The Hepatitis B Vaccine
The first version of the hepatitis B vaccine was approved by the Food and Drug Administration in 1981. Since the early 1990s, the World Health Organization has recommended that all countries add the vaccine to their public immunization plans.
Several types of approved hepatitis B vaccines are available, including one suitable for people of all ages, from infants to adults. The Center for Disease Control recommends that everyone under age 19 get the vaccine, with infants receiving the first dose at birth. The agency also recommends that most adults get the vaccine, especially those who:
- have sexual or common household contact with someone with hepatitis B
- have more than one sexual partner
- have experienced sexual abuse
- are likely to be in contact with blood and bodily fluids at work
- have other liver conditions, including hepatitis C
- are being treated for sexually transmitted diseases, including HIV
The most common version of the vaccine requires three separate doses. There’s also a version that the FDA approved for adults that only requires two doses.
You can get the hepatitis B vaccine at the same time as other vaccines. You’ll never catch hepatitis B from the vaccine.
Combination vaccines also exist that protect against both hepatitis A and B. Once you’re vaccinated against hepatitis B, you should be immune for the rest of your life and won’t need a booster.
Im On Treatment For Hep B Can I Still Get The Covid Vaccine
YES. There is no evidence to suggest that the COVID-19 vaccines have any impact on your hep B treatment. Just like with all other vaccines, the COVID vaccines are safe for people on hep B treatment.
Its really important to always take hep B medication. You should only stop taking it if told to by your specialist.
Vaccines For Hepatitis A And B
Our immune system battles foreign invaders every day, such as when we get a cold virus. When this happens, we develop immunity to that specific virus. This means that our body will fight off the virus if it is ever exposed to it again.
The same protection happens with vaccines. However, the benefit of a vaccination is that you don’t have to go through being sick to enable your body to fight off disease.
Gregory Poland, MD, director of the Mayo Clinic’s Vaccine Research Group, explains that hepatitis vaccinations contain a small amount of the inactive virus. When you get a dose of the vaccine, he says, your immune cells respond by developing immunity against the virus. This immunity lasts over a long period of time.
“So if I get these two doses of hepatitis A vaccine, and then I get exposed 30 years from now, my body will remember that immunity to the vaccine and rapidly start producing antibodies again,” says Poland.
Due to the way hepatitis vaccinations are developed, it is impossible to contract the virus from the vaccine itself, according to Poland.
The hepatitis A vaccine is usually given in two shots and the hepatitis B vaccine is administered as a series of three shots. The most common side effects are redness, pain, and tenderness where the shots are given.
To get long-term protection from these viruses, it’s important to receive all the shots as scheduled. However, if you received one shot and never went back for the others, it’s not too late to catch up.
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About Adenovirus Type 41
With the presence of adenovirus F type 41 reported in many affected children, the virus is currently the medical communitys best clue regarding the source of hepatitis. However, Dr. Kalaskar added:
We are still learning more about what exactly has led to the known cases. Its true that a specific strain of adenovirus has been identified in the majority of cases, but if and how this has possibly triggered the illness is not yet known. More investigation including testing and identification of this virus and other viruses will be needed to help establish a connection, if any.
More than 100 adenoviruses have been identified to date. They are
Who Should Get The Hbv Vaccine
The Centers for Disease Control and Prevention recommends that children should get their first hepatitis B vaccine at birth and complete the doses by 6 to 18 months of age. However, the HBV vaccine is still recommended for all children if they havent already gotten it, from infanthood up to 19 years old. Most U.S. states require a hepatitis B vaccine for school admittance, however.
Its also recommended for adults at an increased risk of catching the HBV infection, or anyone who fears they have or will be exposed to it in the near future.
The HBV vaccine is even safe to administer to pregnant women.
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Hcv Presents Research Challenges
Although research has made great strides, studying HCV is still challenging. This can hamper vaccine development and testing.
Were still trying to get more information on the immune response to HCV. Because some people clear HCV after an acute infection, researchers can study the immune response in these people to find factors important to clearing the virus and apply them to vaccine development.
Despite the knowledge weve gained from this research, only one vaccine has made it to phase 2 clinical trials. More on that later.
Learning more about immunity isnt the only research challenge for HCV vaccine development. Some others include:
- a lack of good laboratory or animal models that can be used to study HCV infection
- a need for established markers that indicate protection from chronic hepatitis C, which can be used to determine vaccine effectiveness in clinical trials
- less research infrastructure where hepatitis C is prevalent, especially in marginalized populations
- a decrease in funding for HCV vaccine research, particularly during the COVID-19 pandemic
Implementing Strategies For Hepatitis B Vaccination
When hepatitis B vaccines became available, strategies for HBV control were initially focused on vaccination of high-risk groups . However, high-risk individuals are mostly difficult to reach and are often infected before vaccination . Consequently, coverage of 3 doses of hepatitis B vaccine remained low in most high-risk groups due to low compliance and logistic reasons . In addition, as many as 30% or more people with acute hepatitis B infection do not have identifiable risk factors and are therefore missed by only a high-risk group approach .
Hence it was clear that an additional global strategy was required as the high-risk strategy made little impact and the global burden of hepatitis B diseases became more and more obvious. Decision makers and health professionals worldwide started to discuss a strategy of universal hepatitis B immunization for a certain age cohort, even in low-endemicity countries. In 1991, the WHOs Global Advisory Group of the Expanded Programme on Immunization recommended that hepatitis B vaccine be integrated into national immunization programs in all countries by 1997 . This 1991 recommendation was endorsed by the World Health Assembly in 1992 . Progressively, it has become more widely used and recommendations for HBV vaccination have been extended in an attempt to achieve maximum protection .
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Chronic Hepatitis Cinfected Patients
Of the 5328 CHC-infected patients identified, 75% were aged 5069 years, 61% were male, and 63% were white. There was documented decompensated cirrhosis in 27% and compensated cirrhosis in 8%. Of the 5328 patients, 2998 had immunity or vaccination against hepatitis A, whereas 659 tested negative and were unvaccinated and 1671 were neither tested for nor vaccinated against hepatitis A infection . Among 3393 unvaccinated participants, 1722 had an anti-HA test, and of these, 1063 were positive. Of the 1935 vaccinated, 1355 received the complete hepatitis A vaccine series of 2 doses.
In univariate analysis , immunity or vaccination against hepatitis A varied between 41% and 58% by 10-year age strata, and those with immunity or vaccination had longer member coverage . Patients with an income of < $30 000 had less immunity or vaccination than those $30 000. Non-Hispanic patients were less likely to be protected than Hispanic patients . Black patients were least likely and Asian patients were most likely to have immunity or vaccination. Patients with compensated cirrhosis also had significantly more immunity or vaccination than those with no documented cirrhosis . After multivariable adjustment, compensated cirrhosis , increased time of member coverage , and increased FIB-4 score were significantly associated with immunity or vaccination.
Who Should Get Hepatitis Vaccinations
Since the vaccines were first developed, the hepatitis A and B vaccines have become part of the regular childhood immunization schedule. They are not considered a routine adult immunization.
“When we’re talking about adults, I would say yes, get the vaccine if they fit into one of these risk factors” says Poland. “If they don’t fit into the risk factors, their risk is so low that there’s no compelling reason to do it.”
People at risk for hepatitis A include:
- Anyone traveling to or working in areas where hepatitis A is more widespread.
- People whose work puts them in potential contact with hepatitis A, such as those who work with the hepatitis A virus in research labs
- People who are treated with clotting-factor concentrates
- People who have chronic liver disease
- People who use recreational drugs, injected or not
- Men who have sex with men
People at risk for hepatitis B include:
- Anyone traveling to or working in areas where hepatitis B is more widespread.
- Health care workers and other people whose job exposes them to human blood
- People with HIV infection, end-stage kidney disease, or chronic liver disease
- People who live with someone with hepatitis B
- People who inject street drugs
- Sexually active people who have had more than one partner
- Anyone who has had an STD
- Men who have sex with men
- Sex partners of people with hepatitis B
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Intrahepatic And Longitudinal Peripheral Immunophenotyping Of Vaccination
Immunophenotype of peripheral and vaccine-elicited CD8 T cells correlates with hepatitis severity. A: t-SNE representation of flow cytometry data comparing non-naïve CD8+ T cells 27 days post boost vaccination in the patients liver and blood . Expression levels of CXCR6, CD69, CD103 and CD38 are indicated . B: Quantified expression levels of CD38, 27 dpb on non-naïve CD8+ T cells within the patients liver and blood compared to time-point matched vaccinees without development of hepatitis. C: Original bivariate plots showing frequencies of spike-specific CD8+ T cells within the CD8+ T cell population at 27dpb, liver and blood . Expression levels of CXCR6, CD69, CD103 and CD38 of spike-specific CD8+ T cells are indicated. D: Longitudinal analysis of calculated ex vivo spike-specific CD8+ T cell frequencies. E: Longitudinal analysis of CD38, F: Granzyme B , G: Tbet+CD38hi CD8+ T cells are shown with time-matched ALT levels depicted in grey with connected dots, circulating non-naïve spike-specific CD8+ T cells and non-naïve bulk CD8+ T cells . Colored background indicates the patients therapy regime .
Hepatitis A And B: Diseases Of The Liver
Hepatitis is an inflammation of the liver, most often caused by a viral infection. There are three common types of hepatitis caused by viruses: hepatitis A, hepatitis B, and hepatitis C. Vaccines have been developed that protect people from contracting hepatitis A and B. There is no vaccine for hepatitis C.
Over the last 20 years, there has been a 90% decrease in cases of hepatitis A and an 80% decrease in hepatitis B cases in the U.S. Health experts believe that immunization efforts have led to this drop in rates of infection.
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Why A Variety Of Hepatitis B Vaccine Schedules Have Been Used
Generally, the recommended number of doses of hepatitis B vaccine required to induce protective immunity varies by product and with the age of the recipient. Historically, the standard 3-dose hepatitis B vaccine series has consisted of 2 priming doses administered 1 month apart and a third dose administered 6 months after the first dose. Today, the WHO recommends multiple options for adding hepatitis B vaccine to existing infant immunization schedules. Several options are considered to be appropriate for infants: 1 birth dose followed by either 2 doses of monovalent or hepatitis B containing combination vaccine at 1 and 6 months of age or at 2, 4, and 6 months of age or at 3, 5, and 11 months of age or at 8, 12, 16 weeks and 12 or 15 months or at 6, 10, and 14 weeks of age, according to the WHOs Expanded Programme on Immunization schedule . Currently, a variety of hepatitis B vaccine schedules have been used successfully worldwide. In general, preference is given to effective options that require minimal additional visits for immunization, to increase compliance and to reduce the logistics burden.
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 .
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Hepatitis C Virus Immunology
The mechanism for how HCV is spontaneously cleared from the body has not been fully elucidated. Early research in chimpanzees has shown that neutralizing antibodies against glycoprotein E2 was associated with viral clearance . Multiple studies demonstrated that rapid development of nAb during the early phases of native infection in humans was also associated with increased ability to clear the virus .
While nAb are important in protecting against acute infection, cell-mediated immunity also appears to play a role. Multiple studies have shown that depletion of both CD4 and CD8 T cells are linked to persistent infection in chimpanzees . Studies in humans also showed that acute HCV infection led to a strong T-cell response . A strong and persistent CD8 T-cell response was consistently observed in those people who achieved spontaneous resolution . Based on these studies, it is clear that a vaccine that can elicit both an nAb and a CMI response would be ideal.
I Have Liver Disease Or Cirrhosis Of The Liver Will This Make Me More At Risk With Covid
If you have cirrhosis of the liver or liver disease, there is no evidence that you are at greater risk of catching COVID-19.
Having cirrhosis of the liver may increase the risk of severe illness if you have COVID-19, but the evidence is limited at the moment.
If you have elevated liver enzymes or abnormal liver function test as a result of liver disease, you may also be at risk of severe illness if you have COVID-19.
For these reasons, its best to take all necessary precautions to keep yourself safe from COVID-19 by following government and medical recommendations.
Everyone with cirrhosis should see their liver specialist regularly. Call and speak to your specialist about what is best for your health.
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Hiv And Hepatitis B And Hepatitis C Coinfection
Hepatitis B and hepatitis C are liver infections caused by a virus. Because these infections can be spread in the same ways as HIV, people with HIV in the United States are often also affected by chronic viral hepatitis.
Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Liver disease, much of which is related to HBV or HCV, is a major cause of non-AIDS-related deaths among people with HIV.
Given the risks of hepatitis B or hepatitis C coinfection to the health of people living with HIV, it is important to understand these risks, take steps to prevent infection, know your status, and, if necessary, get medical care from someone who is experienced in treating people who are coinfected with HIV and HBV, or HIV and HCV.
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.
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Hepatitis C Virus Genome
The HCV genome is roughly 9 kb long with seven known genotypes, and there are at least 67 subtypes of HCV identified . Given this genetic diversity, producing a vaccine that is active against all genotypes and subtypes is a monumental task. Moreover, the HCV NS5B polymerase, the target of drugs such as sofosbuvir, can generate genetically distinct but related species within a single host known as quasispecies . This is largely due to the fact that NS5B does not have a proof-reading mechanism to correct errors in replication . This generation of quasispecies within an individual can select for viral resistance to host immune responses, further hindering development of a broadly reactive vaccine .