is Hepatitis B?

Hepatitis B (HBV) is a viral infection. Like hepatitis A (HAV) and C (HCV), HBV causes inflammation of the liver. Young children living with HBV may have few or no symptoms. Only a blood test can identify HBV infection and distinguish HAV, HBV, and HCV from one another. HBV can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. There is a safe and effective vaccine to prevent HBV.

Signs and symptoms

An estimated 1.2 million people in the U.S. have chronic HBV. Most are unaware of their infection because they have never experienced symptoms. Symptoms may include:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Fatigue
  • Abdominal pain
  • Diarrhea
  • Joint pain
  • Dark urine
  • Fever
  • Clay-colored stools
  • Jaundice (yellowing of the skin and whites of eyes)

Incubation period

45-160 days (average 90 days)

Contagious period and spread

HBV is transmitted by direct contact with blood or body fluids of a person living with HBV. It can also be transmitted by sharing non-sterilized needles or syringes, sexual contact, or from a pregnant person to their infant at birth. When an infant acquires HBV at birth, they have a 90% chance of living with HBV for life and a 25% chance of experiencing complications from HBV. HBV is not spread through casual activities, such as hugging, kissing, or by sharing eating utensils. It is uncommon in school/child care facilities.

People living with HBV are infectious as long as the virus is in the blood. This can be several weeks before the onset of symptoms, throughout the clinical course of the illness, and in some cases for life. 

Public health reporting requirements

  • Report the infection to the facility director or school nurse. 
  • Report to the local or state health department within four days of diagnosis.

Control of spread

  • Cover open wounds or sores and prevent scratching, biting, or combative behavior.
  • Surfaces contaminated with blood should be cleaned and sanitized while wearing medical exam quality gloves. Disinfect areas contaminated with blood spills using an EPA-registered (List B) tuberculocidal agent. See Disease Prevention: The Facility Environment. 
  • Dispose of soiled items in plastic bags.
  • Encourage proper handwashing techniques.
  • Consult with local or state public health with implementation of control measures.

Vaccination

Routine child/adolescent recommendations:

  • Hepatitis B is a 3-dose vaccine series routinely given at birth, 1-2 months, and 6-18 months of age. 
  • The hepatitis B vaccine is recommended for all children or adolescents younger than 19 years of age who have not been vaccinated. 

Colorado school-required vaccines:

  • Child care/preschool: Infants and children are required to have a complete hepatitis B vaccine series and be up to date according to their age. Three doses are required by 9 months of age. 
  • School (K-12): Three doses of hepatitis B are required.
  • A complete school-required vaccine exemption provided to the child/adolescent’s school may be accepted in place of documentation of an age-appropriate hepatitis B vaccination series.

Routine adult/other recommendations:

  • The hepatitis B vaccine is recommended for all adults aged 19-59 years, and adults aged 60 years or older with risk factors for hepatitis B infection.
  • Adults who are 60 years or older without know risk factors for hepatitis B may also receive hepatitis B vaccine. 

Treatment

There is no specific treatment for acute HBV. Antiviral medications are available for people living with chronic HBV.

Exclusion

Exclusion is not necessary in most cases. 

Role of teachers, caregivers, and family

  • Encourage routine vaccination and routinely check that children in the facility are fully vaccinated.
  • Use universal precautions for handling body fluids and blood.