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How serious?
Risk of death
Yes
Vaccine available?
Time to symptoms
Countries affected
Active outbreaks
Vaccination provides >95% protection and is recommended for all travelers. Transmission occurs through blood, sexual contact, and contaminated medical equipment. Avoid unsterile tattoos, piercings, and medical/dental procedures in resource-limited settings.
Serious liver infection caused by the hepatitis B virus (HBV). Leading cause of liver cirrhosis and hepatocellular carcinoma worldwide. Highly effective vaccine available.
Symptoms | Frequency | Severity | Onset |
|---|---|---|---|
| Fatigue | 70% | Mild | Early |
| Loss of appetite | 60% | Mild | Early |
| Malaise | 65% | Mild | Early |
| Nausea | 55% | Mild | Early |
| Arthralgia | 25% | Mild | Early |
| Fever | 30% | Mild | Early |
| Myalgia | 30% | Mild | Early |
| Vomiting | 35% | Mild | Early |
| Diarrhea | 15% | Mild | Early |
| Headache | 25% | Mild | Early |
| Joint swelling | 10% | Mild | Early |
| Rash | 15% | Mild | Early |
| Swollen lymph nodes | 10% | Mild | Early |
| Abdominal pain | 50% | Moderate | Peak |
| Dark urine | 45% | Moderate | Peak |
| Hepatomegaly | 50% | Mild | Peak |
| Jaundice | 40% | Moderate | Peak |
| Itching | 20% | Mild | Peak |
| Splenomegaly | 15% | Mild | Peak |
| Weight loss | 15% | Mild | Any phase |
Serious liver infection caused by the hepatitis B virus.
Hepatitis B virus (HBV) is a partially double-stranded DNA virus transmitted via blood, sexual contact, and perinatally. Globally, ~296 million people live with chronic HBV infection. Most acute infections in adults resolve spontaneously; chronic infection develops in ~95% of infected newborns and ~5% of infected adults.
Seek urgent medical care if:
Rapidly deepening jaundice (yellowing of skin/eyes) over hours to days
Severe abdominal pain, especially right upper quadrant
Altered mental status, confusion, or extreme drowsiness (hepatic encephalopathy)
Vomiting blood or passing black tarry stools (variceal bleeding — cirrhosis complication)
Sudden abdominal distension (ascites)
Most common signs and symptoms
Acute hepatitis B (incubation 1–6 months):
Jaundice (yellowing of skin and eyes), dark urine, pale stools
Fatigue, anorexia, nausea, vomiting, abdominal pain
Arthralgia and urticaria (serum sickness-like prodrome in ~10%)
Fever (usually low-grade or absent)
~70% of acute infections are subclinical or anicteric
Chronic hepatitis B (after 6 months):
Often asymptomatic for years or decades
Fatigue, abdominal discomfort
Signs of advanced disease: jaundice, ascites, spider angiomata, splenomegaly (cirrhosis)
Knowing the symptoms is the first step to a quick response.
Typical disease course:
Serological timeline: HBsAg appears 1–10 weeks after exposure, before symptoms. Anti-HBc IgM marks acute infection. Anti-HBs indicates recovery and immunity.
How this disease is identified
Key serological markers:
HBsAg: positive = active HBV infection (acute or chronic)
Anti-HBs: positive = immunity (vaccination or resolved infection)
HBeAg: marker of high replication and infectivity
Anti-HBc IgM: acute infection or reactivation
Anti-HBc IgG: prior or current infection
HBV DNA (viral load): quantifies replication; guides treatment decisions
Liver function tests: elevated ALT/AST in active disease
Liver biopsy or FibroScan: assesses fibrosis stage in chronic disease
Screen for HDV coinfection in endemic areas
Available treatment methods
Acute hepatitis B: supportive care
Chronic hepatitis B:
Tenofovir disoproxil fumarate (TDF) or Tenofovir alafenamide (TAF): first-line oral antivirals
excellent safety profile
Entecavir: alternative first-line option
Pegylated interferon-alfa (Peg-IFN): finite treatment (48 weeks)
suitable for select patients
achieves HBsAg loss in ~3–7% Goals of treatment: suppress viral replication, prevent fibrosis progression, reduce HCC risk. Treatment is lifelong for most patients. Regular monitoring: HBV DNA, liver enzymes, AFP, and HCC surveillance by ultrasound every 6 months.
Most cases are effectively treated with early diagnosis.
How to protect yourself
The hepatitis B vaccine is one of the most effective vaccines available (95%+ efficacy):
Standard schedule: 3-dose series (0, 1, 6 months) or 4-dose accelerated series (0, 1, 2, 12 months)
Infants: birth dose + completion of 3-dose series by 6 months — prevents perinatal transmission
Post-exposure prophylaxis: HBV vaccine + HBIG (hepatitis B immunoglobulin) within 24 hours of exposure Additional prevention:
Use barrier contraception (condoms)
Never share needles, syringes, or personal items (razors, toothbrushes)
Ensure blood and blood products are screened
Universal precautions in healthcare settings
Preparation is the best protection.
Vaccination is recommended for all unvaccinated travelers regardless of destination.
Higher risk in sub-Saharan Africa, Asia, Eastern Europe, and Central America.
Travelers requiring medical procedures or blood transfusions abroad are at particular risk.
Avoid unprotected sex, sharing needles, or unsterile tattooing/piercing.
Carry hepatitis B vaccination record; some countries require proof for long-term visas (healthcare workers).
Travelers injured abroad should receive post-exposure prophylaxis (vaccine ± HBIG) upon return.
Statistics and geographic data
WHO estimates ~296 million people have chronic HBV infection globally (2019). Approximately 820,000 deaths per year from HBV-related cirrhosis and HCC. Prevalence is highest in sub-Saharan Africa and East Asia (5–10%). Intermediate in South Asia, Middle East, Eastern Europe, and Central Asia (2–5%). Low in Western Europe, North America, Australia (<2%). Perinatal transmission is the dominant route in East Asia; blood-borne and sexual transmission predominate in low-prevalence regions.
Who is most at risk
Risk factors for acquiring hepatitis B:
Birth to an HBsAg-positive mother: The most important risk factor globally. Perinatal transmission leads to chronic infection in ~90% of cases. Without prophylaxis, 70–90% of infants born to HBeAg-positive mothers become infected.
Unvaccinated status: Lack of vaccination is the primary modifiable risk factor. HBV vaccine is >95% effective at preventing infection.
Healthcare workers and first responders: Occupational needlestick injuries carry a 6–30% HBV transmission risk from a single exposure to HBeAg-positive blood (compared to 0.3% for HIV).
People who inject drugs (PWID): Sharing of needles, syringes, and drug preparation equipment. Prevalence of HBV markers reaches 40–60% in some PWID populations.
Sexual transmission: Multiple sexual partners, men who have sex with men (MSM), and sexual contact with HBV-infected individuals. HBV is 50–100 times more infectious than HIV via sexual contact.
Household contacts of chronically infected individuals: Sharing razors, toothbrushes, or contact with open wounds.
Residence in or travel to endemic areas: Sub-Saharan Africa (6–8% prevalence), East Asia (5–7%), Southeast Asia (2–5%).
Recipients of blood products or organ transplants in countries without universal screening.
Hemodialysis patients: Impaired immune response leads to lower vaccine efficacy (60–70%) and higher infection risk.
Risk factors for progression to chronic infection:
Age at infection: 90% chronicity in neonates; 30% in children aged 1–5; <5% in immunocompetent adults.
Immunosuppression: HIV co-infection, chemotherapy, organ transplant recipients.
Male sex: Males are more likely to remain chronically infected and develop HCC.
Potential complications
Acute complications:
Fulminant hepatic failure: rare (<1%) but high mortality
requires liver transplant evaluation
Chronic infection complications:
Liver cirrhosis: develops in ~20–30% of chronically infected over 20–30 years
risk of liver failure
Hepatocellular carcinoma (HCC): HBV is the leading cause of HCC globally
risk increased 20–100-fold compared to uninfected
regular surveillance required
Extrahepatic manifestations: polyarteritis nodosa, glomerulonephritis, cryoglobulinemia
HDV coinfection/superinfection: accelerates fibrosis
higher risk of cirrhosis and HCC
Expected outcomes and recovery
Acute infection prognosis: >95% of immunocompetent adults clear the virus spontaneously. Fulminant hepatitis occurs in <1% of cases but carries 60–80% mortality without transplant.
Chronic infection prognosis:
Risk of chronicity inversely correlates with age at infection: 90% in neonates, 30% in children 1–5 years, <5% in adults.
Of chronic carriers: 15–40% develop cirrhosis, hepatocellular carcinoma (HCC), or liver failure over decades.
HCC risk: 100× higher than uninfected population. Annual HCC incidence in cirrhotics: 2–5%.
With antiviral treatment (tenofovir, entecavir): viral suppression in >95%, regression of fibrosis possible, HCC risk significantly reduced but not eliminated.
Functional cure (HBsAg loss): Achieved in <10% with current therapy. HBV DNA persists as cccDNA in hepatocytes indefinitely.
This disease is vaccine-preventable. Effective protection is available through vaccination.
Talk to a travel health specialist about the recommended schedule before your trip.
Find a vaccination clinic →The content on this page is for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment recommendations. If you have health concerns, consult a qualified healthcare professional. Medova is not a medical service provider.
Full terms of useGeographic distribution and active outbreaks
Recent epidemiological data from the World Health Organization Global Health Observatory.
Source: WHO GHO OData ↗
Source: WHO GHO OData ↗
This data is provided for informational purposes. Please consult official WHO sources for the most current information.
View WHO data source →| Flag | Country | Risk level |
|---|---|---|
 | Burkina Faso | High risk |
 | Ghana | High risk |
 | Mali | High risk |
 | Vanuatu | High risk |
 | South Sudan | High risk |
 | Equatorial Guinea | High risk |
 | Mauritania | High risk |
 | Guinea | High risk |
 | Djibouti | High risk |
 | Sao Tome and Principe | High risk |
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