Who Should Not Get The Hepatitis B Vaccine
Hepatitis B is a safe vaccine that does not contain a live virus.
However, there are some circumstances in which doctors advise against getting the HBV vaccine.
You should not receive the hepatitis B vaccine if:
- youve had a serious allergic reaction to a previous dose of the hepatitis B vaccine
- you have a history of hypersensitivity to yeast or any other HBV vaccine components
Who Should Receive Hepatitis B Vaccination
- All newborns before hospital discharge. Infants born to hepatitis B-positive women need hepatitis B vaccine and HBIG within 12 hours of birth.
- All children and adolescents not previously vaccinated.
- Children born in the U.S. to individuals born in a country with high hepatitis B endemicity.
- All individuals at risk of hepatitis B infection:
- Sex partners of hepatitis B-positive persons.
- Sexually active persons who are not in a long-term, mutually monogamous relationship .
- Persons seeking evaluation or treatment for a sexually-transmitted disease.
- Men who have sex with men.
- Persons who inject drugs.
- Household contacts of hepatitis B-positive persons.
- Persons born in countries where hepatitis B infection is endemic should be tested and vaccinated if susceptible.
- International travelers to regions with high or intermediate rates of endemic hepatitis B infection.
- Health care and public safety workers that may be exposed to blood or blood-contaminated body fluids.
- Residents and staff of facilities for developmentally disabled persons, corrections facilities, and other facilities that serve adults at risk for hepatitis B infection.
- Persons with end-stage renal disease, including pre-dialysis, hemodialysis, peritoneal dialysis, and home dialysis patients.
- Persons with chronic liver disease.
- Persons to age 60 years with diabetes.
- Persons with HIV infection.
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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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.
How Long Does Hep B Vaccine Last And Who Should Take It
Hepatitis B vaccine is one of the most common vaccines today. It is used to develop immunity to Hepatitis B, a heavily contagious disease caused by the virus of the same name.
According to the Centers for Disease Control and Prevention, Hepatitis B is in decline in recent years. The figures have dropped from around 200,000 new infections a year in the 1980s to an average of 20,000 in 2016.
Contracting the virus doesnt necessarily put you at risk of a chronic infection. For individuals above the age of five, the chances of that happening are between 5 and 10%. Younger children are at a much higher risk. Under the age of five, the estimation is 25-50%. Infants run a 90% chance of developing a chronic infection if they contract the Hepatitis B virus.
The Hep B vaccine is the most common prevention methods for Hepatitis B, with the first vaccine being approved in the United States in 1981. In 1986, the first recombinant version became available. But how long does Hep B vaccine last? This article will explore the question. The possible side effects, risk factors and risk groups will also be considered.
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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 HepB-CpG 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 first and second doses are separated by 4 weeks, and the third dose is given 4 to 6 months after the second dose. However, a 2-dose schedule using Recombivax HB can be used the second dose is given 4 to 6 months after the first.
Adults age 19 through 59 years who have not been previously vaccinated should complete a 2- or 3-, or 4-dose series. 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 third dose 4 to 6 months after the second dose. HepB-CpG 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.
HepB-CpG 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 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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Transmission Symptoms And Treatment
How is HBV transmitted?
HBV is transmitted through activities that involve percutaneous or mucosal contact with infectious blood or body fluids , including
- sex with a partner who has HBV infection
- injection drug use that involves sharing needles, syringes, or drug-preparation equipment
- birth to a person who has HBV infection
- contact with blood from or open sores on a person who has HBV infection
- exposures to needle sticks or sharp instruments and
- sharing certain items with a person who has HBV infection that can break the skin or mucous membranes , potentially resulting in exposure to blood.
How long does HBV survive outside the body?
HBV can survive outside the body and remains infectious for at least 7 days .
What should be used to clean environmental surfaces potentially contaminated with HBV?
Any blood spills should be disinfected using a 1:10 dilution of one part household bleach to 9 parts water. Gloves should be worn when cleaning up any blood spills.
Who is at risk for HBV infection?
The following populations are at increased risk for becoming infected with HBV:
- Infants born to people with HBV infection
- Sex partners of people with HBV infection
- Men who have sex with men
- People who inject drugs
- Household contacts or sexual partners of known people with chronic HBV infection
- Health care and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluids
- Patients on hemodialysis
Who should be screened for HBV?
Site Of Injection For Vaccination And Antibody Response
Hepatitis B vaccination should be given in the upper arm or the anterolateral aspect of the thigh and not in the buttock. There are over 100 reports of unexpectedly low antibody seroconversion rates after hepatitis B vaccination using injection into the buttock. In one center in the USA a low antibody response was noted in 54% of healthy adult health-care personnel. Many studies have since shown that the antibody response rate is significantly higher in centers using deltoid injection than centers using the buttock. On the basis of antibody tests after vaccination, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention in the USA recommended that the arm be used as the site for hepatitis B vaccination in adults, as has the Department of Health in the UK.
These observations have important public health implications, well illustrated by the estimate that about 20% of the 60 000 people immunized against HBV in the buttock in the USA by March 1985 had failed to attain a minimum level of antibody of 10 IU/l and were therefore not protected.
Hepatitis B surface antibody titers should be measured in all people who have been immunized against HBV by injection in the buttock, and when this is not possible a complete course of three injections of vaccine should be administered into the deltoid muscle or the anterolateral aspect of the thigh, the only acceptable sites for HBV immunization.
Dean A. Blumberg, in, 2012
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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.
More Information On Side Effects
Reactions listed under âpossible side effectsâ or âadverse eventsâ on vaccine product information sheets may not all be directly linked to the vaccine. See Vaccine side effects and adverse reactions for more information on why this is the case.
If you are concerned about any reactions that occur after vaccination, consult your doctor. In the UK you can report suspected vaccine side effects to the Medicines and Healthcare products Regulatory Agency through the Yellow Card Scheme
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Neutralizing Activities Against Hbv Strains Of Various Genotypes
To investigate the genotype dependency of the neutralizing activities of HB vaccine-induced antibodies, HBV/NLs harboring the L-HBs region of GTA , GTB , and GTD were generated and used . These HBV/NL strains were incubated with serially diluted antibodies and used to infect G2/NT18-C cells. The neutralizing activities of S-HBs vaccine-induced antibodies to HBV/NL-GTA and -GTB were comparable to those to HBV/NL-WT . The IC50 values of antibodies to these genotypes were 1.31±0.208- and 1.26±0.0876-fold those to HBV/NL-WT , respectively . Regarding HBV/NL-GTD, the neutralizing activity of S-HBs vaccine-induced antibodies was lower than those of HBV/NL-GTA and -GTB , and the IC50 value was 2.19±0.489-fold that of HBV/NL-WT . In experiments using L-HBs+Addavax-induced antibodies, the neutralizing activities against HBV/NL-GTA and -GTD were comparable to that against HBV/NL-WT . The neutralizing activity against HBV/NL-GTB was low, and the IC50 value of antibodies was 7.18±2.94-fold that of HBV/NL-WT . These data indicate that the neutralizing effects of antibodies induced by the S-HBs vaccine and L-HBs+Addavax depend on HBV genotypes attenuation of the neutralizing activities of S-HBs vaccine-induced and L-HBs+Addavax-induced antibodies was observed in the GTD and GTB strains, respectively.
Fig. 5: Neutralizing activities against HBV strains of various genotypes.
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.
Several 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 . A combination formulation that combines hepatitis A and hepatitis B vaccines is available.
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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.
Recommended Doses Of Hepatitis B Vaccine
Recommended doses of hepatitis B by vaccine type, age, formulation, dosage and schedule.
Download PDF version formatted for print: Recommended Doses of Hepatitis B Vaccine
Infants: birth, 1-4, 6-18 monthsOROlder children: 0, 1-2, 4-6 months
20 years & older
Infants: birth, 1-4, 6-18 monthsOROlder children: 0, 1-2, 4-6 months
0, 1, 4-6 months
* The schedule for hepatitis B is flexible, but minimal intervals and minimum ages need to be observed:
- There should be at least 4 weeks between doses 1 and 2, and at least 8 weeks between doses 2 and 3.
- The minimum interval for the overall series from dose 1 to final dose is 4 months .
- Infants, should receive the final dose of hepatitis B vaccine on or after 6 months of age, otherwise long term immunity may be impacted.
- Adults who are immunocompromised or on dialysis require a larger dose of hepatitis B vaccine.
- The Engerix-B dose required is 40mcg/2.0mL on a scheduled of 0, 1, 2, and 6 months.
- For Recombivax HB, a special formulation is available. The dose is 40mcg/1.0mL given on a schedule of 0, 1, and 6 months
6 weeks thru 6 years
Hep B as Engerix-B 10 mcg, DTaP as Infanrix, Polio
Give single antigen hep B dose at birth followed by Pediarix at: 2, 4, 6 months
Hep A as Havrix 720 El.U, Hep B as Engerix-B 20 mcg
0, day 7, day 21-30, 12 months
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Hepatitis B Vaccine Side Effects
The hepatitis B vaccine is considered a very safe and effective vaccine. Its made with an inactivated virus, so most types of the vaccine are even safe for pregnant people.
The hepatitis B vaccine may cause some mild side effects. The most common symptom is redness, swelling, or soreness where the injection was given. Some people also experience headache or fever. These effects usually last a day or two .
Rarely, some people have a serious and potentially life threatening allergic reaction to the vaccine. Call 911 or get to a hospital immediately if you experience any of the following symptoms after 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.
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Does The Hepatitis B Vaccine Have Side Effects
Some children will develop pain or soreness in the local area of the shot, and low-grade fever.
There is one extremely rare, but serious, side effect. About 1 out of every 600,000 doses of the hepatitis B vaccine will cause a severe allergic reaction, called anaphylaxis, with symptoms including swelling of the mouth, difficulty breathing, low blood pressure or shock. Anaphylaxis usually occurs within 15 minutes of receiving the vaccine. Although anaphylaxis can be treated, it is quite frightening. People should remain at the doctors office for about 15 minutes after getting the vaccine.
Although the hepatitis B vaccine is made in yeast cells, no one has ever been shown to be allergic to the yeast proteins contained in the hepatitis B vaccine .
Common And Local Adverse Events
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.
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.
Reactions are usually mild and transient, and include fever, irritability, restlessness and injection site reactions .
Headache, diarrhea, fever, urticaria, angioedema and injection site reactions may occur.
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