A Look At Each Vaccine: Hepatitis B Vaccine
View larger image The hepatitis B vaccine is given to prevent the severe liver disease that can develop when children or adults are infected with hepatitis B virus. The hepatitis B vaccine is given as a series of three shots. The first dose is given within 24 hours of birth. The second dose is given one to two months after the first dose, and the third dose is given between 6 months and 18 months of age. The vaccine is also recommended for those up to 60 years of age who have not previously received it and those 60 years and older who are at increased risk or who simply want the protection afforded by vaccination.
Guidance On Reporting Adverse Events Following Immunization
Vaccine providers are asked to report, through local public health officials, any serious or unexpected adverse event temporally related to vaccination. An unexpected AEFI is an event that is not listed in available product information but may be due to the immunization, or a change in the frequency of a known AEFI.
Refer to Reporting Adverse Events Following Immunization in Canada and Adverse events following immunization in Part 2 for additional information about AEFI reporting.
What Is In The Hepatitis B Vaccine
Vaccines are given by a course of three injections, usually as part of the 6-in-1 vaccine scheme.
Although there are different types of vaccines, they usually contain one of the proteins from the surface of the hepatitis B virus thats then inserted in to the genetic code into yeast cells which stops the risk of viral DNA getting into the final product.
They also contain small amounts of sodium chloride and aluminium, and can contain yeast and formaldehyde.
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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.
Neurologic disorders
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.
Active Vaccination To Prevent Infection
Hepatitis B vaccination is available for preexposure and postexposure prophylaxis and provides long-term protection. Hepatitis B vaccines are produced recombinantly in yeast cell systems. The vaccines contain noninfectious HBsAg , a small amount of yeast protein, and aluminum hydroxide as an adjuvant. Pediatric formulations contain trace or no thimerosal. Administration is via the intramuscular route. Adverse effects are generally mild and mainly consist of local tenderness and low-grade fever. After a vaccine series, more than 95% seroconversion is achieved, which results in > 90% efficacy. Studies are ongoing to determine length of immunity, but it is at least 20 years.
Two hepatitis B single antigen vaccines are available in the United States: Recombivax from Merck & Co. and Engerix-B from GlaxoSmithKline. Both vaccines come in doses for pediatric and adult populations. High-dose vaccines are available for adult hemodialysis and immunocompromised patients. Both vaccines are given in a three-dose series and are generally interchangeable. A fourth dose may be given if a birth dose was administered. The birth dose must be a single antigen formulation.
Booster doses of hepatitis B vaccine beyond the initial series are generally not recommended. The long incubation period of hepatitis B theoretically allows for the development of a protective anamnestic immune response after exposure.
Fabrizio Fabrizi MD, … Paul Martin MD, in, 2017
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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.
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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Who Should Receive The Hepatitis B Vaccine
Vaccination is the most reliable way to prevent getting hepatitis B or developing serious related medical complications.
The CDCs Advisory Committee on Immunization Practices recommends that people in all age groups get the hepatitis B vaccine, including:
- All infants within 24 hours after birth
- Children and teens who have not previously been vaccinated against hepatitis B
- Adults ages 19 to 59
- Adults ages 60 and older with at least one risk factor for hepatitis B
Adults over 60 who are not at risk of developing hepatitis B can also receive the HepB vaccine if they choose.
Other Reported Adverse Events And Conditions
While serious events and chronic illnesses such as chronic fatigue syndrome, multiple sclerosis, Guillain-Barré syndrome, rheumatoid arthritis and sudden infant death syndrome have been alleged or reported following HB vaccination, no evidence of a causal association has been demonstrated in a number of studies.
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Vaccine Side Effects And Risks
The vaccine is safe, effective and generally well tolerated. The most frequent reactions are pain and redness where the vaccine was given. Common side effects include headache, fever, dizziness, nausea or feeling faint shortly after receiving the vaccine. Reactions are usually mild and lasts only a few days.
In rare cases, serious allergic reactions such as trouble breathing, rash, swelling in the throat and face may occur. Allergic reactions can be treated and are usually temporary. Please stay at the clinic for 15 minutes after vaccination for staff to monitor for any reactions. There are no long-term side effects associated with this vaccine.
Persons With Inadequate Immunization Records
Evidence of long term protection against HB has only been demonstrated in individuals who have been vaccinated according to a recommended immunization schedule. Independent of their anti-HBs titres, children and adults lacking adequate documentation of immunization should be considered susceptible and started on an immunization schedule appropriate for their age and risk factors. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information.
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How Do You Bill A Physical Therapy Unit
To calculate the number of billable units for a date of service, providers must add up the total minutes of skilled, one-on-one therapy and divide that total by 15. If eight or more minutes remain, you can bill one more unit.
How do you charge physical therapy units?
First for any service provided for at least 15 minutes you must bill 1 unit. Sometimes thats easy: if you provide 15 minutes of Therapeutic Exercise you bill 1 unit of that code, 30 minutes of Neuromuscular Re-education is 2 units of that code.
Persons New To Canada
Health care providers who see persons newly arrived in Canada should review the immunization status and update immunization for these individuals, as necessary. In many countries outside of Canada, HB vaccine is in limited use.
All persons from a country that is endemic for HB should be assessed and vaccinated against HB if not immune and not infected. Individuals born in developing countries are more likely to be carriers of HB, necessitating vaccination of their sexual and household contacts based on review of their serologic test results. HB vaccine is recommended for all household contacts whose families have immigrated to Canada from areas in which there is a high prevalence of HB and who may be exposed to HB carriers through their extended families or when visiting their country of origin.
Children adopted from countries in which there is a high prevalence of HB infection should be screened for HBsAg and, if positive, household or close contacts in the adopting family should be immunized before adoption or as soon as possible thereafter. Adults going to pick-up children from these countries should be vaccinated before departure. Refer to Immunization of Persons New to Canada in Part 3 for additional information.
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Concurrent Administration Of Vaccines
HB-containing vaccines may be administered concomitantly with other vaccines or with HBIg. Different injection sites and separate needles and syringes must be used for concurrent parenteral injections.
Refer to Timing of Vaccine Administration in Part 1 for additional information about concurrent administration of vaccines.
What Is The 8
The 8-minute rule is a stipulation that allows you to bill Medicare insurance carries for one full unit if the service provided is between 8 and 22 minutes. As such, this can only apply to time-based CPT codes. But, the 8-minute rule doesnt apply to every time-based CPT code, or every situation.
What is the CPT code for syphilis?
Quantitative syphilis testing is indicated in the follow up of previous positive testing at periodic intervals not to exceed semiannually until seronegativity occurs. Local policies are determined by the performing test location.
How do you code syphilis?
Code 096 is assigned for syphilis without clinical manifestations, with positive serological reaction and negative spinal fluid test, two years or more after infection. Code 097.1 is assigned for latent syphilis, unspecified or when there is a positive serological reaction for syphilis.
What is syphilis unspecified?
Infections with a predominantly sexual mode of transmission A stage of syphilis characterized by the serologic evidence of infection by treponema pallidum without evidence of accompanying signs or symptoms related to the disease.
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How Long Is Hep B Vaccine Good For
How long does protection from hepatitis B vaccine last? Studies indicate that immunologic memory remains intact for at least 30 years among healthy people who initiated hepatitis B vaccination at > 6 months of age .
What is the 8-minute rule in physical therapy?
8-Minute Rule Basics Basically, a therapist must provide direct, one-on-one therapy for at least eight minutes to receive reimbursement for one unit of a time-based treatment code.
For Adults At High Risk Of Exposure
Adults who have not received the hepatitis B vaccine series should be immunized when they have an increased risk of exposure. Job, travel, health condition, or lifestyle all may increase a persons risk of contracting hepatitis B.
People who live or work where there is risk of exposure include:
- Health care and public safety workers who are likely to be exposed to blood or blood products.
- Clients and staff of institutions or residential settings with known or potential HBV carriers.
- People planning extended travel to China, Southeast Asia, Africa, and other areas where hepatitis B infection is high.
People who have health conditions that put them at high risk for exposure or a severe infection include:
- People who have a severe kidney disease that requires them to have their blood filtered through a machine .
- People who have chronic liver disease.
- People who have hemophilia and other conditions in which they need to have blood products on an ongoing basis.
- People who had a stem cell transplant.
People whose lifestyle puts them at high risk for exposure include:
- People who inject illegal drugs.
- Men who have sex with men.
- People who have had more than one sex partner in the past 6 months or who have a history of sexually transmitted infection.
- Household contacts and sex partners of hepatitis B carriers.
- Prison inmates.
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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.
Common And Local Adverse Events
HB vaccine
HB vaccine is well tolerated. Reactions are generally mild and transient, and include: irritability, headache, fatigue and injection site reactions in 10% or more of recipients.
HAHB vaccine
There is no increase in adverse events when HAHB vaccine is compared with HA vaccine given alone or concomitantly with HB vaccine at a different injection site. When the adult formulation of HAHB vaccine is given to children in the 2 dose schedule, there is no increase in adverse events compared with those occurring after administration of the pediatric formulation of HAHB vaccine.
DTaP-HB-IPV-Hib vaccine
Reactions are usually mild and transient, and include fever, irritability, restlessness and injection site reactions .
HBIg
Headache, diarrhea, fever, urticaria, angioedema and injection site reactions may occur.
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Indications For Recombivax Hb Indications For Recombivax Hb
RECOMBIVAX HB® is indicated for prevention of infection caused by all known subtypes of hepatitis B virus.
RECOMBIVAX HB is approved for use in individuals of all ages.
RECOMBIVAX HB Dialysis Formulation is approved for use in adult predialysis and dialysis patients 18 years of age and older.
RECOMBIVAX HB is indicated for prevention of infection caused by all known
RECOMBIVAX HB is indicated for prevention of infection caused by all known subtypes of hepatitis B virus.
RECOMBIVAX HB is approved for use in individuals of all ages.
Selected Safety Information For Recombivax Hb Selected Safety Information For Recombivax Hb
Do not administer RECOMBIVAX HB® to individuals with a history of severe allergic or hypersensitivity reactions after a previous dose of any hepatitis B-containing vaccine or to any component of RECOMBIVAX HB, including yeast.
The vial stopper and the syringe plunger stopper and tip cap contain dry natural latex rubber, which may cause allergic reactions in latex-sensitive individuals.
Apnea following intramuscular vaccination has been observed in some infants born prematurely. Decisions about when to administer an intramuscular vaccine, including RECOMBIVAX HB, to infants born prematurely should be based on consideration of the individual infants medical status and the potential benefits and possible risks of vaccination. For RECOMBIVAX HB, this assessment should include consideration of the mothers hepatitis B antigen status and high probability of maternal transmission of hepatitis B virus to infants born to mothers who are HBsAg positive if vaccination is delayed.
Hepatitis B vaccination should be delayed until 1 month of age or hospital discharge in infants weighing < 2000 g if the mother is documented to be HBsAg negative at the time of the infants birth. Infants weighing < 2000 g born to HBsAg positive or HBsAg unknown mothers should receive vaccine and hepatitis B immune globulin in accordance with ACIP recommendations if HBsAg status cannot be determined.
Vaccination with RECOMBIVAX HB may not protect all individuals.
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How Do You Catch Hepatitis B Virus
Blood from a person infected with hepatitis B virus is heavily contaminated with the virus. As a result, contact with blood is the most likely way to catch hepatitis B. Even casual contact with the blood of someone who is infected can cause infection.
Healthcare workers are at high risk of catching the disease, as are intravenous drug users and newborns of mothers infected with the virus. Sexual contact can also expose people to infection. The virus is also present in low levels in saliva.
Administration Of Hepatitis B Vaccine
The hepatitis B vaccine is typically given in a series of two or three injections into a muscle. However, if people who have been vaccinated are exposed to the virus, a doctor measures their antibody levels against hepatitis B. If the antibody levels are low, they may need another injection of hepatitis B vaccine.
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People who are under age 60 and have diabetes Diabetes Mellitus Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar levels to be abnormally high. Urination and thirst are… read more and sometimes people who are age 60 and older who have diabetes
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People who are employed by or are given care in places where there are people at high risk of hepatitis B
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Pregnant women if they are at risk of getting the infection or of getting very sick or dying of infection during pregnancy
If people have a temporary illness, doctors usually wait to give the vaccine until the illness resolves .
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Use In Special Populations
Pregnancy
There are no adequate and well-controlled studies designed to evaluate RECOMBIVAX HB in pregnant women. Available post-approval data do not suggest an increased risk of miscarriage or major birth defects in women who received RECOMBIVAX HB during pregnancy.
Nursing Mothers
Data are not available to assess the effects of RECOMBIVAX HB on the breastfed infant or on milk productions/excretion. The developmental and health benefits of breastfeeding should be considered along with the mothers clinical need for RECOMBIVAX HB and any potential adverse effects on the breastfed child from RECOMBIVAX HB or from the underlying maternal condition.
Pediatric Use