Hepatitis B is a serious liver infection that's common in the Philippines. Learn about prevention through vaccination, testing, and treatment options for those infected.
Hepatitis B: A Silent Epidemic in the Philippines
Hepatitis B is one of the most significant public health challenges in the Philippines. With an estimated 7.3 million Filipinos chronically infected—approximately 7.3% of the population—the Philippines has one of the highest Hepatitis B prevalence rates in the Western Pacific region. Yet many of those infected have no idea they carry the virus.
Hepatitis B is often called a "silent" disease because it can damage your liver for decades without causing noticeable symptoms. By the time symptoms appear, significant harm may already be done. Understanding Hepatitis B—how it spreads, how to prevent it, and how to manage it—could save your life or the life of someone you love.
"Hepatitis B is both preventable and treatable, but awareness remains our biggest challenge. Too many Filipinos discover they have Hepatitis B only when they develop serious liver disease. Regular testing and vaccination are the keys to stopping this epidemic." — Philippine Society of Gastroenterology
Understanding Hepatitis B
Hepatitis B is a viral infection that attacks the liver. The Hepatitis B virus (HBV) is carried in blood and bodily fluids. When it enters the body, it infects liver cells and can cause both acute (short-term) and chronic (long-term) disease.
Acute vs. Chronic Hepatitis B
📊 The Two Faces of Hepatitis B
Acute Hepatitis B
- Short-term illness occurring within the first 6 months of infection
- Many adults clear the virus naturally and develop immunity
- About 95% of healthy adults who become infected will recover completely
- Some people become seriously ill during acute infection
Chronic Hepatitis B
- When the virus remains in the body for more than 6 months
- A lifelong condition requiring monitoring and often treatment
- Can lead to cirrhosis, liver failure, and liver cancer
- Risk of developing chronic infection depends on age at infection:
- Infants infected at birth: 90% become chronic
- Children infected at ages 1-5: 25-50% become chronic
- Adults newly infected: 5-10% become chronic
How Hepatitis B Spreads
Hepatitis B is highly contagious—50 to 100 times more infectious than HIV. The virus spreads through contact with infected blood and certain bodily fluids:
Main Transmission Routes
- Mother to child (perinatal transmission): The most common route in the Philippines. Infected mothers can pass the virus to their babies during childbirth. Without intervention, 90% of babies born to mothers with high viral loads will become chronically infected
- Sexual contact: Unprotected sex with an infected person allows the virus to spread through semen and vaginal fluids
- Blood-to-blood contact: Sharing needles for drugs, tattoos, or piercings; accidental needle sticks in healthcare settings; receiving contaminated blood transfusions (rare with modern screening)
- Sharing personal items: Razors, toothbrushes, nail clippers, and other items that may have microscopic amounts of blood
- Household contact: Living with someone with chronic Hepatitis B increases risk through shared items and minor cuts or scratches
✅ Hepatitis B Does NOT Spread Through:
- Casual contact (hugging, shaking hands, sitting next to someone)
- Sharing food or drinks, using the same utensils
- Coughing, sneezing, or kissing
- Breastfeeding (when baby is vaccinated)
- Mosquito or insect bites
- Water or food contamination (unlike Hepatitis A and E)
You cannot get Hepatitis B from normal social interactions. People with Hepatitis B should not be stigmatized or isolated.
Who Is at Higher Risk?
- People born to mothers with Hepatitis B
- Sexual partners of infected individuals
- People with multiple sexual partners
- Healthcare workers exposed to blood
- People who inject drugs or share needles
- Recipients of blood transfusions before screening was standard
- People from high-prevalence regions (including the Philippines)
- Household members of chronically infected individuals
- People with HIV or Hepatitis C
- Patients requiring hemodialysis
Recognizing Hepatitis B Symptoms
One of the challenges with Hepatitis B is that many people have no symptoms at all—especially in the early stages of chronic infection. When symptoms do occur, they can range from mild to severe:
Acute Infection Symptoms (1-4 months after exposure)
- Fatigue: Extreme tiredness that doesn't improve with rest
- Loss of appetite: No desire to eat, sometimes with nausea
- Nausea and vomiting: Stomach upset and digestive problems
- Abdominal pain: Discomfort in the upper right area where the liver is located
- Dark urine: Tea or cola-colored urine (one of the earlier signs)
- Clay-colored stool: Pale or grayish bowel movements
- Jaundice: Yellowing of the skin and whites of the eyes
- Fever: Low-grade fever
- Joint pain: Aching joints, especially in the morning
Chronic Infection
Most people with chronic Hepatitis B have no symptoms for years or even decades. The virus silently damages the liver until complications develop. Some people eventually experience:
- Persistent fatigue
- Vague abdominal discomfort
- Joint or muscle pain
- Symptoms of advanced liver disease (discussed below)
⚠️ The Danger of "Silent" Infection
Because chronic Hepatitis B often has no symptoms, the only way to know if you're infected is through a blood test. Many people discover their infection only during routine screening, blood donation, or when they develop serious complications. Testing is the only way to know your status.
Long-Term Consequences of Untreated Hepatitis B
Without proper monitoring and treatment, chronic Hepatitis B can lead to life-threatening complications:
Liver Fibrosis and Cirrhosis
Over years, the virus causes ongoing inflammation that leads to scarring (fibrosis). Advanced scarring is called cirrhosis—the liver becomes stiff and nodular, and loses its ability to function properly. Approximately 15-25% of people with chronic Hepatitis B will develop cirrhosis.
Liver Cancer (Hepatocellular Carcinoma)
People with chronic Hepatitis B have a 25-40% lifetime risk of developing liver cancer—even without cirrhosis. HBV is responsible for about 50% of all liver cancer cases worldwide. In the Philippines, liver cancer is the third leading cause of cancer death, largely driven by Hepatitis B.
Liver Failure
When the liver can no longer perform its essential functions—processing nutrients, filtering toxins, producing proteins—liver failure occurs. This is life-threatening and may require a liver transplant.
"I've seen too many patients who came to me only after their liver disease was advanced. With Hepatitis B, early detection and regular monitoring can prevent cirrhosis and catch liver cancer when it's still treatable. Please get tested if you haven't been—your life may depend on it." — Dr. Roberto Lim, Gastroenterologist
Prevention: The Hepatitis B Vaccine
The Hepatitis B vaccine is one of the most effective vaccines ever developed—95% effective at preventing infection. It's also the first vaccine that prevents cancer (by preventing the infection that causes liver cancer).
Vaccination Schedule
💉 Hepatitis B Vaccination in the Philippines
For Infants (EPI Schedule)
- Birth dose: Within 24 hours of birth (critical for preventing mother-to-child transmission)
- Plus 3 additional doses at 6, 10, and 14 weeks (as part of pentavalent vaccine)
For Unvaccinated Adults
- 3-dose series: Initial dose, then 1 month later, then 6 months after the first dose
- 2-dose option available with some newer vaccines
- No booster needed for healthy individuals who completed the series
Who Should Get Vaccinated?
- All infants at birth and completing the series
- All children who weren't vaccinated as infants
- Adults at risk: Healthcare workers, sexual partners of infected persons, people with multiple partners, people who inject drugs, travelers to high-prevalence areas
- People with chronic liver disease: Including Hepatitis C
- Anyone who wants protection
Preventing Mother-to-Child Transmission
This is the most critical intervention for reducing Hepatitis B in the Philippines:
- All pregnant women should be tested for Hepatitis B
- Babies born to infected mothers need the vaccine AND Hepatitis B immune globulin (HBIG) within 12 hours of birth
- This combination is 85-95% effective at preventing infection in the baby
- Pregnant women with high viral loads may benefit from antiviral treatment during the third trimester
Getting Tested: Know Your Status
Testing is simple—a blood test can determine your Hepatitis B status. Key tests include:
Basic Hepatitis B Panel
- HBsAg (Hepatitis B surface antigen): If positive, you currently have the virus (acute or chronic infection)
- Anti-HBs (Hepatitis B surface antibody): If positive (and HBsAg negative), you're immune—either from vaccination or past resolved infection
- Anti-HBc (Hepatitis B core antibody): Indicates past or current infection. Helps distinguish between vaccination immunity and infection-related immunity
Who Should Get Tested?
- Everyone born in the Philippines or other high-prevalence countries
- People whose mothers have Hepatitis B
- Household members and sexual partners of infected persons
- Healthcare workers
- Anyone who has ever injected drugs
- People with HIV or Hepatitis C
- Pregnant women
- Anyone considering the vaccine (to check if already immune or infected)
- Anyone with abnormal liver tests
✅ Test Results Interpretation
- HBsAg negative, Anti-HBs positive: You're immune (from vaccine or cleared infection)
- HBsAg positive: You currently have Hepatitis B—see a doctor for further evaluation
- All negative: You're susceptible and should be vaccinated
Treatment: Managing Chronic Hepatitis B
While there's currently no cure for chronic Hepatitis B, treatment can control the virus and prevent liver damage:
Goals of Treatment
- Suppress viral replication (reduce HBV DNA to undetectable levels)
- Prevent progression to cirrhosis
- Reduce risk of liver cancer
- Improve quality of life and survival
Antiviral Medications
- Entecavir (Baraclude): First-line oral antiviral with high potency and low resistance risk
- Tenofovir (Viread, Vemlidy): First-line oral antiviral, also effective and safe for long-term use
- Pegylated interferon: Injectable medication given for a defined period (usually 48 weeks). May achieve "functional cure" in some patients but has more side effects
Who Needs Treatment?
Not everyone with chronic Hepatitis B needs immediate treatment. Treatment decisions depend on:
- Viral load (HBV DNA levels)
- Liver enzyme levels (ALT)
- Degree of liver fibrosis or damage
- Family history of liver cancer
- Age and overall health
A gastroenterologist or hepatologist will determine if and when treatment should start.
Lifelong Monitoring
Even if you don't need treatment immediately, regular monitoring is essential:
- Blood tests: Every 6-12 months to check liver enzymes and viral load
- Liver cancer screening: Ultrasound every 6 months for high-risk patients (those with cirrhosis or family history)
- Fibrosis assessment: Periodic evaluation of liver scarring through blood tests or imaging
🚨 Lifestyle Recommendations for Hepatitis B
- Avoid alcohol: Alcohol accelerates liver damage in people with Hepatitis B
- Maintain healthy weight: Fatty liver disease adds stress to an already vulnerable liver
- Avoid unnecessary medications: Some drugs, including herbal supplements, can harm the liver. Always inform doctors of your Hepatitis B status
- Get vaccinated against Hepatitis A: Dual infection causes more severe disease
- Don't donate blood, organs, or sperm
- Inform sexual partners and household members so they can be tested and vaccinated
Living with Hepatitis B
A Hepatitis B diagnosis can feel overwhelming, but millions of people live full, healthy lives with the condition:
- Most people with chronic Hepatitis B will not develop serious complications if they're monitored and treated when needed
- You can work, exercise, travel, marry, and have healthy children
- You can share meals and live normally with family (ensure they're vaccinated)
- With proper prenatal care, mothers with Hepatitis B can have babies who are protected from infection
"A Hepatitis B diagnosis is not a death sentence. With regular monitoring, antiviral treatment when needed, and lifestyle modifications, people with chronic Hepatitis B can live long, healthy lives. The key is knowing your status and staying engaged with your healthcare team." — Dr. Roberto Lim, Gastroenterologist
Breaking the Stigma
Unfortunately, Hepatitis B carries significant stigma in many communities. People with Hepatitis B may face discrimination in employment, relationships, and social settings. This stigma is based on misunderstanding:
- Hepatitis B is NOT spread through casual contact
- People with Hepatitis B pose no risk to coworkers, classmates, or friends
- Discrimination against people with Hepatitis B is unjust and, in many contexts, illegal
- Education and understanding can combat stigma
Take Action: Your Next Steps
Hepatitis B is preventable and treatable, but action is required:
- Get tested: If you don't know your Hepatitis B status, ask your doctor for a blood test
- Get vaccinated: If you're not immune and not infected, the vaccine protects you for life
- If you're infected: See a gastroenterologist or hepatologist for evaluation and regular monitoring
- Protect others: Ensure family members and sexual partners are tested and vaccinated
- If pregnant: Get tested early so your baby can be protected at birth
The Philippines can eliminate Hepatitis B—but only with widespread testing, vaccination, and treatment. It starts with you knowing your status and protecting those you love.
Don't let a silent infection become a serious disease. Get tested, get vaccinated, and if you have Hepatitis B, get the care you need.
