Hepatitis B Symptoms

On This Page: Symptoms | Complications | How Serious is it? | Hep B & Pregnancy

Hepatitis B is a liver infection caused by the hepatitis B virus (HBV), which can be spread through certain activities that involve infectious blood or body fluids⁠—such as sex, shared needle use, close household contact, and childbirth. Most people don’t know they have hepatitis B because they often don’t show symptoms and the infection usually goes away on its own. When there are symptoms, they can range from mild to severe and may feel like the flu. Testing is the only way to truly know if you are infected or not.

Most adults fully recover from hepatitis B without treatment, but in some cases, hepatitis B can become chronic, or lifelong, and cause serious liver disease. When the liver is inflamed or damaged, its ability to work properly can be affected. Over time, chronic hepatitis B can cause cirrhosis (liver scarring), liver cancer, and even death.

Hepatitis B Symptoms

Most people with hepatitis B don’t experience any symptoms. Because they don’t look or feel sick, many are unaware they are infected and unknowingly spread the virus to others.

If symptoms do appear, they usually begin between 8 weeks to 5 months after infection, with the average being 90 days (3 months) after exposure to the virus¹. Symptoms typically last several weeks, but some people can feel ill for up to 6 months. A person with chronic infection may experience ongoing symptom episodes, but many show no symptoms until they have cirrhosis or end-stage liver disease.

Signs of hepatitis B can include:

• Fever
• Tiredness
• Loss of appetite
• Light or clay-colored stools
• Dark urine
• Jaundice (yellowing of the skin and whites of the eyes)
• Abdominal pain
• Muscle or joint pain
• Mild to severe nausea and vomiting
• Bloated stomach

Hepatitis B Complications

Hepatitis B can range from a mild short-term illness that only lasts a few weeks or months, to a lifelong liver infection that can progress over the years and cause major health issues.

Hepatitis B is categorized as either:^1-2

• Acute hepatitis: An infection that occurs within the first 6 months of infection. Severity differs from person to person; most people have few or no symptoms, but it can also be a serious condition that requires hospitalization. Acute infection can be brief, and it doesn’t always lead to chronic infection. Some people, including most adults, are able to clear the virus on their own without treatment. Someone who clears the hepatitis B virus becomes immune and can’t get re-infected.
• Chronic hepatitis B: A long-term infection that lasts 6 months or longer. In some people, the immune system isn’t able to fight off the virus, and the infection most likely will stay in the blood and liver for a lifetime.

Having chronic hepatitis B increases the risk of developing problems, including:

• Cirrhosis– When damaged liver cells are replaced by scar tissue. This impacts the liver’s ability to work properly.
• Liver failure– Over the years, cirrhosis caused by long-term liver damage can cause your liver to stop working, which can be life-threatening.
• Liver cancer– People with cirrhosis have an increased risk of developing liver cancer and require frequent monitoring.

In rare cases (about 1 percent of those infected with hepatitis B)³, an infection can cause fulminant hepatitis, which can cause sudden liver failure, coma, and even death.

Symptoms may at first include feeling unwell, tired, and nauseous or feeling stomach pain. As the condition worsens, symptoms include yellowing of the skin or eyes (jaundice), sleepiness, stomach swelling, and changes in personality or behavior, such as feeling irritable or very confused. Because fulminant hepatitis can quickly become life-threatening, it requires immediate medical attention.⁴

How Likely Is It That Acute Hepatitis B Develops Into Chronic Infection?

Depending at what age a person is infected, the likelihood of hepatitis B infection developing from acute to chronic varies. Babies and young children who become infected have a much greater chance of developing a chronic infection than adults, and the risk goes down as they get older. According to the Centers for Disease Control and Prevention, about 95% of adults infected with hepatitis B make a full recovery and don’t progress to chronic infection. In contrast, approximately 90% of infected infants and 25-50% of infected children between 1-5 years old go on to develop chronic infection.¹

How Serious Is HBV Infection?

For most healthy adults, hepatitis B infection is short-lived, resolves without treatment (although proper rest, nutrition, and hydration can help), and causes no permanent damage. However, along with hepatitis C, having chronic hepatitis B is a leading cause of liver cancer.⁵ According to the Centers for Disease Control and Prevention (CDC), approximately 25% of people who become chronically infected during childhood and 15% of those who become chronically infected after childhood die prematurely from cirrhosis or liver cancer.⁶ Approximately 3,000 people in the United States die from hepatitis B-related liver disease each year.⁷

Chronic hepatitis B is a serious condition that requires care and monitoring. Although there’s no cure, antiviral treatment can help people with chronic hepatitis B improve long-term survival and live healthier by preventing liver damage from the virus and slowing the progression of cirrhosis (liver scarring).

Hepatitis B and Pregnancy

If you’re pregnant and have hepatitis B, you can potentially pass the infection to your baby. If not properly treated at birth, babies born to mothers with hepatitis B have greater than a 90% chance of developing chronic hepatitis B.⁸

Knowing your hepatitis B status helps protect your child against lifelong infection and potentially serious problems, like liver disease and cancer. That’s why the CDC recommends all pregnant women get tested for hepatitis B early on in their pregnancy. 

How Do You Prevent Spreading Hepatitis B to Your Baby?

If you test positive for hepatitis B, it’s important to communicate your status to your healthcare provider. Steps can be taken to prevent hepatitis B transmission to your baby. As recommended by the CDC, two shots should be given to the newborn within the first 12 hours of life (or preferably immediately after birth in the delivery room):^8-9

• The first dose of hepatitis B vaccine
• One dose of the hepatitis B immunoglobulin (an antibody, also called HBIG)

In some cases, a doctor may prescribe oral antivirals in the third trimester to reduce the risk of transmission.

What Can You Do?

If you think you’ve been exposed to hepatitis B or are showing symptoms of hepatitis B, get tested. A simple blood test can look for hepatitis B surface antigens, the earliest indicator of infection which continues to be present in chronic infection. It can detect hepatitis B even before symptoms appear and liver damage has advanced.

Medically Reviewed by Julie Hutchinson, MD on February 14, 2023