Hepatitis B Immunisation

Overview

Hepatitis B is a virus that attacks the liver. Hepatitis B immunisation means having the vaccine — a short course of injections that teaches your body's defence system (your immune system) how to recognise and fight off that virus before you ever meet it. The vaccine contains only a tiny, harmless part of the virus, so it cannot give you hepatitis B. In the UK, immunisation is offered to all babies and to children and adults at higher risk.

Hepatitis B is common in many parts of the world, including parts of Asia, Africa, Eastern Europe, the Middle East and South America. In the UK it is much less common, which is why the vaccine is offered to babies and to people at higher risk rather than to everyone.

Anyone can catch hepatitis B, but some people are more likely to come into contact with it: babies born to a mother with hepatitis B, people living with someone who has it, healthcare workers, people who inject drugs, men who have sex with men, people on kidney dialysis, people with liver disease, people in prisons, and travellers to countries where hepatitis B is common. Sex partners of someone with hepatitis B are also at risk.

Symptoms

Common symptoms

• Most adults who catch hepatitis B feel unwell for a few weeks. Early signs can feel like flu — tiredness, a high temperature, aching muscles and feeling sick.
• Some people lose their appetite, feel sick, or get a dull pain under the ribs on the right side, where the liver sits.
• Later signs can include yellowing of the skin and the whites of the eyes (jaundice), dark urine and pale poo.
• About 1 in 3 adults have no symptoms at all and never know they were infected.
• After the vaccine itself, the most common side effect is a sore, heavy arm for a day or two where the injection went in.
• Some people get a mild temperature, a headache or feel tired for a day or so after the injection. This usually settles on its own.

Symptoms in children

• Babies and young children usually have no symptoms at all when they catch hepatitis B, which is one reason it can spread quietly within a family.
• If symptoms do appear, they are often mild — poor feeding, being sleepier or more grouchy than usual, or a mild temperature.
• After the vaccine, a baby may be a little grouchy or have a sore leg where the injection went in. This usually passes within a day or two.

Symptoms in older adults

• Older adults are more likely to feel quite unwell with hepatitis B and may need to rest in bed for a while.
• Jaundice (yellow skin and eyes) tends to be more noticeable and can take several weeks to fade.
• People with a weaker immune system, or with other long-term health conditions, should ask their doctor whether they are protected.

Causes

Main causes

• Hepatitis B is caused by a virus. It spreads when blood, semen or vaginal fluid from someone who has the virus gets into your body.
• Common routes include: from a mother to her baby during birth, sex without a condom, sharing needles or drug equipment, sharing razors or toothbrushes, and unsterile tattoo or piercing equipment.
• You cannot catch hepatitis B from hugging, kissing, sharing food, coughing, sneezing or swimming pools.
• The vaccine works by showing your immune system a tiny, harmless part of the virus so it learns to fight it. It cannot cause hepatitis B.

Risk factors

• Being born in, or travelling to, a country where hepatitis B is common.
• Living with, or having sex with, someone who has hepatitis B.
• Working in healthcare or another job where you may contact blood.
• Injecting drugs, or sharing needles and drug works.
• Having kidney dialysis or a weakened immune system.
• Having a tattoo or piercing done with unsterile equipment.
• Being in prison, or having a history of being in prison.
• Having another liver condition, such as hepatitis C.

When to see a doctor

See a doctor urgently if:

• You or your child has a severe reaction after a vaccine — trouble breathing, swelling of the face or throat, or becoming floppy and unresponsive. Call your local emergency number straight away.
• You develop yellow skin or eyes, severe tummy pain, or vomit blood.
• You think you may have been exposed to hepatitis B — for example a needlestick injury, or sex with someone who has it. Go to a sexual health clinic or urgent care the same day, because protection started within 24 hours works best.

Book a routine appointment if:

• You are planning to travel to a country where hepatitis B is common — ask about the vaccine 6 to 8 weeks before you go.
• You or your child has missed a dose of the vaccine course.
• You are pregnant or planning a pregnancy and want to talk about hepatitis B.
• You work in healthcare or another job where you might come into contact with blood.
• You live with someone who has hepatitis B, or have a new partner who does.
• You are not sure whether you have been vaccinated — your GP can check your records or arrange a simple blood test.

Diagnosis

You usually do not need any tests before having the hepatitis B vaccine — your GP or practice nurse can offer it based on your age, health and risk. Sometimes a blood test is done first, for example to check whether you already have hepatitis B or are already protected from an earlier course. This avoids giving doses you do not need.

Tests that may be done

• A blood test for hepatitis B surface antigen (HBsAg) — this shows whether the virus is in your body now.
• An antibody test (anti-HBs) — this shows whether you are already immune, either from vaccination or from a past infection.
• Liver blood tests — to check how well your liver is working if an infection is suspected.
• In pregnancy, hepatitis B is one of the routine blood tests offered early on, so the baby can be protected from birth.

What to expect at your appointment

The vaccine is a small injection, usually into the upper arm for adults and older children, or the thigh for babies. A full course is usually three doses over about six months. In the UK, babies have theirs within the 6-in-1 vaccine at 8, 12 and 16 weeks, plus an extra dose at one year. If you need protection quickly, for travel or after possible exposure, a faster schedule can be used. You can usually carry on with your day straight afterwards.

Treatment

For most people, the only thing to 'treat' after immunisation is finishing the course. There are no medicines to take and no recovery time needed. If you have already been exposed to hepatitis B, treatment means starting protection as soon as possible — this is called post-exposure prophylaxis, and it can stop the infection taking hold.

Self-care at home

• Keep a record of the dates of every dose, including any given abroad — it helps if you need proof for work, study or travel.
• Move your arm gently afterwards and use a cool pack if it feels sore.
• If you feel a little feverish or achy, rest and drink plenty of fluids. Ask your pharmacist which pain relief is suitable for you or your child.
• Finish the full course — stopping early can leave you less well protected.

Medical treatments

If you are exposed to hepatitis B and are not already protected, a doctor may offer the vaccine straight away, sometimes with an injection of ready-made antibodies (called immunoglobulin). This gives short-term protection while your own immune system catches up. If someone does develop hepatitis B, care focuses on checking the liver regularly and, where needed, antiviral medicines prescribed by a specialist. Not everyone needs treatment, and many adults clear the virus on their own.

When is surgery considered?

Surgery is not part of hepatitis B immunisation. Very rarely, someone whose liver has been badly damaged by long-term hepatitis B may be assessed for a liver transplant, but this only happens after specialist care.

Living with this condition

For most people, life after hepatitis B immunisation carries on exactly as before. You may need to show proof of vaccination for some jobs, university courses or travel, so keep your record somewhere safe. If you are in a group that needs boosters, your GP surgery or workplace health team will tell you when.

Lifestyle tips

• Practise safer sex by using condoms, especially with new or casual partners.
• Never share needles, syringes or drug works — needle exchanges can give you clean equipment.
• Do not share razors, toothbrushes or nail clippers, which can carry tiny traces of blood.
• Choose a licensed tattoo and piercing studio that uses sterile, single-use equipment.
• If you travel often, check whether you need vaccines before each trip.

Diet and exercise

No special diet or exercise is needed because of the vaccine. Eating a balanced diet, staying active and not drinking too much alcohol are good for your liver in general. If you already have liver disease, your doctor can advise on what is right for you.

Mental health and emotional wellbeing

Some people feel anxious about needles, or worry about what hepatitis B might mean for their family or relationships. That worry is understandable and very common. Talking it through with your GP, practice nurse or a counsellor can help, and there is no shame in asking for support. If you ever feel you cannot cope, contact your local emergency number or a crisis support line in your country.

Prevention

Yes. Hepatitis B is one of the infections that vaccination prevents very effectively. The vaccine is safe and has been given to hundreds of millions of people worldwide. Using condoms, never sharing needles and choosing sterile tattoo equipment add extra layers of protection.

Vaccines

In the UK, all babies are offered the hepatitis B vaccine within the 6-in-1 vaccine at 8, 12 and 16 weeks, with a fourth dose at one year. Babies born to mothers with hepatitis B get an extra dose at birth, plus a blood test later to check they are protected. The vaccine is also free on the NHS for people at higher risk, including healthcare workers, people who inject drugs, men who have sex with men, close contacts of someone with hepatitis B, people with kidney or liver disease, and travellers to higher-risk countries. For travel, aim to start the course 6 to 8 weeks before you leave.

Screening programmes

Pregnant women in the UK are offered a hepatitis B blood test as part of routine antenatal screening. Blood donations are screened too. Some jobs, such as healthcare, ask for proof of immunity, which can be checked with a simple blood test.

Complications

If left untreated

• If hepatitis B is not prevented and becomes long-lasting (chronic), it can slowly scar the liver — this is called cirrhosis.
• Cirrhosis can stop the liver working properly and lead to serious health problems.
• Long-term hepatitis B raises the risk of liver cancer.
• Rarely, a sudden severe infection can cause liver failure.
• Most healthy adults who catch hepatitis B clear it within a few months and are then immune for life.

Long-term outlook

The hepatitis B vaccine is one of the great success stories of modern medicine. A full course protects more than 9 in 10 people, and for most people protection lasts for decades — often for life. Because of vaccination, hepatitis B has become rare in countries that vaccinate all babies. If you are at higher risk or may have been exposed, getting protected now is a simple and powerful step.

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