Hepatitis B 2023
Introduction
Hepatitis B is a vaccine-preventable liver infection caused by the hepatitis B virus. It is spread by contact with bodily fluids through sex, IV drug use, or from mother to baby at birth. Hepatitis B infections can be either acute (short-term) or chronic (long-term).
Most healthy people recover from acute hepatitis B without treatment, but acute hepatitis B can sometimes lead to life-long infection known as chronic hepatitis B. Infants and young children are most likely to develop chronic hepatitis B if infected.1 About 15 to 25 percent of people with chronic infection will develop chronic liver disease, including cirrhosis, cancer, or liver failure.1
Currently, there is no treatment available for acute cases of hepatitis B, but people with chronic hepatitis B infections may be prescribed medication if symptoms are severe.
Vaccination remains the best method of preventing hepatitis B infections.
Acute Hepatitis B
Acute hepatitis B is a short-term illness that occurs within six months after exposure. Symptoms can include fatigue, poor appetite, stomach pain, nausea, and jaundice, but not everyone experiences symptoms. Up to half of older children and adults will have symptoms when newly infected with hepatitis B, and most children under five have no symptoms.2
Because many people with acute hepatitis B do not experience symptoms, CDC estimates that the true number of cases is much higher than reported. In 2022, CDC said that there were 2,126 reported cases of acute hepatitis B, but an estimated 13,800 infections nationwide.3
In 2023, Allegheny County had two reported cases of acute hepatitis B.
Chronic Hepatitis B
Almost all healthy adults clear an acute HBV infection with no lasting effects; however 90% of infants with acute hepatitis B develop a chronic hepatitis B infection.1 Chronic hepatitis B is a life-long infection that can cause serious health problems, including liver damage, cirrhosis, liver cancer, and death.1
In 2023, there were 37 confirmed cases and 109 probable** cases of newly diagnosed chronic hepatitis B reported in Allegheny County. (Figure 1)
*A confirmed case of chronic hepatitis B is defined as:
- Negative IgM anti-HBc AND a positive result on one of the following tests: hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), or nucleic acid test for hepatitis B virus DNA (including qualitative, quantitative and genotype testing), OR
- Two positive HBV DNA positive or HBeAg at least 6 months apart (Any combination of these tests performed 6 months apart is acceptable)4
**Probable cases of hepatitis B are not nationally notifiable but are included in this report in line with PADOH’s annual report. A probable case of chronic hepatitis B is defined as a person with a single positive HBsAg HBV DNA or HBeAg positive lab result who does not meet the case definition for acute hepatitis B.4
Figure 1: Newly reported confirmed* and probable** chronic hepatitis B infections by year, Allegheny County 2013-2023
Of the 146 confirmed and probable cases, 57 (39%) were females, and 89 (61%) were males. The 40-49 year-old age group had the most cases reported (Figure 2).
Figure 2: Newly reported confirmed and probable* chronic hepatitis B infections by age group and sex, Allegheny County, 2023
Perinatal Hepatitis B
Hepatitis B infection can pass from mother to infant at birth, but transmission can be prevented by providing hepatitis B immune globulin and hepatitis B vaccine to infants within 12 hours of birth. According to the World Health Organization, without intervention, up to 90 percent of infants born to infected mothers with high viral loads will be infected with hepatitis B.5
In 2023, there were 18 infants born to mothers with chronic hepatitis B infections in Allegheny County. Of these infants, all 18 received hepatitis B immune globulin and hepatitis B vaccine. To date, no infant developed a hepatitis B infection.
Hospitalizations Associated with Hepatitis B
Depending on the severity of symptoms, hepatitis B infections may lead to hospitalization. Most people who have hepatitis B go to the hospital for other ailments, which may be complicated by their hepatitis B infection. In 2023, 190 people in Allegheny County were hospitalized with a primary or secondary diagnosis of hepatitis B. Of these, 189 (99%) had chronic or unspecified hepatitis B, and one (<1%) had acute hepatitis B (Figure 3).
Figure 3: Hepatitis B-related hospitalizations, Allegheny County residents, 2016-2023
Data source: Pennsylvania Health Care Cost Containment Council
In 2023, the median age for females hospitalized with a diagnosis of hepatitis B was 62 years, with a range 25-80 years, compared to a median age of 63 years for hospitalized males, with a range of 0-89 years (Figure 4). Pregnancy related concerns were among the most common primary diagnoses for females hospitalized with hepatitis B diagnosis, accounting for 19 percent of these hospitalizations.
Figure 4: Hepatitis B-related hospitalizations by age group and sex, Allegheny County, 2023
Data source: Pennsylvania Health Care Cost Containment Council
Deaths Associated with Hepatitis B
From 2021 through 2023, a total of 6 people in Allegheny County had hepatitis B listed as an underlying or contributing cause on their death certificate. Deaths associated with hepatitis B have decreased since the 2003-2005 timeframe (Figure 5).
Figure 5: Number of cases with hepatitis B listed as a cause of death, 2000-2023
Data source: CDC Wonder6
Prevention
The best way to prevent Hepatitis B is to get vaccinated. CDC recommends that all infants and adults under 60 get vaccinated against hepatitis B. If you haven’t been vaccinated, or if you’re unsure if you have been vaccinated, talk with your doctor or visit ACHD’s Immunization Clinic.
CDC also recommends all people over 18 years old get tested for hepatitis B at least once in their lifetime.
Other ways to prevent hepatitis B:
- Never share needles
- People who use intravenous drugs are at high risk of getting infected with hepatitis if they share needles or other equipment
- Avoid direct exposure to blood or blood products
- Any tools that encounter blood or draw blood should be disposed of safely or sterilized
- Don’t share personal care items
- Sharing razors or toothbrushes can also be a vehicle for viral transmission since small cuts sometimes occur on the skin or gums during use
- Avoid getting a tattoo or piercing
- If getting a tattoo or piercing, ask the artist about their sanitary procedures, such as using new disposable needles and ink wells for each customer and properly using an autoclave for non-disposable supplies.
- Practice safe sex
Resources
References:
- Centers for Disease Control and Prevention. Clinical overview of hepatitis B. https://www.cdc.gov/hepatitis-b/hcp/clinical-overview/index.html November 2024
- Centers for Disease Control and Prevention. Symptoms of Hepatitis B. https://www.cdc.gov/hepatitis-b/signs-symptoms/index.html November 2024.
- Centers for Disease Control and Prevention. Hepatitis B Surveillance 2022. https://www.cdc.gov/hepatitis/statistics/2022surveillance/hepatitis-b.htm November 2024
- Centers for Disease Control and Prevention. Hepatitis B, chronic (historical version) 2012 Case Definition. https://ndc.services.cdc.gov/case-definitions/hepatitis-b-chronic-2012
- World Health Organization. Hepatitis: Preventing mother-to-child transmission of the hepatitis B virus. https://www.who.int/news-room/questions-and-answers/item/hepatitis-preventing-mother-to-child-transmission-of-the-hepatitis-b-virus December 2024
- Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/ October 2024