Hepatitis viruses cause infectious inflammation of the liver (hepatitis), which can progress to cirrhosis or liver cancer. Hepatitis A, B, and C are the most common types. Globally, up to 30% of people have been infected with the hepatitis B virus (HBV); approximately 296 million individuals carry chronic hepatitis B. In Europe, around 14 million people were living with chronic HBV in 2024. Each year, there are 1.5 million new infections and 850,000 deaths attributed to the disease. The risk of liver cancer in chronic carriers is approximately 10–25%.
HBV is transmitted through blood and sexual contact, but infection can also occur via saliva and through close contact—such as communal settings in daycare where minor bites can spread the virus. Transmission also occurs among injection drug users via shared needles; in healthcare settings through contaminated blood products or instruments; and perinatally from mother to child during pregnancy or childbirth. The younger a child is at exposure, the more likely they are to develop chronic HBV infection, which significantly increases later risk of liver disease.
The incubation period ranges from one to six months. Symptoms include lack of appetite, fatigue, nausea, and jaundice (yellowing of the skin and eyes), hence the disease’s Finnish name—“keltatauti” (yellow disease). Other symptoms may include fever, joint pain, and itching. In some cases, the infection is asymptomatic and detected only through elevated liver enzyme levels.
Most cases resolve within a few weeks, but close monitoring is important. Age at infection significantly influences outcome: infants under one year have up to a 90% risk of chronic infection, often without symptoms, while in adults, 30–50% exhibit symptoms, and chronic infection is less common. Chronic HBV can be managed with antiviral treatment, which suppresses disease progression, but this therapy is lifelong.
Most cases in Finland are acquired through sexual contact or during birth. In the late 1990s, more than 600 cases were recorded annually. Vaccination coverage has since reduced prevalence sharply. In 2020, there were four acute and 160 chronic cases in Finland. The majority of chronic infections were diagnosed in individuals born abroad, partly detected through hepatitis B screening of asylum seekers.
The hepatitis B vaccine contains surface antigens combined with an adjuvant. Finland also offers a combination vaccine that protects against both hepatitis A and B.
Standard vaccination includes three doses: the second dose one month after the first, and the third dose six months after the first. An accelerated schedule with an optional fourth dose is available when needed. Vaccination may cause mild local reactions like pain or redness at the injection site, and mild systemic symptoms such as malaise, headache, or fatigue. Over-the-counter pain or fever relief may be used if necessary. Severe allergic reactions are rare.
Hepatitis B vaccination is not yet part of Finland’s universal immunisation programme, but it is provided free of charge to high-risk groups such as:
Vaccination is also administered immediately following exposure, such as needlestick injuries, and newborns of HBV-positive mothers receive the full vaccine series. As a result, incidence among children under five has dropped to one-fifth of the level seen 25 years ago.
After three vaccine doses, approximately 90% of recipients develop lifelong protection. Efficacy drops significantly if fewer doses are received: only 30–55% develop adequate immunity after one or two doses—even if young and healthy. Response is better in women than men, and in younger versus older individuals. Because a small percentage may not respond adequately, antibody testing is recommended for those at high occupational risk to confirm protection.
Text updated: 19 February 2024
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