Hepatitis B

Hep B Hub WA

This service provides primary health care staff with clinical support, advice and education to enable them to monitor, treat and manage patients with chronic hepatitis B, possibly without the need to refer to a tertiary specialist centre.

The statewide hepatitis B email clinical advice service is monitored Monday to Friday with a 2 business day response time, with advice from a specialist nurse practitioner provided by either email, phone/video call, or if required, an in-person visit.

Outreach clinics (including use of a Fibroscan®) to metropolitan general practices help provide a complete clinical picture for clinicians to ensure patients get the most appropriate care with onward referral if needed. Email HepBHubWA@health.wa.gov.au to organise an outreach clinic.

GP/NP Prescription Request form: This online form is for primary/community health care providers to obtain a Hepatitis B antiviral prescription from the Hep B Hub WA for their patient if they are not an s100 prescriber, or an s100 prescriber is not available to them. Requests can be either to initiate or to continue current treatment and both paper and e-scripts are available.

To become a hepatitis B s100 community prescriber see Information for pharmacists Hepatitis B s100 community prescribers and Prescriber Program | ASHM Health (external site)

For specialist advice, see Contacts for specialist advice on STIs, hepatitis and HIV.

Hepatitis B in a pregnant person: seek specialist advice and refer to Hepatitis B in Pregnancy (external site) and Hepatitis B Virus (HBV): Care of the infant born to a HBV positive woman (external site) 

Refer to alcohol and drug services for opioid substitution treatment as necessary, e.g. Mental Health Commission (external site)

If your patient is continuing to engage in injecting drug use refer to the Peer Based Harm Reduction WA (external site) or a Needle and Syringe Exchange Program in their local area

Offer hepatitis A vaccination in accordance with Guidelines for the Provision of Hepatitis A and B Vaccine to Adults in Western Australia at Risk of Acquiring these Infections by Sexual Transmission and Injecting Drug Use (PDF 248KB).

Patient information: Hepatitis B (HealthyWA)

Acute hepatitis B virus (HBV) infection may be asymptomatic or may present with the following symptoms: 

• right upper quadrant pain
• lethargy
• nausea
• fever
• anorexia for a few days then jaundice
• pale stools and dark urine. 

The incubation period is 45 to 180 days (mean: 60 days).

In some cases of HBV infection, the virus will not be eliminated and the person will become chronically infected. Chronic HBV infection is commonly asymptomatic. However, there is no such thing as a healthy carrier. Even if they appear to be healthy, people with chronic HBV should be monitored 6 monthly by their GP for signs and symptoms of liver disease and for hepatocellular carcinoma (HCC) surveillance.

Chronic HBV infection is usually asymptomatic until the patient has progressed to cirrhosis (severe liver damage and scarring). Symptoms of cirrhosis include:

• jaundice
• ankle swelling
• ascites
• GI bleeding
• encephalopathy.

People with chronic HBV, regardless of whether they have cirrhosis or not, are at increased risk of developing hepatocellular carcinoma and may require hepatocellular carcinoma surveillance.

People with chronic HBV may transmit infection vertically (from mother to baby), or through sexual or percutaneous exposure to sexual and household contacts.

To determine hepatitis B status, order 3 tests:

• HBsAg (hepatitis B surface antigen)
• anti-HBc (hepatitis B core antibody)
• anti-HBs (hepatitis B surface antibody)

If acute HBV is suspected (through recent risk, presentation, or both), also order anti-HBc IgM.

The tests detect antibodies to, and antigen of the virus. There is a period after infection, when the test will not detect antibody or antigen because they are yet to be produced or are present at a level that cannot be detected. This is called the window period which may last up to 3 months.

For help with ordering and interpreting HBV tests, see the ASHM Decision Making in Hepatitis B Toolkit (external site) or contact the Hep B Hub WA.

People who should be offered testing include:

• Populations with higher prevalence of chronic hepatitis B:

• people born in intermediate and high prevalence countries
• Aboriginal and Torres Strait Islander peoples
• people who have ever injected drugs
• men who have sex with men
• people in custodial settings or who have been incarcerated in a custodial setting
• people living with hepatitis C.

• Populations with higher risk of onward transmission and/or adverse health outcomes:

• pregnant people
• infants and children born to mothers who have chronic or acute HBV
• patients undergoing chemotherapy or immunosuppressive therapy (risk of reactivation)
• partners and household contacts of people with acute or chronic HBV
• people diagnosed with any STI, test for hepatitis B when testing for STIs and at the 3-month follow up appointment
• people who have had condomless sex with a new partner
• people living with HIV
• people initiating HIV pre-exposure prophylaxis (PrEP)
• health-care workers conducting exposure-prone procedures.

HBsAg testing is recommended for all pregnant women in the first trimester of each pregnancy to allow appropriate measures to be implemented to prevent newborn infants developing chronic HBV infection.

1. To become a hepatitis B s100 community prescriber see Information for pharmacists hepatitis B s100 community prescribers and Prescriber program | ASHM (external site).

Hep B Hub WA

This service provides primary health care staff with clinical support, advice and education to enable them to monitor, treat and manage patients with chronic hepatitis B, possibly without the need to refer to a tertiary specialist centre.

The statewide hepatitis B email clinical advice service is monitored Monday to Friday with a 2 business day response time, with advice from a specialist nurse practitioner provided by either email, phone/video call, or if required, an in-person visit.

Outreach clinics (including use of a Fibroscan®) to metropolitan general practices help provide a complete clinical picture for clinicians to ensure patients get the most appropriate care with onward referral if needed. Email HepBHubWA@health.wa.gov.au to organise an outreach clinic.

• Contact tracing is important to prevent re-infection and reduce transmission.
• The diagnosing doctor is responsible for initiating and documenting a discussion about contact tracing.
• Acute hepatitis B: all sexual and injecting partners in at least the past 6 months should be traced.
• Chronic hepatitis B: many patients acquired their infection at the time of birth so trace parents, siblings, and current sexual and injecting partner/s
• Offer hepatitis B testing and vaccination to all contacts.
• See Australasian contact tracing guidelines (external site)

• Confirm contact tracing has been undertaken or offer more contact tracing support.
• Repeat testing 6 months following acute hepatitis B to determine if HBsAg has resolved or is persisting and leading to chronic hepatitis B.
• Ensure patients with chronic hepatitis B are having life-long 6 monthly monitoring of viral load and liver function and commenced on treatment if indicated.
• Some patients with chronic hepatitis B require 6-monthly hepatocellular carcinoma surveillance (abdominal ultrasound and alpha-fetoprotein) in addition to life-long 6 monthly monitoring of viral load and liver function, see ASHM's Decision Making in Hepatitis B Toolkit (external site). 
• Offer hepatitis A vaccination in accordance with Guidelines for the Provision of Hepatitis A and B Vaccine to Adults in Western Australia at Risk of Acquiring these Infections by Sexual Transmission and Injecting Drug Use (PDF 248KB).
• Check for hepatitis C and other causes of hepatitis, e.g. alcohol, fatty liver.
• Check for hepatitis D if patient born in a hepatitis D endemic region.
• Follow ASHM's Decision Making in Hepatitis B Toolkit (external site). 
• Educate about condom use, contraception, safe injecting practices, consent, cervical screening, vaccinations for HAV, HPV and mpox as indicated, and not sharing personal grooming items such as toothbrushes, razors, tweezers, nail clippers. 
• Refer to alcohol and drug services for opioid substitution treatment as necessary, e.g. Mental Health Commission (external site)
• If your patient is continuing to engage in injecting drug use refer to the Peer Based Harm Reduction WA (external site) or a Needle and Syringe Exchange Program (Healthy WA) in their local area

• Occupational exposure in a healthcare setting, refer to Management of Occupation Exposure to Blood and Body Fluids (HealthyWA)
• Non-occupational exposure, see section on Contract Tracing