Hepatitis B

Hepatitis B can cause various symptoms, including a lack of appetite, nausea and vomiting, yellowish skin and eyes (jaundice), generally feeling unwell, achy joints and fever.

Many people who become infected don’t have any symptoms, or they don’t have typical symptoms. And it can take 1 to 6 months for symptoms to occur after becoming infected. So a person may have hepatitis B for quite a while before it's diagnosed, and could unknowingly pass the virus on to other people during that time.

The virus is usually spread through unprotected sex (without using a condom) – most commonly between men who have sex with each other. People who have different sexual partners have a higher risk of getting hepatitis B. Other routes of infection include using non-sterile syringes when consuming drugs or having a tattoo done with non-sterile needles. The risk of infection is also higher for people who live with someone who has hepatitis B, and for people who permanently live in a country with a high number of infected people.

If a pregnant woman has hepatitis B, she might pass it on to her baby while giving birth. In Germany and other countries, pregnant women are offered a hepatitis B test. If a woman is found to be infected with the virus, measures can be taken to prevent her baby from becoming infected during or after the birth.

Fewer than 1 out of 100 people have hepatitis B in Germany. According to data collected by the Robert Koch Institute, about 6,800 people were infected with the hepatitis B virus in Germany in 2020.

Hepatitis B infections can lead to inflammation in the liver. Acute infections in adults usually clear up on their own and don’t have to be treated. In very rare cases they can lead to sudden liver failure.

If someone has had hepatitis B in the past and recovered from it, it means that their immune system has made antibodies that will most likely keep the virus under control. In rare cases hepatitis B viruses can become active again – for instance, if the immune system is very weak due to chemotherapy.

In some people the infection becomes permanent. Over time, chronic hepatitis B can lead to serious complications such as liver cirrhosis, a build-up of fluid in the abdomen (ascites), bleeding and liver cancer.

If a baby gets hepatitis B from their mother during or after their birth, the infection usually becomes chronic. This happens in 90 out of 100 children in this situation.

Hepatitis B can be diagnosed using a blood test to detect certain parts of the virus (such as virus antigens) or antibodies to parts of the virus.

The blood test can also be used to screen for hepatitis B – in other words, to detect hepatitis B in people who don’t have any symptoms yet.

Statutory health insurers in Germany cover the costs of being tested once for the hepatitis B virus for people aged 35 and over as part of a general check-up.

In Germany, pregnant women can be tested for hepatitis B for free – statutory health insurers pay for it as part of their standard prenatal care.

There is a vaccine for the prevention of hepatitis B. The German Standing Committee on Vaccination (STIKO) at the Robert Koch Institute (RKI) recommends that all babies and toddlers be vaccinated against hepatitis B. Whether or not the vaccine makes sense for adults will depend on their individual risk of infection, which depends on the risk factors mentioned above.

The vaccine is recommended if you

• have a weakened immune system,
• are planning to have medical treatment that suppresses the immune system,
• are in close contact with people who have chronic hepatitis B, or
• are more likely to be exposed to the virus at work (healthcare professionals or cleaning staff at a hospital).

It can be a good idea to have the vaccine before traveling to countries where hepatitis B is very common. You will find more information about travel vaccinations on the website of the World Health Organization.

In most cases the body’s immune system is able to effectively fight a hepatitis B infection. Symptoms such as nausea and pain can be treated with suitable medication. Several months after hepatitis B is diagnosed, another blood test can be done to see whether any signs of the virus are still detectable. Sometimes small amounts of the virus remain in liver cells although there are no viruses in the blood. But the viruses in the liver cells rarely cause further problems.

Chronic hepatitis B infections are usually treated with tablets designed to fight the virus and prevent liver damage (nucleotide analogues / nucleoside analogues). Temporary treatment with interferon alpha may be considered too.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.