HBV is transmitted through activities that involve percutaneous (i.e., puncture through the skin) or mucosal contact with infectious blood or body fluids (e.g., semen, saliva), including:

• Sex with an infected partner
• Injection drug use that involves sharing needles, syringes, or drug-preparation equipment
• Being born to an infected mother
• Contact with blood or open sores of an infected person
• Needle sticks or sharp instrument exposures 
• Sharing items such as razors or toothbrushes with an infected person 

HBV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.

The presence of signs and symptoms varies by age. Most children under the age of five and newly infected immunosuppressed adults have no symptoms. For individuals over the age of five, 30%–50% have initial signs and symptoms. When present, signs and symptoms can include:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellowish skin or eyes)

There are two stages to hepatitis B: acute and chronic. When first infected with hepatitis B, the person has acute hepatitis B. After that, their hepatitis B will resolve. This makes them either immune to further infection or they will become chronically infected. With chronic infection, they can infect other people and may continue to have other symptoms or complications. After acute infection, about 90% of infants and 30% of children under five years of age will become chronically infected compared to about 5% of adults.

People with chronic HBV infection might show no symptoms, have no evidence of liver disease, or have a spectrum of diseases ranging from chronic hepatitis to cirrhosis or hepatocellular carcinoma (a type of liver cancer).

Incubation (the number of days between when you’re infected with something and when you might see symptoms)

This period is 45–180 days with an average of 60–90 days.

Communicability (how easily an infected person can infect others)

The blood of an infected person is contagious many weeks before symptoms begin. It stays contagious at the beginning of the disease and during the chronic carrier state, which may last for life. The younger a person is when infected, the more likely it is he or she will become a chronic disease carrier. Also, people who are hepatitis Be antigen (HBeAg, also referred to as “little e antigen”) positive are very contagious. 

To prevent infection, Texas recommends the vaccination of all children at birth. Vaccination is currently required for school entry in Texas. Adults who are at high risk for infection can also receive immunization. This includes healthcare workers and people who use drugs or practice unsafe sex. Besides vaccination, practicing safe sex and not sharing needles or other instruments that might have exposure to bodily fluids can reduce the risk of spreading hepatitis B.

Pregnant women are routinely screened during prenatal care and at birth to ensure that hepatitis B is not passed to their babies. If a woman has hepatitis B, her baby will receive preventive medication at birth to help prevent infection. We have a Perinatal Hepatitis B Program that works alongside public and private healthcare providers and coalitions to prevent perinatal hepatitis B transmission.

Vaccination Information

• For Healthcare Professionals
  • Hepatitis B Vaccine information for healthcare professionals on the Center for Disease Control and Prevention’s (CDC) website
• For the Public
  • Hepatitis B Vaccine information for the public FAQs on the CDC website
• ACIP Hepatitis B Vaccine Recommendations
• ACIP Vaccine Recommendations by Date Published

Children with acute or chronic hepatitis B do not need to be excluded from school or childcare. Rules for the exclusion of sick children from school and childcare are outlined in the Texas Administrative Code, specifically Rule 97.7 for schools.

Since 1991, there has been a steady decline in the number of new cases of acute hepatitis B in Texas. Currently, only acute hepatitis B is reportable in Texas. Over the past 10 years, the reported number of new cases of acute hepatitis B has continued to decrease. There were 394 cases in 2010 and 50 cases in 2020. Adults ages 18 and older make up the majority of acute hepatitis B cases in Texas.

Table I. Reported Hepatitis B, acute Disease and Reported Disease Rates - Texas, 2014-2023

¹ Cases per 100,000 population. Population data for years 2014-2018 is from the Department of State Health Services, Center for Health Statistics. Population data for 2019-2023 is projected

population from Texas Demographic Center’s Texas Populations Projections Program and updated on July 18, 2019. For years 2014 (27,470,110), 2015 (27,695,284),

2016 (28,240,245), 2017 (28,797,290), 2018 (29,366,479), 2019 (29,193,268), 2020 (29,677,668), 2021 (30,168,926), 2022 (30,667,390), and 2023 (31,172,832)

projected population was used.

Additional case data can be found in the Texas Annual Reports.