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 Strategy For Hepatitis B Immunization
Although major progress has been achieved in hepatitis B immunization, a number of challenges remain. That is why the WHO called for comprehensive prevention and control of HBV infection and the development of time-specific immunization goals in its member states. The strategy includes the following: universal vaccination of infants within 24 hours of birth, full immunization of infants by routine immunization programs, catch-up vaccination of unimmunized cohorts, and monitoring progress and assessing the impact of immunization .
Universal Vaccination of Infants Within 24 Hours of Birth: a Real Challenge
Full Immunization of Infants by Routine Immunization Programs and Catch-Up Vaccination of Unimmunized Cohorts
Wider provision of the existing, safe and effective HBV vaccine, through universal childhood vaccination and by catch-up vaccination of unimmunized cohorts, will further reduce new hepatitis B infections, reducing rates of chronic illness and death. However, to achieve and/or sustain high coverage, stronger and resilient immunization delivery systems will be needed. Still, some countries adopt risk-grouptargeted vaccination only, instead of adding a universal vaccination program. However, changing demography, increasing immigration, and the current vaccine costs make the cost-benefit ratios in these remaining low-endemicity countries strongly in favor of universal HBV vaccination.
Monitoring Progress and Assessing the Impact of Immunization
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 theyre 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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Data Collection And Laboratory Methods
After a signed informed consent, participants provided data on their demographic, drug use, social, and behavioral characteristics. We collected this information through verbally administered questionnaires that were also recorded electronically via computer-assisted personal interviews . We collected variables such as age, gender, race/ethnicity, education level, marital status, living arrangements, employment, history of drug use patterns, and sexual habits. We recorded drug use patterns such as current drug use, past drug use, age at drug initiation and length of drug use, 30-day use frequency, and the pattern at the time of heaviest use. We collected these details for drugs such as crack cocaine, powder cocaine, methamphetamine, marijuana, fry, heroin, speedball, codeine syrup, alcohol, or other street drugs. We also documented a detailed history of binging on these drugs. Drug history also included questions on injecting drugs, age at first injection, frequency and duration of injections, type of drug injected, use of clean needles, and sharing of drug use equipment with others19 .
We performed blood draws for viral markers along with interviews at 0, 6, 12, 18, and 24 months. We tested the blood specimens for HBsAg, anti-HBs, anti-HBc, and anti-HCV antibodies using Abbotts AxSYM system and anti-HIV antibodies using the Abbott PPC Commander system.
What Is Hepatitis B Virus
Hepatitis B virus attacks the liver. Hepatitis B virus infections are known as the “silent epidemic” because many infected people don’t experience symptoms until decades later when they develop hepatitis , cirrhosis , or cancer of the liver . Every year in the United States about 22,000 new hepatitis B infections occur and about 2,000 people die from their infections.
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Postexposure Management Of Health Care Personnel After Occupational Exposure To Blood And Body Fluids By Health Care Personnel Hepb Vaccination And Response Status
|HepB Vaccination and Response Status||Postexposure testing results for source patient||Postexposure testing results for HCP||HBIG* postexposure prophylaxis|
*HBIG should be administered intramuscularly as soon as possible after exposure when indicated. The effectiveness of HBIG when administered greater than 7 days after percutaneous, mucosal, or nonintact skin exposures is unknown. HBIG and HepB vaccine should be administered in separate anatomic injection sites.Should be performed 1 to 2 months after the last dose of the HepB vaccine series using a quantitative method that allows detection of the protective concentration of anti-HBs .§A responder is defined as a person with anti-HBs greater than or equal to 10 mIU/mL after 3 or more doses of HepB vaccine.¶A nonresponder is defined as a person with anti-HBs less than 10 mIU/mL after 2 complete series of HepB vaccine.**HCP who have anti-HBs less than 10 mIU/mL, or who are unvaccinated or incompletely vaccinated, and sustain an exposure to a source patient who is HBsAg-positive or has unknown HBsAg status, should undergo baseline testing for HBV infection as soon as possible after exposure and follow-up testing approximately 6 months later. Initial baseline tests consist of total anti-HBc testing at approximately 6 months consists of HBsAg and total anti-HBc.
The Vaccination And Serology Test Of Infants
The HepB used in this study contained 20 g HBsAg in each dose . All newborns received the birth dose vaccine and 100 IU HBIG within 12 h after birth, followed by the second dose vaccine within 2835 days after birth, and the third dose vaccine between 180 and 210 days after birth. One month after completing the basic immunization program, 3 ml blood samples were collected to test for HBsAb and HBsAg. In June 2020, 3 ml blood samples were collected from all enrolled HBsAg negative infants to detect HBsAb and HBsAg.
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How Is The Hepatitis B Vaccine Made
People are protected against hepatitis B virus infection by making an immune response to a protein that sits on the surface of the virus. When hepatitis B virus grows in the liver, an excess amount of this surface protein is made. The hepatitis B vaccine is made by taking the part of the virus that makes surface protein and putting it into yeast cells. The yeast cells then produce many copies of the protein that are subsequently used to make the vaccine. When the surface protein is given to children in the vaccine, their immune systems make an immune response that provides protection against infection with the hepatitis B virus.
The first hepatitis B vaccine was made in the 1980s by taking blood from people infected with hepatitis B virus and separating or purifying the surface protein from the infectious virus. Because blood was used, there was a risk of contaminating the vaccine with other viruses that might be found in blood, such as HIV. Although contamination with HIV was a theoretical risk of the early, blood-derived hepatitis B vaccine, no one ever got HIV from the hepatitis B vaccine. That is because the blood used to make vaccine was submitted to a series of chemical treatments that inactivated any possible contaminating viruses. Today, there is no risk of contaminating the vaccine with other viruses because the surface protein is manufactured in the laboratory.
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?
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Emergency Hepatitis B Vaccination
If you have been exposed to the hepatitis B virus and have not been vaccinated before, you should get immediate medical advice, as you may benefit from having the hepatitis B vaccine.
In some situations, you may also need to have an injection of antibodies, called specific hepatitis B immunoglobulin , along with the hepatitis B vaccine.
HBIG should ideally be given within 48 hours, but you can still have it up to a week after exposure.
I Am A Healthcare Worker Who Did Not Develop Hepatitis B Antibodies After Immunization What Should I Do
Two versions of hepatitis B vaccine are available. One, called Heplisav-B, contains a novel adjuvant that was not present in previous versions used by adults . Some people did not respond to the older version hepatitis B vaccine. In fact, in a group of adults younger than 40 years of age who received two doses of the older version vaccine 75 of 100 were protected. Following the third dose, this number increased to 90 of 100. However, people older than 40 years of age were less likely to respond to the vaccine with increasing age. On the other hand, 90 to 100 of 100 adults 18 years of age and older respond to Heplisav-B, which was approved for use in 2018.
About 5-10 of every 100 children and adults younger than 40 years of age do not respond to the third dose of the hepatitis B vaccine. Some of these people will be recommended to get vaccinated again. About 5 of 100 people will still not respond after getting all recommended doses of both series. Note that children younger than 18 years of age cannot get Heplisav-B.
If the people who do not respond to vaccination are determined not to have chronic hepatitis B, they will be reliant on taking precautions to reduce the chance of exposure and relying on those around them for protection. In other words, these people will be reliant on herd immunity.
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What Are The Side Effects
The most common of the hepatitis B vaccine are mild and include:
- Sore arm from the shot.
Prepare for your child’s vaccine visit and learn about how you can:
- Research vaccines and ready your child before the visit
- Comfort your child during the appointment
- Care for your child after the shot
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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History And Development Of The First Anticancer Vaccine
The first hepatitis B vaccines, commercially available since 1982, were plasma-derived vaccines. The American microbiologist Maurice Hilleman produced these vaccines by harvesting subvirion particles of HBsAg from the plasma of asymptomatic chronic HBV-infected donors . The particles in the pooled plasma were highly purified and any residual infectious particles were inactivated by various combinations of urea, pepsin, formaldehyde, and heat . Plasma-derived vaccines have been investigated with success in several hundred million individuals, leading to the first licensed hepatitis B vaccines. This first HBV vaccines were manufactured under the name Heptavax B and Hevac B and targeted a number of high-risk groups, the main focus of the immunization program at that time. Although concerns about the safety of these vaccines regarding transmission of bloodborne pathogens, including human immunodeficiency virus , have proven to be unfounded, public anxieties over the safety of the plasma-derived vaccine persisted and hampered its acceptance in many populations . Other barriers for high coverage included high vaccine costs and the lack of global vaccine policies .
Advisory Committee On Immunization Practices
The Centers for Disease Control and Preventions Advisory Committee on Immunization Practices provide recommendations for the hepatitis B vaccine. The following include persons recommended to receive the hepatitis B vaccination :
- Adults aged 60 years and older with risk factors for hepatitis B:
Persons at risk for infection by sexual exposure
- Sex partners of persons testing positive for HBsAg
- Sexually active persons who are not in a long-term, mutually monogamous relationship
- Persons seeking evaluation or treatment for a sexually transmitted infection
- Men who have sex with men
Persons at risk for infection by percutaneous or mucosal exposure to blood
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Immunogenicity And Vaccine Efficacy
More than 90% of infants, children, and adolescents and more than 90% of healthy adults younger than age 40 years develop a protective antibody response following a complete HepB vaccine series. However, there is an age-specific decline in immunogenicity. By 60 years, only 75% develop protective antibody titers. In adults receiving Heplisav-B, 90 to 100% develop adequate antibody after the 2-dose series.
Infants born to women who are HBsAg-positive are at high risk of HBV transmission and chronic HBV infection. HepB vaccination and 1 dose of HBIG administered within 24 hours after birth are 85% to 95% effective in preventing chronic HBV infection. HepB vaccine administered alone beginning within 24 hours after birth is 70% to 95% effective in preventing perinatal HBV infection.
HepB vaccine is 80% to 100% effective in preventing infection or clinical hepatitis in those who receive the complete vaccine series. Larger vaccine doses or an increased number of doses are required to induce protective antibody in most dialysis patients age 20 years or older and may also be necessary for other immunocompromised persons age 20 years or older. The recommended dosage of vaccine differs depending on the age of the recipient and type of vaccine.
For dialysis patients who did respond to vaccine, the need for booster doses should be assessed by annual testing of vaccine recipients for antibody levels, and a booster dose should be provided when antibody levels decline below 10 mIU/mL.
How To Get Vaccinated Against Hepatitis B
All babies in the UK born on or after 1 August 2017 are given 3 doses of hepatitis B-containing vaccine as part of the NHS routine vaccination schedule.
These doses are given at 8, 12 and 16 weeks of age.
Babies at high risk of developing hepatitis B infection from infected mothers are given extra doses of the hepatitis B vaccine at birth, 4 weeks and 1 year of age.
If you think you’re at risk and need the hepatitis B vaccine, ask your GP to vaccinate you, or visit any sexual health or genitourinary medicine clinic.
If your job places you at risk of hepatitis B infection, it’s your employer’s responsibility to arrange vaccination for you, rather than your GP. Contact your occupational health department.
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