Hepatitis B
Also called: hep B, HBV infection, hepatitis B virus infection, chronic hepatitis B
Hepatitis B is a liver infection caused by a virus that spreads through blood, sex and from mother to baby at birth. Many people feel well for years, but long-term infection can scar the liver or cause liver cancer. A safe vaccine prevents it, and medicines can control it.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Hepatitis B is swelling and damage of the liver (hepatitis) caused by the hepatitis B virus (HBV). The virus lives in blood and other body fluids. It passes from an infected mother to her baby around the time of birth, between young children, through sex, and through needles, razors or other tools that carry blood. It does not spread through food or water.
Some people clear the virus within a few months. This short illness is called acute hepatitis B. Others keep the virus for life, which is called chronic (long-term) hepatitis B. Age matters a lot: almost all babies infected at birth stay infected for life, while most adults clear the virus. Many people with chronic infection have no symptoms for years, so they do not know they have it and can pass it on.
The World Health Organization (WHO) estimated that about 240 million people were living with chronic hepatitis B in 2024, and that it caused around 1.1 million deaths that year, mostly from liver scarring (cirrhosis) and liver cancer. Only a small share of people with the infection know about it or receive treatment.
The good news is that a vaccine gives long-lasting protection, and daily antiviral tablets can keep the virus under control and lower the risk of serious liver disease.
In Pakistan: what studies show
Pakistan's 2007-2008 national survey found hepatitis B in 2.5% of people, highest in Balochistan; a 2019-2020 survey in Sindh found 1.0%. WHO and UNICEF estimate 86% of babies got all three infant doses of the vaccine in 2025, but only 30% got a dose at birth.
- Pakistan's first national hepatitis survey, done in 2007-2008, found hepatitis B (a positive HBsAg blood test) in 2.5% of people tested.[1] (national survey, data July 2007 - May 2008)
- In the same 2007-2008 national survey, Balochistan had the highest rate of hepatitis B at 4.3%, compared with 2.5% in Sindh and 2.4% in Punjab.[1] (national survey, data July 2007 - May 2008)
- Khyber Pakhtunkhwa had the lowest rate of hepatitis B in that national survey, at 1.3%.[1] (national survey, data July 2007 - May 2008)
- A 2019-2020 household survey across all 29 districts of Sindh tested 6,672 people and found hepatitis B in 1.0% of them.[2] (cross-sectional household serosurvey, data November 2019 - mid-June 2020)
- One study of 375 pregnant women at two hospitals in Swabi district, Khyber Pakhtunkhwa, found hepatitis B in 3.7% of them.[3] (cross-sectional, data July 2019 - January 2020)
- At one large blood transfusion centre in Rawalpindi, 1.06% of 15,405 healthy blood donors screened in 2019 tested positive for hepatitis B.[4] (cross-sectional, data 1 Jul 2019 - 31 Dec 2019)
- WHO and UNICEF estimate that 86% of babies in Pakistan received all three infant doses of hepatitis B vaccine (given inside the 5-in-1 pentavalent vaccine) in 2025.[5] (modelled estimate, data 2025 (estimates for 2014-2025))
- WHO and UNICEF estimate that only 30% of newborns in Pakistan got a hepatitis B vaccine dose at birth in 2025, down from 40% in 2023, the first year with an estimate.[5] (modelled estimate, data 2023-2025)
Pakistan guidance: Pakistan's National Hepatitis Strategic Framework (2024-2030), which aims to lower hepatitis B among children and cut hepatitis deaths (Pakistan national hepatitis programme (published in the Journal of the Pakistan Medical Association), 2026)[6]
What we do not know yet: The only nationwide hepatitis B survey is from 2007-2008; newer data come from one province (Sindh) or single hospitals and blood banks, so today's national rate is not known. Sources disagree on the birth dose: the 2024 Sindh paper said Pakistan had not yet added it to routine immunisation, while WHO/UNICEF show birth-dose coverage from 2023 (30% in 2025); the Sindh paper also gives a slightly different figure in its discussion than in its results.
Pakistan studies cited
- Qureshi H, Bile KM, Jooma R, et al. Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey appealing for effective prevention and control measures. Eastern Mediterranean Health Journal 2010;16(Suppl):S15-S23. PMID 21495584. Open source
- Qureshi H, Alam E, Dharejo Z, et al. Prevalence of hepatitis and HIV in Pakistan. Eastern Mediterranean Health Journal 2024;30(10):689-697. doi:10.26719/2024.30.10.689. Open source
- Israr M, Ali F, Nawaz A, et al. Seroepidemiology and associated risk factors of hepatitis B and C virus infections among pregnant women attending maternity wards at two hospitals in Swabi, Khyber Pakhtunkhwa, Pakistan. PLOS ONE 2021. doi:10.1371/journal.pone.0255189. Open source
- Zorob T, Farooqi MA, Ahsan A, et al. Prevalence and Trends in Hepatitis B & C Virus among Blood Donors in Pakistan: A Regional Transfusion Center Study. Livers 2023;3(2):271-281. doi:10.3390/livers3020018. Open source
- World Health Organization and UNICEF Pakistan: WHO and UNICEF estimates of immunization coverage: 2025 revision. WHO/UNICEF (WUENIC), via data.unicef.org 2026. Open source
- Mahmood H, Alaama AS, Jamil MS, et al. Pakistan's national hepatitis strategic framework (2024-2030). Journal of the Pakistan Medical Association 2026;76(3):400-416. doi:10.47391/JPMA.31929. Open source
Symptoms
- No symptoms at all, which is common in both new and long-term infection
- Tiredness and weakness
- Loss of appetite
- Nausea (feeling sick) and vomiting
- Stomach (abdominal) pain
- Yellow skin or eyes (jaundice)
- Dark urine
- Mild fever
- Aching muscles and joints
Causes and risk factors
Causes
- The hepatitis B virus, which is carried in blood, semen, vaginal fluid and other body fluids
- Passing from an infected mother to her baby around the time of birth
- Contact with blood between young children in the same home, especially in the first years of life
- Sex without a condom with someone who has the infection
- Sharing or reusing needles and syringes, or unclean tools for tattoos, piercing or acupuncture
- Sharing razors or toothbrushes, or a needlestick injury at work
What makes it more likely
- Being born to a mother with hepatitis B
- Not being vaccinated against hepatitis B
- Living in a home with, or being the sexual partner of, someone who has hepatitis B
- Injecting drugs or receiving injections with reused equipment
- Working in health care or other jobs with contact with blood
- Long-term kidney dialysis
- Having HIV or hepatitis C
- Having several sexual partners without using condoms
Complications
Most adults recover fully from a new infection. A small number become very ill very quickly, and the liver can fail. The bigger danger is long-term infection. Over many years the virus can scar the liver (cirrhosis), which can lead to liver failure. People with chronic hepatitis B also have a much higher chance of liver cancer (hepatocellular carcinoma). The US CDC estimates that about 15 to 25 out of every 100 people with chronic infection develop serious long-term liver disease. In people who have or once had the virus, it can wake up again (reactivation) if their immune system is weakened by strong medicines, and this can be severe. Infection with another virus, hepatitis D, on top of hepatitis B is a major cause of serious liver illness.
When to see a doctor
- Yellow skin or eyes with dark urine: see a doctor soon for blood tests
- Becoming very unwell very quickly, with severe sickness and vomiting: go to an emergency department, as this can be a sudden severe form that causes liver failure
- Symptoms that last longer than two to three weeks, or new symptoms that appear
- You are pregnant and have hepatitis B, or have never been tested: tell your doctor early so your baby can be protected
- You have had contact with the blood of someone with hepatitis B (for example a needlestick) or unprotected sex, and are not vaccinated: see a doctor the same day, as early vaccine or antibody injection may help
- You have hepatitis B, or had it in the past, and are about to start chemotherapy or other immune-lowering treatment: tell the doctor before you start
Diagnosis
Hepatitis B looks like other kinds of hepatitis, so blood tests are needed to confirm it. The main test looks for a part of the virus called hepatitis B surface antigen (HBsAg). When a person is tested for the first time, doctors often check three markers together: HBsAg, the antibody that shows protection (anti-HBs) and the antibody that shows past or current infection (anti-HBc). Together these show whether someone has a new infection, a long-term infection, has recovered, or is protected by the vaccine.
If the infection is long-term, the doctor checks liver blood tests such as ALT (a liver enzyme), measures how much virus is in the blood (HBV DNA or viral load), and checks for liver scarring with an ultrasound scan or a special scan of liver stiffness (elastography). People with hepatitis B should also be tested once for hepatitis D, HIV and hepatitis C. WHO advises testing all adults in places where hepatitis B is common, and all pregnant women should be tested.
Treatment
- For a new (acute) infection there is no specific cure; rest, fluids, healthy food and blood tests to check recovery are usually enough, but severe cases need hospital care
- For long-term (chronic) infection, a liver specialist or trained doctor checks liver tests, viral load and liver scarring to decide whether treatment is needed now
- If treatment is needed, the usual choice is a daily antiviral tablet (tenofovir or entecavir); your doctor decides the medicine and the dose
- Antiviral tablets usually need to be taken long term, often for life; do not stop them without your doctor's advice, because the virus can flare up
- People who do not need medicine yet still need regular check-ups with blood tests, because the infection can change over time
- People with cirrhosis or other high-risk features have regular liver ultrasound scans to look for liver cancer early
- Pregnant women with a high viral load may be given antiviral medicine in pregnancy, and the baby is vaccinated straight after birth, ideally with an antibody injection too
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Nucleoside and nucleotide analogue antivirals | first choice for chronic hepatitis B; tablets that stop the virus multiplying and are usually taken long term | Tenofovir disoproxil (58 brands), Tenofovir alafenamide (4 brands), Entecavir (122 brands) |
| Pegylated interferon | an injected treatment given for a fixed period in selected people; chosen by a specialist | Peginterferon alfa-2a (2 brands) |
| Hepatitis B vaccines | prevent infection; given to babies at birth and in infancy, and to unprotected adults at risk | Hepatitis B vaccine (recombinant HBsAg) (18 brands), Diphtheria + Tetanus + Whole-cell Pertussis + Hepatitis B + Hib conjugate vaccine (DTwP-HepB-Hib) (1 brand) |
| Hepatitis B immunoglobulin (antibodies) | given with the vaccine to babies of infected mothers, and sometimes after an exposure, for quick short-term protection | Human hepatitis B immunoglobulin (1 brand) |
Self-care and prevention
Self-care
- Take antiviral tablets every day exactly as prescribed and keep all follow-up appointments
- Avoid alcohol, or at least keep it low, as it adds to liver damage
- Ask your doctor or pharmacist before taking any over-the-counter medicine, herbal product or supplement
- Ask your doctor about the hepatitis A vaccine to protect your liver further
- Do not smoke, and keep a healthy weight and good control of diabetes, which also affect liver health
- Do not share razors, toothbrushes or needles, and cover cuts so others do not touch your blood
- Ask for your household members and sexual partners to be tested and vaccinated if they are not protected
- Tell any doctor or dentist treating you that you have hepatitis B
Prevention
- Vaccinate every baby as soon as possible after birth, and complete the full course of hepatitis B vaccine in infancy
- Adults at risk, including health workers and family members of people with hepatitis B, should get tested and vaccinated if not protected
- Pregnant women should be tested so that the baby can be protected at birth
- Use condoms, especially with a new partner or a partner with hepatitis B
- Never share or reuse needles, syringes, razors or tattoo and piercing tools; ask for a new, sealed syringe for every injection
- Health workers should follow infection control rules for blood and sharp instruments
Common questions
Can hepatitis B be cured?
Most adults with a new infection clear the virus on their own. Long-term hepatitis B usually cannot be fully cured yet, but antiviral tablets can keep the virus under control, slow liver damage and lower the risk of liver cancer. Most people who start these tablets need to keep taking them for life.
Does everyone with hepatitis B need medicine?
No. Some people with long-term infection have low virus levels and a healthy liver, so they only need regular check-ups. Your doctor decides based on blood tests, viral load and the amount of liver scarring. Treatment can start later if things change.
How long does the hepatitis B vaccine protect?
According to WHO, a full course protects for at least 20 years and probably for life. People who have completed the course usually do not need a booster.
Can a mother with hepatitis B have a healthy baby?
Yes. The baby should get the hepatitis B vaccine as soon as possible after birth, ideally with an antibody injection. Mothers with a high viral load may also be given antiviral medicine during pregnancy. Together these greatly lower the chance of passing the virus to the baby.
Can hepatitis B spread through food, water or hugging?
No. Hepatitis B spreads through blood and body fluids, such as during birth, sex or sharing needles and razors. Sharing meals or ordinary social contact is not listed by health agencies as a way it spreads.
Sources
- World Health Organization (fact sheet). Hepatitis B (2026).
- World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection (2024).
- European Association for the Study of the Liver (Journal of Hepatology); PDF copy hosted by Hepatitis B Foundation. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection (2025).
- US Centers for Disease Control and Prevention. Clinical Overview of Hepatitis B | Hepatitis B | CDC (2025).
- US Centers for Disease Control and Prevention. Clinical Care of Hepatitis B | Hepatitis B | CDC (2025).
- MedlinePlus (US National Library of Medicine). Hepatitis B: MedlinePlus Medical Encyclopedia (2026).
- Eastern Mediterranean Health Journal (WHO EMRO); Qureshi H, Alam E, Dharejo Z, Mahmood H. 2024;30(10):689-697. Prevalence of hepatitis and HIV in Pakistan (2024).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.