If you are planning a trip abroad, you may have been told to think about the hepatitis B vaccine. For most short holidays the risk is low, but for some travellers, such as long-stay visitors, people who may need medical or dental treatment overseas, healthcare and aid workers, and others, vaccination is well worth considering. This guide explains what hep B is, its symptoms, how it spreads (including whether it can spread through saliva), whether it is curable, and how the hep B vaccine schedules work when your departure date is close.

If you would like personal advice, our travel clinic in Manchester in Altrincham can review your itinerary and medical history and help you choose the right schedule.

Hepatitis B at a Glance

• Hepatitis B is a viral infection of the liver, spread through contact with infected blood or body fluids.
• Many people have no symptoms, or only a mild flu-like illness.
• In most healthy adults the short-term infection clears on its own, but it can become a long-term (chronic) infection that damages the liver. Chronic hepatitis B can be controlled with treatment but there is currently no cure.
• The hepatitis B vaccine is safe, does not contain live organisms, and gives long-lasting protection.
• Fast schedules exist if you are travelling soon, but starting early gives you the most choice.

What Is Hep B?

Hep B is short for hepatitis B, an infection of the liver caused by the hepatitis B virus (HBV). It is one of the most common blood-borne viruses in the world. The World Health Organization estimated that around 254 million people were living with chronic hepatitis B in 2022, and that about 1.1 million people died from its effects that year. Hepatitis B is a major cause of long-term liver disease and liver cancer.

Hepatitis B is found worldwide, but it is much more common in some regions. The highest numbers of people with chronic infection are in the Western Pacific and African regions, and many other parts of the world have intermediate to high levels. TravelHealthPro’s country pages show the recommendations for your destination. If you are heading to South-East Asia, you may also want to read our guide to Vietnam travel vaccinations.

Symptoms of Hepatitis B

The symptoms of hepatitis B can be easy to miss. Most people infected with the virus have no symptoms at all, or a mild flu-like illness. When symptoms do appear, they usually start 40 to 160 days after infection and can include:

• Yellowing of the skin and eyes (jaundice)
• Dark urine
• Loss of appetite
• Pain in the upper tummy
• Nausea and vomiting
• Fever
• Feeling extremely tired

Jaundice develops in around 30 to 50 percent of infected adults, and in about 10 percent of younger children. Occasionally a severe short-term infection can cause liver failure.

Because hepatitis B often causes no symptoms, you cannot rely on feeling well to know you are not infected. A blood test is the only way to diagnose it. If you think you may have been exposed, for example through a needlestick injury, unprotected sex, or unsterile medical or dental treatment abroad, contact your GP, a sexual health clinic or NHS 111 for advice as soon as possible.

How to Get Infected with Hepatitis B

Hepatitis B spreads when blood or other body fluids from an infected person get into the body of someone who is not infected. The main routes are:

• From mother to baby at birth
• Through a puncture wound in the skin, such as a needlestick injury
• Sharing injecting equipment
• Tattooing, piercing or acupuncture with equipment that is not sterile
• Poor infection control during medical or dental treatment
• Sharing razors or toothbrushes that may have blood on them
• Unprotected sex
• Contact with infected blood or body fluids, for example during contact sports

In countries where hepatitis B is common, most infections are passed from mother to baby or from person to person in early childhood. For travellers, the risk comes mainly from the activities above, and from needing medical or dental care in places where infection control is poor. A survey of backpackers in Thailand found that about one in five had taken part in at least one activity that could carry a risk, such as piercings, tattoos, medical or dental treatment or sex with a new partner.

Can Hepatitis B Spread Through Saliva?

This is one of the most common questions people ask. The hepatitis B virus can be found in saliva, but UK patient information is clear that it is not spread by kissing, hugging, coughing, sneezing, holding hands, or sharing food, drinks, plates or cutlery. Saliva matters mainly if it contains blood, for example from a bite that breaks the skin or open sores in the mouth, or when items such as toothbrushes carry blood. This is why you should never share toothbrushes or razors, even with family and friends.

Is Hepatitis B Curable?

The answer depends on whether the infection is short-term or long-term.

• Acute (short-term) hepatitis B: in most healthy adults the body clears the virus on its own, usually within a few months. There is no specific treatment, and doctors treat the symptoms, for example with pain relief and medicines for nausea. Fewer than five in 100 healthy adults infected as adults go on to develop chronic infection.
• Chronic (long-term) hepatitis B: if the virus is still present after six months, it is called chronic hepatitis B. There is currently no cure, but medicines taken under the care of a specialist can slow liver damage, reduce the risk of liver cancer and improve survival. Between 15 and 40 percent of people with chronic infection develop liver damage over time.
• Babies and young children: as many as 90 percent of children infected in their first year of life develop chronic infection, which is why babies are vaccinated.

Because there is no cure for chronic hepatitis B, prevention is vital. Vaccination is the most effective way to protect yourself.

Who Needs the Hepatitis B Vaccine for Travel?

The risk of hepatitis B for tourists and short-term travellers is usually low. UK guidance recommends the hep B vaccine for travellers who are going to areas where hepatitis B is common (intermediate or high prevalence) and whose activities or medical conditions put them at risk. This includes travellers who:

• May have unprotected sex
• May be exposed to blood or blood products through their job, such as healthcare professionals and aid workers
• May be exposed to contaminated needles
• May need medical or dental treatment abroad, including people with existing medical conditions and those travelling for medical care or dialysis
• Will take part in contact sports
• Are adopting a child from a country where hepatitis B is common
• Are long-stay travellers in higher-risk areas

Pilgrims may also want to consider vaccination, because head shaving is part of the Hajj rites. Read more in our Hajj and Umrah health guide.

Note that since 2017, babies in the UK have been given hepatitis B vaccine as part of the 6-in-1 vaccine, so many adults and older children were never vaccinated as part of the routine schedule. If you are not sure whether you have had the vaccine, bring any vaccination records to your appointment. The hepatitis B vaccine can be given to adults and to children from birth.

Hepatitis B Vaccine Schedules: Standard, Accelerated and Very Rapid

The hepatitis B vaccines used in the UK are inactivated, which means they contain no live organisms and cannot give you hepatitis B. Which schedule you need depends mainly on how long you have before you travel. The schedules below are for adults aged 16 and over. Children’s schedules and doses differ.

Standard schedule: 0, 1 and 6 months

Three doses are given at 0, 1 and 6 months. This works well if you have plenty of time and are likely to attend all of your appointments. UK guidance suggests using it only where rapid protection is not needed.

Accelerated schedule: 0, 1 and 2 months, plus a dose at 12 months

This is the schedule UK travel health guidance recommends for most at-risk travellers using the single (hepatitis B only) vaccine. Three doses are given in the first two months, with a fourth dose at 12 months to give longer-lasting protection.

Very rapid schedule: days 0, 7 and 21, plus a dose at 12 months

If you are travelling soon, a very rapid schedule can be used. Doses are given on day 0, day 7 and day 21, with a fourth dose at 12 months. It is licensed for adults aged 18 and over, and can be considered “off-licence” for 16 and 17 year olds. Because the very rapid schedule gives lower antibody levels than the longer schedules, the 12-month dose is important, and it is generally reserved for people who are starting within about a month of departure. If you have time, the 0, 1, 2 and 12 month schedule is usually preferred.

Combined hepatitis A and B vaccine

If you also need protection against hepatitis A, a combined hepatitis A and B vaccine can be given on the standard 0, 1 and 6 month schedule or on a very rapid schedule of days 0, 7 and 21 with a fourth dose at 12 months. Our hepatitis A vaccine page explains how hepatitis A spreads through food and water.

Which schedule is right for me?

• Six months or more before travel: the standard schedule is possible, but many travellers prefer the accelerated schedule so that they are protected sooner.
• About two months before travel: the accelerated schedule (0, 1, 2 and 12 months) fits well.
• Within a month of travel: a very rapid schedule may be suitable.
• Leaving very soon: tell us your travel dates. It is not necessary to repeat doses if a course is interrupted, so we can discuss starting a course and completing the remaining doses afterwards, as appropriate.

We suggest booking a consultation four to six weeks before travel, or earlier if you can. For other jabs, see our overview of travel vaccinations in Manchester and our options for same day travel vaccines.

How Long Does Hep B Vaccine Protection Last?

Studies of people who respond well to the vaccine show that protection against infection lasts for 20 to 30 years or more. Healthy adults and children who have completed a full primary course, such as 0, 1 and 6 months or 0, 1, 2 and 12 months, do not normally need a booster. Booster doses are considered in some situations, such as for healthcare workers who have not responded to a primary course, people with kidney failure, and after a significant exposure. Routine testing to check your immunity is not usually needed except for people at occupational risk or those with kidney failure. If you are not sure what applies to you, ask your pharmacist or doctor.

Hepatitis B Vaccine Side Effects and Safety

Side effects are usually mild and short-lived. The most common are soreness and redness where the injection was given. Some people report fever, a rash, feeling unwell or flu-like symptoms, but these may not be caused by the vaccine. You should not have the vaccine if you have had an allergic reaction to a previous dose or to any of its ingredients, and vaccination should be delayed if you have a fever. If you are pregnant, breastfeeding or have a medical condition, tell the pharmacist before your appointment.

How to Reduce Your Risk of Hepatitis B Abroad

Vaccination is the best protection, but these steps help too, and they also reduce your risk of other blood-borne infections such as HIV and hepatitis C, which cannot be prevented by vaccine:

• Avoid unprotected sex with new partners.
• Never share needles, razors, toothbrushes or other items that might carry blood.
• Avoid tattoos, piercings and acupuncture unless sterile equipment is used.
• Remember that medical and dental treatment overseas may not follow the same infection control standards. Some travellers consider carrying a sterile medical equipment kit when travelling to resource-limited areas.
• Take comprehensive travel insurance that covers medical treatment and repatriation. Our travel health checklist can help you prepare.

Hep B Vaccine at Oldfield Pharmacy Travel Clinic, Manchester

At Oldfield Pharmacy, our travel clinic serves travellers across Manchester and Altrincham. We can check your vaccination history, explain whether the hep B vaccine is advisable for your destination and activities, and talk you through the schedules that fit your departure date, including combined hepatitis A and B vaccination where suitable. We can also advise on other travel health needs such as rabies protection and travel vaccinations for children.

As your local pharmacy in Manchester, we are also here for everyday healthcare and advice.

Ready to plan your travel vaccines? Book your travel health consultation or call us on 0161 942 9701.