Medically reviewed by Dr Usman Naeem, 24 Oct 2026.
Key points
- Hepatitis B spreads through blood, from mother to baby around birth, and through unprotected sex. It does not spread by hugging, shaking hands, sharing meals or coughing.
- Vaccination is safe and highly effective. Babies of infected mothers need the vaccine promptly after birth.
- Not everyone with hepatitis B needs treatment straight away, but almost everyone needs regular monitoring.
- Antiviral treatment can control the virus and protect the liver. It usually controls rather than completely cures the infection, and stopping it without advice can be dangerous.
Overview
After infection, adults usually clear the virus. When the virus stays in the blood for more than six months, the infection is called chronic hepatitis B. The younger a person is when infected (especially around birth), the more likely it is to become chronic.
Chronic hepatitis B goes through phases. In some phases the virus is active and inflames the liver; in others it is quiet. Because phases change, a single normal test does not mean you can stop follow-up.
Over many years, active infection can cause scarring (cirrhosis) and increases the risk of liver cancer, which is why regular checks matter even if you feel well.
Causes and risk factors
- Mother-to-child spread at birth (the commonest route worldwide)
- Contaminated needles, syringes or reused medical or dental equipment, shared razors, unsterile tattooing, piercing or barber tools
- Unprotected sex with an infected partner
- Living in a household with an infected person without being vaccinated
- Blood transfusion where blood is not properly screened
Symptoms
- Often none
- Tiredness, loss of appetite, nausea, dark urine or yellow eyes during a new (acute) infection
- In advanced disease: swelling of the abdomen or legs, easy bruising or confusion
When to seek urgent medical care
- Yellow eyes with confusion, severe drowsiness or bleeding need urgent care
- If you have hepatitis B and are about to start chemotherapy, high-dose steroids or other immune-suppressing medicines, tell your doctor first. The virus can reactivate and flare, and this is preventable
In an emergency go to the nearest emergency department or call Rescue 1122.
How it is assessed
- Blood tests: HBsAg (shows infection), HBV DNA (viral load), liver enzymes (ALT), HBeAg/anti-HBe and other markers
- An ultrasound and, where available, elastography or blood scores to look for scarring
- Tests for other infections such as hepatitis C, hepatitis D and HIV, and a check of immunity to hepatitis A
- Screening of family members and close contacts, and of pregnant women so the baby can be protected
Treatment
Who needs antiviral treatment?
- The decision depends on the viral load, liver enzymes, the amount of scarring, age, family history of liver cancer and other factors. Your doctor will use current guidelines
- People with cirrhosis or significant scarring and detectable virus are generally treated
- Treatment uses antiviral tablets that are taken long term. They are usually well tolerated, but kidney and bone health may be monitored
- Do not stop antiviral tablets on your own, because the infection can flare
Monitoring if treatment is not needed yet
- Blood tests and sometimes elastography at intervals set by your doctor
- Ultrasound screening for liver cancer for people at higher risk, as advised
Pregnancy and babies
- Tell your doctor early in pregnancy. In some cases an antiviral is given in the last months to lower the viral load
- Newborns of mothers with hepatitis B should receive the vaccine, and in many cases an additional injection (HBIG), within the first 12 to 24 hours after birth
What you can do
- Get household and sexual contacts tested and vaccinated if they are not immune
- Do not share razors, toothbrushes or nail clippers; cover cuts and clean blood spills with bleach-based solution
- Avoid alcohol and be careful with herbal and over-the-counter remedies
- Get hepatitis A vaccination if not immune
- Insist on new, sealed syringes and properly sterilised instruments at clinics, dentists and barbers
Common questions
Can hepatitis B be cured?
Hepatitis B is usually controlled rather than completely cured. Antiviral medicines can keep the virus suppressed and protect the liver, and a small number of people clear the surface antigen. Regular monitoring remains important.
Can I live a normal life with hepatitis B?
Yes. Most people with hepatitis B can work, study, marry, have children and live normally with proper monitoring and, when needed, treatment. Children can attend school and play with others; it is not spread by casual contact.
Do my family members need testing?
Yes. Close contacts and sexual partners should be tested. Those who are not immune should be vaccinated.
Can I fast in Ramadan with hepatitis B?
Many people with stable hepatitis B can fast, but those with advanced liver disease or on treatment should ask their doctor first. Never skip antiviral tablets; ask how to time them.
اردو خلاصہ
ہیپاٹائٹس بی جگر کا وائرس سے ہونے والا انفیکشن ہے جو خون، ماں سے بچے کو پیدائش کے وقت، اور غیر محفوظ جنسی تعلق سے پھیل سکتا ہے۔ یہ ہاتھ ملانے، ساتھ کھانا کھانے یا گلے ملنے سے نہیں پھیلتا۔
بہت سے مریضوں میں برسوں تک کوئی علامت نہیں ہوتی، اس لیے ٹیسٹ (HBsAg اور HBV DNA) اور باقاعدہ نگرانی ضروری ہے۔ ہر مریض کو فوراً دوا کی ضرورت نہیں ہوتی، لیکن جسے دوا شروع ہو اسے ڈاکٹر کے مشورے کے بغیر بند نہ کریں۔
ویکسین محفوظ اور مؤثر ہے۔ گھر کے افراد کا ٹیسٹ اور ضرورت ہو تو ویکسین لگوائیں، اور ایسے بچے کو جس کی ماں کو ہیپاٹائٹس بی ہو پیدائش کے فوراً بعد ویکسین لگنی چاہیے۔
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This page gives general information prepared for Dr Usman Naeem and is not personal medical advice. See the medical disclaimer.