Can you be immune to hepatitis B?

Hepatitis B is an infectious disease that is transmitted in various ways, such as through sexual contact or through contaminated blood. This article talks about what hepatitis B is, what the different types of hepatitis B are, and how you can be immune to hepatitis B.

What is hepatitis B?

Hepatitis B is caused by the hepatitis B virus (HBV). Hepatitis B belongs to the hepadnavirus family. It is an infectious disease which causes inflammation of the liver (hepat- = liver; -itis = inflammation). The virus causes problems in the liver because it replicates in hepatocytes, a certain type of liver cell.

Hepatitis can be caused by many things, but the most common cause of hepatitis is viral hepatitis. The main causes of viral hepatitis are hepatitis A, B, C, D and E. These viruses all belong to different families of viruses and are contracted in different ways, but all cause very similar symptoms. There are also key differences in the progression of disease. For example, hepatitis A does not cause chronic illness, whereas most people with hepatitis C will go on to develop chronic hepatitis C.

Hepatitis B is transmitted, or spread, in various ways. The most common ways for hepatitis B to spread is through vaginal, anal, or oral sex and sharing, or being injured by contaminated needles.

The hepatitis B virus can live outside the body at room temperature for at least 7 days. If someone who is not immune to hepatitis B comes into contact with the virus, and the virus enters the body, they can become infected with hepatitis B.

Some people don’t have any symptoms of hepatitis B, but others may experience nausea, vomiting, jaundice (yellowing of the skin), fatigue, dark urine and abdominal pain. These symptoms will usually start between 30 and 180 days post-infection. This is known as the acute stage infection.

People who are infected with HBV for longer than six months are considered to be suffering from chronic HBV infection. Chronic HBV is more serious than acute HBV, because it can cause liver damage.

What is acute hepatitis B infection?

Acute hepatitis B infection describes the short-term infection that usually lasts for less than six months. Most people who have an acute hepatitis B infection do not require treatment, and many people infected with HBV don’t know they have it. In healthy adults, the hepatitis B virus is cleared by their immune system, without any need for treatment.

People with an acute hepatitis B infection may or may not experience any symptoms. In adults whose immune systems work well, they are usually able to clear the infection without any need for treatment. People with HBV whose symptoms are severe may need hospital treatment but can recover.

What is chronic hepatitis B infection?

Chronic hepatitis B infection occurs when the infection lasts longer than six months. Many people with chronic hepatitis B do not have any symptoms (asymptomatic) until the disease progresses. Some people with chronic hepatitis B infection may have ‘non-specific’ symptoms, such as fatigue, and some individuals can develop symptoms that are similar to those found in acute hepatitis.

Chronic hepatitis B infection is usually lifelong. Your risk of developing chronic infection depends on your age and genetics. People who contact hepatitis B in adulthood who have a good immune system are unlikely to develop chronic hepatitis B. However, infants who contract hepatitis B are very likely to develop a life-long chronic infection (CDC, 2023). Those who are immunocompromised, such as those who ‘ction.

If chronic hepatitis B infection progresses, it can cause cirrhosis. Cirrhosis is severe scarring of the liver and is sometimes called ‘end-stage liver disease’. Cirrhosis can’t be cured, but treatment may stop cirrhosis from getting worse. People with chronic hepatitis B infection and cirrhosis will develop signs of liver failure, particularly if treatment is not sought.

People with chronic hepatitis B can take oral medicine. The medicine can help to slow the progression of cirrhosis, reduce the risk of getting liver cancer and improve life expectancy. If you start taking medicine to treat your chronic hepatitis B, you will usually need to continue it for life.

How is hepatitis B spread?

Hepatitis B is transmitted through blood or other bodily fluids. The hepatitis B virus can survive on surfaces outside of the body for 7 days at room temperature. That means if someone comes into contact with a contaminated surface and the virus gets into their body, they could get infected with hepatitis B.

Transmission of hepatitis B can occur through:

• Vaginal, anal or oral sex without using a protective contraception, such as condoms
• Injecting drugs using shared needles, or being injured by a contaminated needle
• Getting a piercing or a tattoo with unsterilised equipment
• Getting a blood transfusion

Vertical transmission happens when a mother who is pregnant contracts an infectious disease, which is then passed on to the baby, either during pregnancy or through birth. If you have hepatitis B during pregnancy, there is a risk that you can pass this on to your baby. Infants with hepatitis B are far more likely to develop chronic hepatitis B infection. In the UK, babies born to mothers who are infected with hepatitis B are given additional vaccinations to help reduce the risk of them contracting the infection (NHS, 2022).

In the UK, the risk of contracting hepatitis B is very low due to strict measures that are in place where the risk of contracting hepatitis B would usually be high. For instance, in order to tattoo somebody, you must be licenced to do so. It is illegal to tattoo somebody without a licence or the correct certification. This helps to ensure that tattoo artists and the premises they use are using the correct equipment and are abiding by UK health and safety laws.

Blood used for transfusions is checked for a variety of infectious diseases in the UK, including hepatitis B, so it is extremely unlikely for someone to contract hepatitis B from a blood transfusion in the UK.

The hepatitis B vaccine, as part of the 6-in-1 vaccine, is given to babies as part of their vaccination schedule in the UK.

To reduce your risk of contracting hepatitis B, use condoms or other protective methods of contraception. Don’t get a tattoo or piercing without checking that the establishment has the required licencing, certification and insurance, and if you are travelling internationally, particularly to an area or country where hepatitis B risk is high, then speak to your doctor about taking the full course of the hepatitis B vaccine.

What are the symptoms of hepatitis B?

Many people who get infected with hepatitis B do not have any symptoms and may not ever know they have it if their immune system clears the infection during the acute stage.

Some people do experience symptoms, most of which are not severe and are non-specific. These include:

• Fatigue
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Yellowish skin (jaundice)

In less than 1% of people with acute hepatitis B infection, fulminant hepatitis (acute liver failure) may occur.  This usually requires antiviral treatment often hospitalisation. Symptoms of this include:

• General weakness
• Rapid onset jaundice
• Changes in mental status which usually begins with mild confusion

If hepatitis B infection lasts longer than six months, it progresses to a chronic infection. Many people with chronic hepatitis B infection are asymptomatic at first, whereas some may experience symptoms like fatigue. However, as the chronic infection progresses, the liver becomes more damaged, and symptoms can appear or worsen. These symptoms may be similar to those seen in acute hepatitis B infection.

Chronic hepatitis B may progress to cirrhosis. A person may start to experience signs and symptoms of liver failure, including:

• An enlarged spleen
• Jaundice
• Fluid retention in the abdomen
• Swelling of the extremities
• Problems with brain function (encephalopathy)
• Hepatocellular carcinoma (liver cancer)

How common is hepatitis B?

Hepatitis B is the most common blood-borne infectious disease. It is the cause of the majority of viral hepatitis cases. HBV is sometimes called the ‘stealth’ virus, because in many usually healthy adults, the virus goes unnoticed, not causing any symptoms. This leads to severe underreporting of hepatitis B.

The World Health Organisation (WHO) estimates that there are roughly 1.5 million new hepatitis B infections every year.  In 2019 there were about 296 million people living with chronic hepatitis B infection globally – approximately 3.9% of the world’s total population.

About 0.3% of people have chronic hepatitis B in the UK, which is around 180,000 people.  According to the UK Government website, most new chronic hepatitis B infections in the UK come from migrants who contracted the virus during early childhood in their birth country. The regions with the highest adult prevalence of chronic hepatitis B (5-10%) include:

• Sub-Saharan Africa
• East Asia
• The Middle East
• Indian Subcontinent
• The Amazon
• Southern parts of Central and Eastern Europe

Can you be immune to hepatitis B?

Most adults who become infected with hepatitis B will clear the infection, making a full recovery and develop life-long immunity to the virus. This is known as natural immunity – when your body’s immune system makes its own antibodies to fight off the infection.

You can also get a hepatitis B vaccine that also provides immunity to the virus.

In this section, we will look at what natural immunity is, what the hepatitis B vaccine is and who should get the vaccine.

Natural immunity to hepatitis B

Our immune system exists to protect us from harmful pathogens. The innate, or ‘non-specific’ immune system is like a generic first-line of defence. It provides a rapid response to an infection by releasing cells whose job it is to ‘capture’ and kill the pathogen or infected cell, and to present special proteins from the pathogen (antigen) to other cells within the immune system.

When antigens from a foreign body, such as a virus or bacteria, are presented to special cells within the immune system, antibodies that are specific to the antigen are made. This is called acquired or ‘specific’ immunity.

If somebody gets infected with HBV, their immune system will start making antibodies that are specific to the hepatitis B antigens. The immune system ‘remembers’ the HBV antigens and how to make the antibodies for HBV, and so if that person comes into contact with the hepatitis B virus again, the acquired immune system will start releasing the antibodies for the virus, and the person won’t get sick. This is called natural immunity – the person is immune to the virus because their immune system has created antibodies as a response to being infected.

Vaccination for hepatitis B

There are several different types of vaccines, and which vaccine you receive will depend on the pathogen you are trying to create immunity for. Some vaccines are made using inactivated or weakened pathogen, some are made with mRNA, and others are synthetic (man-made) parts of the pathogen you wish to create immunity to.

Vaccines work by causing your body to produce antibodies to the pathogen you are trying to protect against, without making you sick. This is different to natural immunity – natural immunity occurs when you get sick, e.g. from a virus, and your immune system makes antibodies to fight the virus.

In the UK, the hepatitis B vaccine is inactivated (dead). It can’t cause you to get the hepatitis B infection. Instead, it causes your body to produce specific anti-hepatitis B antibodies (anti-HBs). If you are vaccinated against HBV and you come into contact with the virus, your body will recognise the hepatitis B antigens and will release the specific hepatitis B antibodies, preventing you from getting sick.

A full vaccine course should provide protection for at least five years, though some people are protected for life. You can also receive booster vaccines if your immunity to hepatitis B begins to decline despite having a full course of the vaccine.

In the UK, babies are given the hepatitis B vaccine as part of their 6-in-1 vaccine schedule. If a baby is born to a mother who has hepatitis B, then the vaccine course is ‘accelerated’ to minimise the risk of the baby getting infected with HBV. The vaccine is also offered to those who are at risk of catching hepatitis B. The NHS website includes a list of groups who are considered ‘at risk’ of catching hepatitis B.

You should consider getting the hepatitis B vaccine if you are planning to travel internationally, particularly if your destination is an area of high hepatitis B prevalence. You can’t usually get free hepatitis B vaccinations for travel purposes. There are several providers of the hepatitis B vaccine in the UK, and you can find out more information about where to get the vaccine and if the vaccine is suitable for you by visiting your local pharmacy or GP.

Who should get the hepatitis B vaccine?

The hepatitis B vaccine is suitable for most people, particularly high-risk groups. These include:

• Sex workers
• People who inject drugs, particularly those who share needles with others
• Partners of people who inject drugs
• Men who have sex with men
• People who have chronic liver or chronic kidney disease
• People who have regular blood transfusions and people who look after them (e.g. carers, family)
• People who live with someone with hepatitis B
• People who are travelling to countries where hepatitis B prevalence is high
• Prisoners
• People living with or caring for people who come from a country where hepatitis B risk is high
• Babies born from mothers who have hepatitis B
• People who work in an environment which increases hepatitis B transmission risk, e.g. laboratory staff, healthcare workers, prison staff, dentists etc.

It’s important for high-risk individuals to get vaccinated against hepatitis B to prevent the transmission of the virus. Some individuals either cannot receive the vaccination, or the vaccination isn’t as effective on them, e.g. if they are immunocompromised.

If you are unsure whether you are at a high risk of getting hepatitis B, or whether you should get the vaccine, you can speak to your local pharmacist or GP who can give you some advice.

Who should not get the vaccine?

If you have already been infected with hepatitis B and have recovered, then you shouldn’t need the vaccine, as you will have natural immunity.

If you are allergic to any of the ingredients in the vaccine or have had an allergic reaction to a previous hepatitis B vaccine, you should not have another hepatitis B vaccine dose. If you are unsure whether you should continue with your vaccination course, seek advice from your healthcare provider.

If you are currently unwell with a moderate or severe acute illness, you should not receive a dose of the vaccine until you have recovered. Speak to your doctor if you are unsure.

Are you immune to hepatitis B after having it once?

Once you have had a hepatitis B infection once, you can’t get infected again. This is because your body has already produced the antibodies necessary to fight the virus, should you come into contact with it again.

In some people, however, the hepatitis B virus can ‘reactivate’. Reactivation is rare and can be caused by many different means. It can happen in people who had a past HBV infection, or people who have chronic HBV. People who had a hepatitis B infection in the past and need certain types of treatment, such as chemotherapy, should tell their doctor about their previous hepatitis B infection. If you had hepatitis B in the past and need to receive immunosuppressive treatment, your risk of hepatitis B reactivation increases.

How do you know if you are immune to hepatitis B?

Many people who get hepatitis B won’t ever know they have it, because they don’t experience any symptoms and their immune system clears the infection, so they don’t know whether they are immune to hepatitis B. Additionally, only a small number of at-risk individuals who are offered the hepatitis B vaccine will be asked to submit a sample for immunity testing following the vaccination.

Healthcare workers will be given a follow-up appointment to see if they have responded to the vaccine. This will usually include taking a blood sample to check for the presence of antibodies to hepatitis B. People in kidney failure will also have their immunity checked following the vaccine.

You can check if you are immune to hepatitis B by purchasing a hepatitis B immunity test from AlphaBiolabs. The test requires a small sample of blood. We will then check your blood sample for hepatitis B antibodies. The results will tell you the amount of antibody present in your sample, which will indicate whether or not you have immunity to hepatitis B.

What will the AlphaBiolabs hepatitis B immunity test at tell me?

The AlphaBiolabs hepatitis B immunity test will tell you if you have the antibodies to the hepatitis B virus. These antibodies will be present if you have been infected with hepatitis B or if you have had the vaccine for hepatitis B.

The immunity test cannot tell you if the presence of the antibodies in your sample are because of having the vaccine, or being infected with hepatitis B in the past. This is because the antibodies caused from hepatitis B infection or vaccine are the same. It can only tell you if antibodies are present, and how much antibody is there.

The hepatitis B immunity test is a good way to check if you are sufficiently immune to the hepatitis B virus after having the hepatitis B vaccination course.

There are several reasons why you may wish to take the AlphaBiolabs hepatitis B immunity test, and you can take it more than once if necessary. For example, if you have had the vaccinations in the past and you take the test and find your immunity to be lower than expected, you may consider getting a booster vaccine. You can then take another hepatitis B immunity test to show you how the booster vaccine has altered your immunity to hepatitis B.

This can give you peace of mind about your immunity, particularly if you are a healthcare worker, or someone who works or lives with at-risk individuals, or people who have hepatitis B.

You can buy the hepatitis B immunity test at AlphaBiolabs for just £42 here.