Charilaos Papafragkakis, MD
Gastroenterologist - Hepatologist

Hepatitis B

Globally, about 240 million people have chronic hepatitis B with a varying prevalence geographically, highest in Africa and Asia Hepatitis B can be transmitted with blood and bodily fluids during sexual act. The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. The incubation period of the hepatitis B virus is 75 days on average, but can vary from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B.


The only protection against hepatitis B is vaccination. In Greece vaccination has been mandatory for infants and children after 1.1.1998. Newborns should be vaccinated soon after birth. There is usually a 3-dose vaccination schedule with the second and third doses 1 month and 6 months after the first dose respectively.

Long term complications of hepatitis B

Risk of liver‐related complications is variable. Among untreated adults with chronic hepatitis B, the 5‐year incidence of cirrhosis is 8%‐20%, and among those with cirrhosis, the 5‐year risk of hepatic decompensation is 20%, and risk of hepatocellular carcinoma is 2%‐5%

Who should get screened for hepatitis B?

Data from the American Association for the Study of Liver Disease guidelines for hepatitis B:

Persons born in regions of high or intermediate hepatitis B endemicity (HBsAg prevalence of 2%) Africa (all countries) North, Southeast, East Asia (all countries) Australia and South Pacific (all countries except Australia and New Zealand) Middle East (all countries except Cyprus and Israel) Eastern Europe (all countries except Hungary) Western Europe (Malta, Spain, and indigenous populations of Greenland) North America (Alaskan natives and indigenous populations of Northern Canada) Mexico and Central America (Guatemala and Honduras) South America (Ecuador, Guyana, Suriname, Venezuela, and Amazonian areas) Caribbean (Antigua-Barbuda, Dominica, Grenada, Haiti, Jamaica, Saint Kitts and Nevis, Saint Lucia, and Turks and Caicos Islands)

 U.S.-born persons not vaccinated as an infant whose parents were born in regions with high HBV endemicity (8%)

Persons who have ever injected drugs

Men who have sex with men

Persons needing immunosuppressive therapy, including chemotherapy, immunosuppression related to organ transplantation, and immunosuppression for rheumatological or gastroenterologic disorders.

 Individuals with elevated ALT or AST of unknown etiology*

 Donors of blood, plasma, organs, tissues, or semen

Persons with end-stage renal disease, including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients

 All pregnant women

Infants born to HBsAg-positive mothers

Persons with chronic liver disease, e.g., HCV

 Persons with HIV

Household, needle-sharing, and sexual contacts of HBsAg-positive persons

Persons who are not in a long-term, mutually monogamous relationship (e.g., >1 sex partner during the previous 6 months)

Persons seeking evaluation or treatment for a sexually transmitted disease

Health care and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluids

Residents and staff of facilities for developmentally disabled persons

Travelers to countries with intermediate or high prevalence of HBV infection

Persons who are the source of blood or body fluid exposures that might require postexposure prophylaxis

Inmates of correctional facilities

Unvaccinated persons with diabetes who are aged 19 through 59 years (discretion of clinician for unvaccinated adults with diabetes who are aged 60 years)

Recommendations for infected persons to minimize transmission risk to others persons:

Have household and sexual contacts vaccinated

Use barrier protection during sexual intercourse if partner is not vaccinated or is not naturally immune

Not share toothbrushes or razors

Not share injection equipment

Not share glucose testing equipment

Cover open cuts and scratches

Clean blood spills with bleach solution

Not donate blood, organs, or sperm

Children and Adults Who Are HBsAg Positive:

Can participate in all activities, including contact sports

Should not be excluded from daycare or school participation and should not be isolated from other children

Can kiss others


Hepatitis B has been an area of significant interest in the recent years. Oral drugs are the mainstay of treatment. They are not prescribed to anyone with chronic hepatitis B, but only to those who fulfill specific criteria according to international treatment guidelines. The treatment suppresses but does not eliminate the virus from the body, so long term treatment and follow up is necessary.


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