What is the difference between acute and chronic hepatitis B?

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Hepatitis B is a virus that transmits through contact with bodily fluids, such as blood, semen, and vaginal secretions, that contain the virus. A fetus may also come in contact with bodily fluids in the womb or during birth.

Hepatitis B can present in two forms: chronic and acute. Acute means the condition comes on rapidly, and the body quickly recovers from the virus, developing immunity.

Chronic hepatitis B happens when the body cannot fully recover from the virus, causing a long-term infection from the virus that can lead to serious liver problems.

Vaccination is the most effective prevention for acute and chronic hepatitis B. Both forms can affect liver health, though the risk of significant damage is much higher in chronic hepatitis B due to its persistent nature.

Chronic hepatitis B occurs when the body’s immune system cannot clear the hepatitis B virus after the initial infection, becoming a long-term infection.

Experts classify it by the presence of HBV in the blood for at least 6 months. Chronic hepatitis B is a major global health issue, leading to significant liver-related morbidity and mortality.

Causes and risk factors

Similar to acute hepatitis B, chronic infection can occur through direct contact with the bodily fluids of someone with the virus, unsafe injection practices, and birth from someone who has the infection.

Infants and young children with HBV are more likely to develop chronic hepatitis B than adults.

Other risk factors include having sex without using a condom or other barrier methods with someone who has the virus, sharing needles, and having a compromised immune system.

Symptoms

Many people with chronic hepatitis B do not exhibit symptoms until complications develop, which may take decades. When symptoms do appear, they may include:

• fatigue
• mild pain on the right side of the abdomen
• jaundice
• dark urine
• pale stool

Treatment

While there is no complete cure for chronic hepatitis B, treatments aim to control the virus and prevent liver damage.

Antiviral medications, such as tenofovir and entecavir, can effectively reduce viral replication and minimize liver injury. Regularly monitoring liver function and screening for cancer are critical for managing chronic hepatitis B.

Acute hepatitis B refers to the newly acquired hepatitis B virus infection that lasts for a short duration, typically less than 6 months.

For most adults, an acute hepatitis B infection does not progress to the chronic stage.

Causes and risk factors

The causes and risk factors are similar to those of chronic hepatitis B, with transmission occurring through exposure to bodily fluids that contain the virus.

Symptoms

Symptoms of acute hepatitis B — when they occur — can range from mild to severe and may include:

• jaundice
• fatigue
• abdominal pain, particularly on the right side below the ribs
• nausea and vomiting
• fever
• dark urine and pale stools

Treatment

Treatment for acute hepatitis B is mainly supportive. This includes rest, adequate nutrition, and plenty of fluids.

For some people, hospitalization may be necessary, especially if dehydration or severe liver dysfunction occurs.

Most people recover completely from acute hepatitis B and develop immunity to the virus.

Preventing hepatitis B infection involves several key strategies to acquire immunity against the virus and reduce the risk of transmission.

The hepatitis B vaccine is the most effective means of prevention. Medical professionals usually administer it in three injections over 6 months.

They can also administer injections to prevent parent-to-child transmission during childbirth. This requires four injections: one at birth and three subsequent doses given at various schedules — depending on the child’s needs — for up to 15 months.

Experts also recommend vaccination for unvaccinated adults at high risk of infection, including healthcare workers, people with multiple sexual partners, people with other sexually transmitted infections, people who inject drugs, and those with chronic liver disease.

Other ways to prevent hepatitis infections include:

• using sterile, disposable needles and syringes each time and never sharing needles is crucial for those who inject drugs
• using condoms and other barrier methods during sexual activity
• avoiding sharing items that might have come into contact with blood, such as toothbrushes, razors, or nail clippers
• ensuring safe blood transfusions and organ transplants by screening blood products for hepatitis B and other bloodborne pathogens.
• screening for pregnant people for hepatitis B
• following universal precautions, including using personal protective equipment (PPE) and avoiding direct contact with blood and other bodily fluids

Here are answers to some frequently asked questions about hepatitis B.

My husband has hepatitis B. Can I get it?

Yes, hepatitis B is contagious and can be transmitted from a person with the virus to someone else through direct contact with their bodily fluids.

This includes sexual contact, sharing needles, or birth from someone who has the infection.

Using protection during sexual activities, avoiding sharing personal items — such as razors or toothbrushes — that may have come into contact with blood, and getting vaccinated against hepatitis B are important preventive measures.

Does acute hepatitis B need treatment?

Acute hepatitis B usually does not require specific treatment. Most people’s immune systems can clear the virus effectively on their own within a few months.

Treatment mainly involves supportive care to relieve symptoms, such as adequate rest, hydration, and maintaining a healthy diet.

However, rarely, hospitalization and intensive care may be necessary if the infection leads to severe complications, such as fulminant hepatitis.

Can chronic hepatitis B go away?

Chronic hepatitis B cannot be completely cured.

However, with effective treatment, it is possible to suppress the virus, significantly reduce the risk of liver damage, and potentially achieve a state of a “functional cure,” where the virus is no longer detectable in the blood and halting or reversing liver damage.

Antiviral medications can control the virus and reduce the risk of long-term complications, such as cirrhosis and liver cancer. Regular monitoring and treatment adjustments are crucial for managing chronic hepatitis B.

Both chronic and acute hepatitis B highlight the importance of prevention, early detection, and management to mitigate the impact of the hepatitis B virus on individual and public health.

Vaccination remains the most effective measure to prevent hepatitis B infection.