Who should get the hepatitis B immunity test?

In this article, we talk about the hepatitis B virus, who is at risk for getting hepatitis B, and who should be tested for hepatitis B immunity.

What is hepatitis B?

Hepatitis B is a virus. The virus attacks cells of the liver and causes inflammation (hepat- = liver; -itis = inflammation). The hepatitis B virus is sometimes abbreviated to HBV.

The initial stage of infection is called the acute stage. Some people may have symptoms such as fatigue, nausea, abdominal pain and yellowing of the skin and whites of the eyes (jaundice), though many don’t have any symptoms at all. In most healthy adults who contract hepatitis B, their immune system is able to clear the infection without any need for treatment.

In some cases, individuals who have hepatitis B can’t clear the infection from their body. When someone has been infected with hepatitis B for more than six months, the condition becomes chronic. Chronic hepatitis B is usually lifelong. The risk of a hepatitis B infection becoming chronic is dependent on multiple factors, such as whether the person has other co-infections (e.g. HIV, hepatitis C) or the age of the person (infants are highly likely to develop chronic hepatitis B following acute HBV infection). The time it takes for chronic hepatitis B infection to progress depends on whether you can access treatment. Treatment can include oral medicines like tenofovir or entecavir (antiviral medicines). These treatments help to slow down or stop the virus from replicating, which in turn slows the advancement of cirrhosis, reduces cases of liver cancer, and improves long-term survival (WHO, 2023).

If left unchecked, chronic hepatitis B leads to cirrhosis. Cirrhosis is severe scarring of the liver. The scarring can stop your liver from working properly, and eventually you will go into liver failure. Damage to the liver also increases your risk of developing liver cancer.

Is hepatitis B the same as hepatitis C?

No. Hepatitis B is not the same as hepatitis C.

There are five main types of viral hepatitis infections, hepatitis A, B, C, D and E. Despite what their names suggest, they are distinct viruses that belong to different families of virus.

They do, however, all cause inflammation of the liver.

Hepatitis A

• Mostly spread by eating or drinking food or water contaminated with faeces
• Shorter average incubation period (time between first exposure and onset of symptoms) compared to hepatitis B
• Chronic hepatitis A is extremely rare – almost all people with hepatitis A will only have acute infection
• Fewer people are thought to be infected with hepatitis A compared with hepatitis B
• Hepatitis A vaccine exists and can be given in conjunction with the hepatitis B vaccine

Hepatitis B

• Spread through blood or other bodily fluids
• Around 3.9% of the world’s population is thought to have hepatitis B
• Can turn into chronic hepatitis B, especially in children under the age of 6
• 95% of infants or very young children with hepatitis B will get chronic hepatitis B
• About 5% of people who acquire HBV in adulthood will get chronic hepatitis B
• Hepatitis B vaccine routinely given for those most at risk
• Babies born in the UK can be immunised against hepatitis B as part of their 6-in-1 vaccine schedule

Hepatitis C

• Transmission similar to hepatitis B virus
• About 58 million people worldwide have chronic hepatitis C
• About 30% of people with hepatitis C will clear the infection without treatment, much fewer compared to hepatitis B
• There is no effective vaccine against hepatitis C

Hepatitis D

• Can only occur if hepatitis B virus is also present
• Affects 5% of people with chronic hepatitis B worldwide
• HBV-HDV co-infection causes more rapid progression of liver problems, such as hepatocellular carcinoma
• Hepatitis D can only be prevented via the hepatitis B vaccine

Hepatitis E

• Usually self-limiting, so no effective treatment available
• Mainly transmitted through water that has been contaminated with faeces
• A vaccine does exist but is not yet available on a global scale

What are the symptoms of hepatitis B?

Many people who become infected with the hepatitis B virus don’t have any symptoms. Other people may experience mild or moderate symptoms around 30-180 days after contracting the infection. These may include:

• Fatigue
• Cold or flu-like symptoms
• Nausea
• Vomiting
• Abdominal pain
• Jaundice
• Dark urine

In very rare cases, symptoms can be severe enough to require hospitalisation.

Some symptoms of hepatitis B are non-specific, e.g. tiredness, nausea, or vomiting. This can make it hard for healthcare workers to identify the cause quickly. Other symptoms, such as jaundice and dark-coloured urine, are better indicators of hepatitis. The problem, however, is that these symptoms are also signs of other types of hepatitis, including all four other types of viral hepatitis.

If the body can’t clear the hepatitis B virus within six months, the infection progresses to chronic hepatitis B infection.

Like with acute infection, many people with chronic hepatitis B are asymptomatic to start with. It is not until the infection progresses, and significant damage to the liver occurs, that many start to experience symptoms. Other people may have symptoms that are similar to those of the acute stage.

If someone with chronic hepatitis B develops cirrhosis, a condition where the liver becomes severely scarred, signs of symptoms of liver failure will appear. These include:

• Fluid retention in the abdomen
• Jaundice
• Enlarged spleen
• Swelling of extremities
• Confusion (caused by encephalopathy)
• A type of liver cancer called hepatocellular carcinoma

Hepatitis B is often referred to as a ‘stealth’ virus or disease, because symptoms can go unnoticed for a long time, increasing the risk of developing serious complications and liver failure. It’s important to get checked for hepatitis B, particularly if you work or live in a high-risk setting, or engage in risky behaviours associated with contracting hepatitis B.

It is important to note that you can’t catch HBV by hugging someone or sharing a meal.

Who should be tested for hepatitis B immunity?

There are two different tests available at AlphaBiolabs which test for hepatitis B – hepatitis B infectivity and hepatitis B immunity.

Our hepatitis B infectivity test looks for hepatitis B-specific surface antigens that are found in the body when you are infected with hepatitis B.

Our hepatitis B immunity test looks for antibodies to hepatitis B that are found in the body, either from a previous infection or because you have had the hepatitis B vaccine.

So, who should take the hepatitis immunity test?

Usually, people who work in a healthcare setting are invited to a follow-up appointment after they have received their vaccine course to check their level of immunity to hepatitis B. However, there are many people who can get the vaccine who won’t have their immunity checked following the hepatitis B vaccination course. This means that many people who are eligible for the vaccine and are at a high risk of contracting hepatitis B, don’t know if they are sufficiently immune or require a booster.

What groups of people are considered high risk for hepatitis B?

There are many people who are considered high risk for contracting the hepatitis B virus. This is because the virus is spread in the blood or bodily fluids from an infected individual and can live on surfaces for 7 or more days.

The NHS website provides a comprehensive list of people who are considered high risk for hepatitis B. In this section, we take a look at these high-risk groups and explain why they are at greater risk of getting hepatitis B than the general public.

Healthcare workers

Healthcare workers (doctors, nurses, healthcare assistants etc.) are at a greater risk of catching hepatitis B. They are in contact with many different people in their line of work, some of whom will have infectious diseases like hepatitis B.

Lots of people who work in healthcare, such as nurses, will have to take lots of samples from patients every day. This increases the risk that they will come in to contact with infected blood or bodily fluids that may contain hepatitis B, which puts them at a greater risk of contracting the virus themselves.

Laboratory staff who are performing the tests are also at risk of getting hepatitis B because they are handling blood or bodily fluids that may potentially be contaminated with HBV.

If your working environment puts you at a higher risk of getting hepatitis B, your employer is responsible for ensuring that you are protected against it. This includes wearing the correct personal protective equipment (PPE) and getting vaccinated against hepatitis B. If you’re unsure whether your line of work puts you at risk for hepatitis B, speak to your employer.

International travel

In the UK, the prevalence of chronic hepatitis B is about 0.3%, which is low. However, in some countries, prevalence is as high as 10%.

When travelling to a country where prevalence is high, it is recommended that you get vaccinated for hepatitis B. You can also get vaccinated for hepatitis A and B if the country you are travelling to has a high prevalence of both.

Things that can increase your risk of catching hepatitis B abroad are:

• Going to a country or area where prevalence is high
• Having sex or partaking in sexual activities, particularly with multiple people
• Playing contact sport or other activities that involve contact with others and a greater risk of injury
• If you have a medical condition, and/or are likely to need medical care whilst abroad
• Injecting drugs

Before travelling abroad, especially if you are planning to stay there for a long period of time, you should speak to your doctor about getting vaccinated against hepatitis B. You usually have to pay for vaccinations for travel. Alternatively, places like Lloyd’s pharmacy and Superdrug offer travel vaccinations. One dose of the vaccine is currently about £50.

If you are planning to travel and are not sure whether you should have the vaccine, speak to your doctor or local pharmacist in advance. They will be able to advise you on whether the vaccine is suitable for your trip.

The NHS website offers information and advice about the type of vaccination you need depending on where you intend on travelling to.

People who have sex with multiple sexual partners

Because hepatitis B can be spread via vaginal, anal or oral intercourse, people who have multiple sexual partners, such as some sex workers, are at a higher risk of contracting hepatitis B.

The best way to prevent the transmission of hepatitis B through sexual intercourse is to always use condoms or dams that have not expired. You should also get regular testing done to ensure you don’t have an infection.

However, sometimes a condom may break, especially if the condom has expired or the condom is the wrong size. Therefore, having the hepatitis B vaccine protects you in case your form of protective contraception fails.

People who live with or care for a HBV-infected person

Living in the same house as other people increases your risk of catching a variety of illnesses, like a common cold or the flu. This is because you are inhabiting shared spaces and touching surfaces that may be contaminated with pathogens.

Similarly, carers are usually in very close proximity with those they care for. Depending on the level of care required, carers may be in close or direct contact with blood or bodily fluids where HBV is transmitted.

The hepatitis B virus can live on surfaces at room temperature for 7 days, sometimes more. If someone comes into contact with the virus and it gets into their body, they are at risk of contracting hepatitis B.

People who live with or care for someone with hepatitis B should get vaccinated to protect themselves in case they accidentally come into contact with the blood or bodily fluids of someone who is infected.

Intravenous drug users and partners of intravenous drug users

Intravenous drug users who share needles are at higher risk of contracting hepatitis B. If someone with HBV injects themself, and then another unaffected person uses the same needle, then then blood from the infected individual can enter the bloodstream of the uninfected person, greatly increasing their risk of getting hepatitis B.

The more times a needle is shared, and the more times a person uses a share needle, the greater the risk of being infected with HBV.

If you inject drugs, you’re also more likely to develop chronic hepatitis B if you get infected with the virus compared to the general population.

Partners of, or people who live with, intravenous drug users are at greater risk of getting hepatitis B. If someone has sex with an intravenous drug user, they risk catching hepatitis B.

There is also the risk of needlestick injuries, should there be needles in shared spaces, which puts partners or people who live with intravenous drug users at risk too.

It’s therefore important to seek medical advice if you are an intravenous drug user, or the partner of somebody who injects drugs. You may be eligible for the hepatitis B vaccine which can help protect you and those around you from getting hepatitis B.

Men who have sex with men (MSM)

Men who have sex with men (MSM) are at higher risk of getting hepatitis B as well as other STI and blood-borne infections, such as HIV.

There is a higher prevalence of HBV within MSM populations. This is because there is greater transmission linked with condomless anal sex, which greatly increases the likelihood of HBV transmission (NCBI, 2018).

Anyone who has sex or takes part in sexual activity of any kind should get regularly screened for STIs and blood-borne viruses commonly transmitted via sex. Getting tested for things like hepatitis B helps keep you and those around you safe.

If you are a man who has sex with men, you should consider getting the hepatitis B vaccine. You can speak to your doctor, or visit your nearest GUM clinic who should be able to help you get the hepatitis B vaccine.

People with chronic liver or kidney disease

There are lots of things that can cause chronic liver disease outside of a viral hepatitis infection, such as some autoimmune disorders or excessive alcohol intake.

Getting an infection when you are already suffering from chronic liver disease puts you at risk of developing a more severe form of disease. This risk is particularly heightened if you get hepatitis B, because the infection attacks the cells of the liver. Having hepatitis B as well as chronic liver disease may accelerate the progression of cirrhosis and eventually liver failure.

Chronic kidney disease can also happen for a multitude of reasons. It’s associated with getting older and is more common in people who are of south Asian origin or are black (NHS, 2023).

Things that might cause chronic kidney disease include high blood pressure, kidney infections and diabetes. There are also genetic factors and long-term use of certain medications that may increase your risk of getting chronic kidney disease.  

People with chronic kidney disease are more prone to infection. These people have chronic inflammation, which in turn weakens the immune system and its ability to fight off infections.

In addition, those who are on dialysis or in need of a kidney transplant are at higher risk of getting a blood-borne infection, such as hepatitis B, because they are more likely to be in contact with blood or bodily fluids. The risk of this is very rare in the UK, particularly in hospitals, because blood must be screened before being accepted for transfusions. Our hospital equipment must also be kept sterile (free from microorganisms like bacteria or viruses). However, should you travel to another country, particularly where hepatitis B is more prevalent, then you are at an increased risk of getting hepatitis B. If you do need to travel and have chronic kidney disease, it’s important you speak to your doctor to ensure that you are taking all the right precautions to protect yourself from getting sick.

Both chronic liver disease or kidney disease sufferers are therefore at an increased risk of getting hepatitis B and should consider getting the hepatitis B vaccine.

If your liver or kidney disease is particularly advanced, the vaccine may not work as well compared to if you were healthy. However, getting the vaccine at an early stage in the disease is thought to work almost as well, if not the same, as in matched healthy individuals. It’s important that you talk to your doctor about getting the hepatitis B vaccine upon getting a diagnosis of chronic liver or kidney disease, as this can help prevent you from contracting hepatitis B and worsening your liver or kidney disease.

Even if your chronic liver or kidney disease is more advanced, you can still get the hepatitis B vaccine. You may need more frequent doses or ‘boosters’ compared to the general population to ensure that you remain immune to HBV.

Where can I get a hepatitis B immunity test?

At AlphaBiolabs, you can find out if you have immunity to hepatitis B here.

Our test requires a simple finger-prick blood sample that you can do at home – no need to have your blood collected at a clinic!

The results will tell you how much hepatitis B antibody we detected in your sample. To help you understand what your results mean, there is an interpretation of results table included in your report.

Our hepatitis B immunity test cannot tell you if the antibodies detected in your sample are from a previous hepatitis B infection or the vaccine. This is because the antibodies produced from both are the same. Our test will be able to tell you if you have immunity to hepatitis B and, if so, how strong that immunity is.

You might find this test useful if you have had a vaccine for hepatitis B and want to know if you still have sufficient immunity to the virus.

If you have never had the hepatitis B vaccine, but suspect you have had hepatitis B in the past, then this test will be able to tell you if there are hepatitis B antibodies present in your body. This is an indication that you have had a previous hepatitis B infection when you have not had the vaccine.

The hepatitis B immunity test is not suitable if you want to find out whether you currently have a hepatitis B infection. If you think you currently have hepatitis B, you can buy a hepatitis B infectivity test here. This test looks for antigens to hepatitis B as opposed to antibodies. Antigens are found in the blood when there is an active infection.

You can take the hepatitis B immunity test more than once! This might be useful for you if you want to check that the hepatitis B vaccine has worked as expected, or you want to check your antibody levels before and after receiving any dose of the vaccine.

You can quickly and easily buy a hepatitis B immunity test today, with laboratory results in just 2-3 working days from receipt of your sample.