Persons With Chronic Diseases
Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional general information about vaccination of people with chronic diseases.
Chronic renal disease and patients on dialysis
People with chronic renal disease may respond sub-optimally to HB vaccine and experience more rapid decline of anti-HBs titres, and are therefore recommended immunization with a higher vaccine dose. Individuals undergoing chronic dialysis are also at increased risk for HB infection. In people with chronic renal disease anti-HBs titre should be evaluated annually and booster doses using a higher vaccine dose should be given as necessary.
People with conditions such as autism spectrum disorders or demyelinating disorders should receive all routinely recommended immunizations, including HB-containing vaccine.
Chronic liver disease
HB immunization is recommended for non-immune persons with chronic liver disease, including those infected with hepatitis C, because they are at risk of more severe disease if infection occurs. Vaccination should be completed early in the course of the disease, as the immune response to vaccine is suboptimal in advanced liver disease. Post-immunization serologic testing may be used to confirm vaccine response.
Non-malignant hematologic disorders
Persons with bleeding disorders and other people receiving repeated infusions of blood or blood products are considered to be at higher risk of contracting HB and should be offered HB vaccine.
Hepatitis B Vaccination In Pregnancy
Hepatitis B infection in pregnant women may result in severe disease for the mother and chronic infection for the baby.
This is why the hepatitis B vaccine is recommended for pregnant women who are in a high-risk category.
There’s no evidence of any risk from vaccinating pregnant or breastfeeding women against hepatitis B.
And, as it’s an inactivated vaccine, the risk to the unborn baby is likely to be negligible .
Us Children And Adult Hepatitis B Vaccine Schedules
*Please note that the first dose should be given as soon as possible. Additional doses require minimum time intervals between doses in order for the vaccine to be effective.
3-Dose Vaccine Series for Children and Adults
The hepatitis B vaccine is an injection that is generally given in the arm as a three-dose series on a 0, 1, and 6-month schedule. Alternative schedules may be considered, noting that a third dose at 6 months, meeting minimum intervals between doses, is needed for maximum, long-term protection. Completing the hepatitis B vaccine series, preferably beginning at birth, will ensure protection against hepatitis B, hepatitis delta and lower the lifetime risk of liver cancer. Greater than 90% of babies and up to 50% of young children who are not vaccinated and are infected with hepatitis B will have lifelong infection, which makes the birth dose essential to their protection.
There are four, 3-dose vaccine brands approved in the U.S.
- PreHevbrio PreHevbrio is only approved for adults age 18 and over.
2-Dose Vaccine Series
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Many People With Hbv Dont Know They Have It
HBV infections are becoming less common in the United States. But HBV is still widespread in other parts of the world. Around 257 million people living around the world currently have HBV, and many of them dont know it. Chronic HBV is often asymptomatic, and even when it isnt, it can take months for symptoms to show up.
HBV can be transmitted through sexual contact and the use of IV drugs , and other risk factors. Although rare, there
Infants Born To Hbsag
The routine schedule for these infants is a birth dose of monovalent HepB plus HBIG, then three routine doses of DTaP-IPV-HepB/Hib at ages 6 weeks, 3 months and 5 months.
All pregnant women should receive antenatal screening for hepatitis B infection by testing for HBsAg. Infants of HBsAg-positive mothers are to be notified at birth using the form HE1446: Consent for hepatitis B vaccine and hepatitis B immunoglobulin and notification to the Medical Officer of Health, available from the Health Ed website or the local authorised health education resource provider or public health unit.
Infants born to HBsAg-positive mothers should receive:
- 100110 IU HBIG neonatal, at or as close as possible to birth
- a birth dose of HepB which should be given at or as close as possible to birth .
If HBIG and/or HepB is inadvertently omitted, administer as soon as the omission is recognised. HBIG can be administered up to seven days post-delivery. If there is a delay for longer than seven days, seek specialist advice.
These infants should then continue as per the Schedule at ages 6 weeks, 3 months and 5 months. Serological testing is required at 9 months of age .
The vitamin K injection may also be given at the same time, in the same limb as the HBIG, but not at the same site.
Infants born to mothers who received oral antiviral therapy for chronic HBV must still receive the recommended neonatal HBIG/vaccine schedule. All other vaccines are administered as per the Schedule.
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Why Should My Baby Get The Hepatitis B Shot
- Protects your child from against hepatitis B, a potentially serious disease.
- Protects other people from the disease because children with hepatitis B usually dont have symptoms, but they may pass the disease to others without anyone knowing they were infected.
- Prevents your child from developing liver disease and cancer from hepatitis B.
- Keeps your child from missing school or child care and you from missing work.
The Hepatitis B Vaccine And Immunosuppressants
If you are taking or about to start taking a medication that suppresses your immune response, let your healthcare provider know. Immunosuppressants may make certain vaccines less effective. Your healthcare provider may recommend that you get the hepatitis B vaccine at a particular time during your course of medication.
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What To Do If You Miss A Scheduled Dose
The recommended schedule for the HBV vaccine follows a three-dose pattern, with all doses complete within 6 months. The good news is that if you miss a dose, you dont need to start the series of shots all over.
If you missed getting the second dose 1 month after the first, make an appointment as soon as possible. If you miss the third dose, you should also try to get it as quickly as possible. Keep in mind that the second and third doses
Reducing Hbv Infections And Deaths By 2030
As part of their plan to address HBV, the CDCs Division of Viral Hepatitis announced a goal to reduce HBV infections by 90% and HBV-related deaths by 65% in 2030.
The Department of Health and Human Services also announced a goal to eliminate viral hepatitis as a public health threat in the United States by 2030.
To help meet these goals, the CDC has outlined new hepatitis B vaccination recommendations for 2022. Vaccines can help prevent the disease and have reduced the number of reported hepatitis B cases by 90% since being introduced in 1982.
A hepatitis B vaccine is now recommended for adults ages 19 to 59 years without risk factor screening and disclosure. This helps increase vaccination coverage and decrease cases.
The vaccine is also recommended for adults ages 60 years or older with risk factors for hepatitis B. Risk factors can include having sex without a condom or barrier method, sharing needles, and having a job that exposes you to human blood, among others.
Its also recommended that adults 60 years or older without known risk factors get a vaccine. New clinical guidance advises providers to offer vaccinations to this group. Previously, clinical guidance instructed providers to administer the hepatitis B vaccine only when it was requested by a patient.
The CDC also continues to recommend hepatitis B vaccination for all infants and unvaccinated children under the age of 19 years.
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Why Is The Hepb Vaccine Recommended
People who dont know they’re infected can spread the hepatitis B virus. So it cant be avoided just by being careful. That’s why health experts recommend that all babies get the vaccine right from birth.
The HepB injection usually creates long-term immunity. Most infants who get the HepB series are protected from hepatitis B infection beyond childhood, into their adult years.
Eliminating the risk of infection also decreases risk for cirrhosis of the liver, chronic liver disease, and liver cancer.
Important Information About Vaccine And Hepatitis B Immunoglobulin Shot Administration
Where available, the hepatitis B birth-dose and HBIG should be administered within 24 hours of birth in order to prevent the transmission of hepatitis B from mother to child. It is very important that the shots be given in opposite limbs, to ensure the highest effectiveness. Please see chart above for more information.
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Why Should I Vaccinate My Newborn Child If I Know That I Am Not Infected With Hepatitis B Virus
Before the hepatitis B vaccine, every year in the United States about 18,000 children were infected with hepatitis B virus by the time they were 10 years old. This statistic is especially important because people are much more likely to develop liver cancer or cirrhosis if they are infected early in life, rather than later in life .
About 9,000 of the 18,000 children infected in the first 10 years of life caught the virus from their mother during birth. However, many young children didn’t catch the disease from their mother. They caught it from either another family member or someone else who came in contact with the child. Because hepatitis B can be transmitted by relatively casual contact with items contaminated with the blood of an infected person, and because many people who are infected with hepatitis B virus don’t know that they have it, it is virtually impossible to be “careful enough” to avoid this infection.
For these reasons, all young children are recommended to receive the hepatitis B vaccine. The best time to receive the first dose is right after birth. This will ensure that the child will be protected as early as possible from catching hepatitis B from people who dont know that they are infected with the virus.
Listen to Dr. Offit explain why newborns get the hepatitis B vaccine by watching this short video, part of the series Talking About Vaccines with Dr. Paul Offit.
Who Should Get The Hbv Vaccine
The Centers for Disease Control and Prevention recommends that all children and adults up to age 59 should receive the hepatitis B vaccine.
Infants should get their first hepatitis B vaccine within 24 hours of birth and complete their doses by age 6 to 18 months.
All unvaccinated children and adults through age 59 should receive the vaccine. Also, unvaccinated adults over the age 60 who are at risk of hepatitis B should get the vaccine.
Adults over age 60 who are not at risk of hepatitis B may also choose to get the shot.
Several types of the HBV vaccine are also safe to administer to pregnant women.
- people who have had more than one sex partner in the last 6 months
- men who have sex with men
- people seeking treatment for a sexually transmitted infection
- people whose partners or household members have hepatitis B
- people who inject drugs
- people who live or work in care facilities
- people who are on dialysis
- travelers to countries where hepatitis B is common
- people with chronic liver disease, HIV, or hepatitis C
- people who are in jail or prison
People who have diabetes should talk with a healthcare professional about their risk for contracting hepatitis B.
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Hepatitis B Vaccine Schedule For Adults
Hepatitis B is a vaccine-preventable viral disease that involves inflammation of the liver.
The hepatitis B virus usually leads to a short-term infection known as acute hepatitis B. If their infection is left untreated, some people develop chronic hepatitis B. Chronic hepatitis B is a serious, permanent condition that can cause organ damage, cirrhosis , liver cancer, liver failure, and even death.
According to the Centers for Disease Control and Prevention , all people should be vaccinated against hepatitis B starting at birth. Adults who are at risk of developing hepatitis B should also receive the vaccine, which is highly effective in preventing infection.
Read on to learn more about the hepatitis B vaccine for adults, including who should receive it, the details of the dosage schedule, side effects, and more.
Prasit photo / Getty Images
Possible Side Effects Of Hepatitis B Vaccination
You may experience minor side effects following vaccination. Most reactions are mild and last no more than a couple of days and you will recover without any problems.
Common side effects of hepatitis B vaccines include:
- pain, redness and swelling at injection site
- occasionally an injection-site lump
Talk to your vaccination provider about possible side effects of hepatitis B vaccines, or if you or your child have possible side effects that worry you.
The Consumer Medicine Information available on the Therapeutic Goods Administration website lists the ingredients and side effects of each vaccine.
Learn more about the possible side effects of vaccination.
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Hepatitis B Vaccination Schedule For Children And Infants
The Centers for Disease Control and Prevention recommends that babies and children receive three 0.5 milliliter doses of either Engerix-B or Recombivax HB, starting just after birth.
The current recommended hepatitis B vaccine schedule for children and infants is as follows:
|Hepatitis B Vaccination Schedule for Infants and Children|
|Hepatitis B Vaccine Dose|
|3||618 months old|
If your child is undergoing hemodialysis, your healthcare provider may recommend that they receive additional doses of the HBV vaccine.
Babies And Hepatitis B Vaccination
Pregnant women have a routine blood test for hepatitis B as part of their antenatal care.
Babies born to mothers infected with hepatitis B need to be given a dose of the hepatitis B vaccine within 24 hours of their birth, followed by further doses at 4, 8, 12 and 16 weeks of age, plus a final dose when they’re 1 year old.
Babies of mothers identified by the blood test as particularly infectious might also be given an injection of HBIG at birth on top of the hepatitis B vaccination to give them rapid protection against infection.
All babies born to mothers infected with hepatitis B should be tested at 1 year of age to check if they have become infected with the virus.
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What Is Hepatitis B
Hepatitis B is a highly contagious liver infection caused by the hepatitis B virus . The infection can range in severity from mild to acute. It may last just a few weeks or become a serious, chronic, and potentially fatal health condition.
The best way to prevent this infection is to get the hepatitis B vaccine. Heres what you need to know.
How Common Is Hepatitis B
One U.S. study following trends in hepatitis B infection over a three-year periodfound that 4.3% of the population had a past or present HBV infection.
Estimates suggest that about 240 million people around the world have chronic hepatitis B. Up to 1.89 million people in the United States have a chronic HBV infection.
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Hepatitis B Vaccine On The Nhs
A hepatitis B-containing vaccine is provided for all babies born in the UK on or after 1 August 2017. This is given as part of the 6-in-1 vaccine.
Hospitals, GP surgeries and sexual health or GUM clinics usually provide the hepatitis B vaccination free of charge for anyone at risk of infection.
GPs are not obliged to provide the hepatitis B vaccine on the NHS if you’re not thought to be at risk.
GPs may charge for the hepatitis B vaccine if you want it as a travel vaccine, or they may refer you to a travel clinic for a private vaccination. The current cost of the vaccine is around £50 a dose.
Preparations Of Hepatitis B Vaccine
Hepatitis B vaccine is produced using recombinant DNA technology. A plasmid containing the gene for hepatitis B surface antigen is inserted into common bakers yeast, which then produces HBsAg. The HBsAg is harvested and purified. This vaccine cannot cause hepatitis B virus infection because no potentially infectious viral DNA or complete viral particles are produced during this process.
Single-antigen and a combination formulation that combines hepatitis A and hepatitis B vaccines are available. Two single-antigen vaccines, Engerix-B® and Recombivax HB®, are conjugated with aluminum. A newer formulation, HepB-CpG , uses the immune-stimulating adjuvant, cytidine-phosphate-guanosine oligodeoxynucleotide .
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The Hepatitis B Vaccine
The hepatitis B vaccine is used to prevent hepatitis B. Its usually provided in three doses.
The first dose can be taken on a date you choose. The second dose must be taken 1 month later. The third and final dose must be taken 6 months after the first dose.
Some people may need two or four doses of this vaccine.
There is also a newer hepatitis B vaccine thats offered in two doses.
Dose And Administration Of Hepatitis B Vaccine
The dose for Engerix-B® and Recombivax HB® is 0.5 mL IM up to age 20 years or 1 mL IM for adults . The dose for Heplisav-B® is 0.5 mL IM for adults 18 years.
The vaccine is typically given to children in a 3-dose series at age 0 months, at 1 to 2 months, and at 6 to 18 months.
Infants who did not receive a dose a birth should begin the series as soon as feasible.
All children not previously vaccinated with HepB vaccine should be vaccinated at age 11 or 12 years. A 3-dose schedule is used the 1st and 2nd doses are separated by 4 weeks, and the 3rd dose is given 4 to 6 months after the 2nd dose. However, a 2-dose schedule using Recombivax HB® can be used the 2nd dose is given 4 to 6 months after the first.
The usual schedule for adults using Engerix-B® or Recombivax HB® is a 3-dose series with 2 doses separated by 4 weeks, and a 3rd dose 4 to 6 months after the 2nd dose. Heplisav-B® is given in 2 doses at least 4 weeks apart and can be given as a substitute in a 3-dose series with a different HepB vaccine. Heplisav-B® should not be given during pregnancy because safety data are not available on its use during pregnancy.
Unvaccinated adults who are being treated with hemodialysis or who are immunocompromised should be given 1 dose of Recombivax HB® 40 mcg/mL in a 3-dose schedule at 0, 1, and 6 months or 2 doses of Engerix-B® 20 mcg/mL given simultaneously in a 4-dose schedule at 0, 1, 2, and 6 months.
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