You may have an increased risk of hepatitis B infection if you have ulcerative colitis. While research suggests the hepatitis B vaccine isn’t as effective in people with UC, it’s still the best way to protect yourself.

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that causes chronic inflammation of the gastrointestinal tract.

Hepatitis B is one of the most common infections worldwide. It can sometimes lead to chronic hepatitis, liver disease with cirrhosis (scarring), and liver cancer.

People with UC may have an increased risk of hepatitis B virus (HBV) infection due to the immunosuppressant medications and other treatments used to treat the disease.

HBV infection is preventable with a vaccine. But research suggests the vaccine may not be as effective in people with UC.

If you have UC, read on to learn more about the hepatitis B virus and how to prevent infection.

Hepatitis B is one of the most common infections worldwide. It’s more common in regions of Asia, Africa, South America, and the Caribbean.

Early research suggested that people with IBD, like UC, may have higher rates of hepatitis B infection than the larger population.

This may be due to UC treatments called immunosuppressant drugs. These medications work by suppressing your body’s immune system. While this helps control inflammation in your gastrointestinal tract, it can make you more susceptible to infections.

However, the link is controversial. More recent studies found that the occurrence of HBV infection among people with IBD is not different from people without IBD.

Still, doctors recommend screening for HBV at the time of diagnosis for UC. Most people with a chronic HBV infection don’t know they have it because it doesn’t cause symptoms in the early stages.

UC and autoimmune hepatitis

Autoimmune hepatitis isn’t the result of an infection with a hepatitis virus.

In autoimmune hepatitis, you develop an immunity to your own liver cells, resulting in inflammation. The condition is more common in people with UC, but the exact cause isn’t known.

A doctor might prescribe oral or injectable medications to help treat HBV. Examples include:

These medications can help control the virus, but they’re not a cure.

If you have HBV and UC, you also have a risk of HBV reactivation once you start taking immunosuppressant drugs. This is because HBV DNA remains in your body even after you successfully treat the virus.

A doctor may recommend you take antiviral treatment before starting any immunosuppressant. They may also recommend you continue taking antivirals during your course of immunosuppressive therapy and for several months after.

The hepatitis B vaccine is effective for most people with UC. However, research suggests that response to the vaccine may be lower in people with UC than in the larger population.

A small, prospective 2022 study conducted in Asia found that the overall response rate to the HBV vaccine was significantly lower in people with UC than in those without UC.

Researchers observed an adequate immune response in 82% of people with UC compared with 96% of those without UC.

Poor response was more likely to occur in people who:

  • were female
  • had UC for more than 5 years
  • were taking corticosteroids, thiopurines, or biological drugs

A larger meta-analysis conducted in 2022 also found that overall immune response to the vaccine was significantly lower in people with IBD than in those without IBD.

After receiving the initial course, a doctor may perform a hepatitis B titer test to look for antibodies that suggest immunity to HBV.

If the titer test shows there’s no response to this initial vaccine regimen, your doctor may recommend re-vaccination with the regular vaccine or with a higher dose.

HBV is a highly contagious virus. It’s transmitted through direct contact with blood or other bodily fluids.

The best way to reduce your risk of hepatitis is to get vaccinated. Experts recommend people with IBD receive vaccinations at least 4 weeks before starting immunosuppressive drugs.

In addition to vaccination, consider the following to help reduce your risk of hepatitis B:

  • Wash your hands thoroughly with soap and water after potential exposure to blood.
  • Use barrier methods during sex, like condoms.
  • Avoid contact with blood and other bodily fluids.
  • Cover all open cuts or wounds.
  • Avoid sharing sharp items, like razors.
  • Use only sterile needles for piercings, tattoos, and acupuncture.
  • Do not share or reuse needles for injectable drugs.

IBD vaccination recommendations

When you have IBD, your immune system isn’t working as well as it should. So, infections may cause you to become sicker than someone who doesn’t have IBD.

The American Gastroenterological Association recommends the following vaccines in adults with IBD:

Talk with a doctor about what vaccines you may need.

Here are answers to some common questions about the link between HBV and ulcerative colitis.

Can I get hepatitis B again if I have UC?

If you have UC and had a prior HBV infection, you can become sick again if the virus “reactivates.” Your risk of reactivation increases when you start taking immunosuppressant drugs.

What chronic conditions are associated with hepatitis B?

For some people, HBV infection leads to a lifelong condition known as chronic hepatitis B, which can lead to serious health problems over time. Complications include cirrhosis, liver failure, and liver cancer.

Can hepatitis cause ulcerative colitis?

Infection with HBV can’t cause UC. But a rare condition called autoimmune hepatitis has links to IBD. Autoimmune hepatitis occurs when you develop an immune reaction to your own liver cells. The cause isn’t yet understood.

If you have UC, you may have a higher risk of HBV. Immunosuppressant therapy can also reactivate the virus if you’ve had a previous infection.

Because HBV can cause serious complications if undetected and untreated, ask a doctor about screening for HBV. The best way to prevent infection is to get the HBV vaccine, preferably before starting immunosuppressive therapy.