What If A Dose Was Given Too Early
A dose can be counted as valid as long as the minimum intervals are met, as described above for hepatitis B vaccine. Keep in mind the additional guidance that an infant should not receive the last dose in the series earlier than 24 weeks of age. In general, CDC allows a four-day “grace period” for vaccines, i.e., vaccine doses administered up to four days before the minimum interval or age can be counted as valid. If a dose was administered five or more days earlier than the recommended minimum interval between doses, it is not valid and should be repeated. The repeat dose should be spaced after the invalid dose by an interval at least equal to the recommended minimum interval.
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.
Immunisation Against Hepatitis B
The current Australia-wide immunisation program is necessary to protect all children from hepatitis B infection.
A full course of hepatitis B injections must be given for a child to be protected. It is recommended that this course begins within 24 hours of birth with a vaccine against hepatitis B alone. Further doses are routinely given at 2 months, 4 months and 6 months, as a combination vaccine.
Immunisation is the best protection against hepatitis B infection. In Victoria a free hepatitis B vaccine is available for a number of groups at high risk, including men who have sex with men, and people living with HIV.
The adult course involves 3 doses of the vaccine over 6 months and gives protection to about 95 per cent of people. Once you have had the 3 doses, you can have a blood test to see if you are protected.
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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.
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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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 .
Burden Of Chronic Hepatitis B In Australia
Chronic infection and its sequelae, including cirrhosis and hepatocellular carcinoma, contribute to most of the hepatitis B disease burden in Australia. The burden from chronic disease has been increasing with the increasing number of immigrants from regions of high hepatitis B prevalence.62
First-generation immigrants from countries of high hepatitis B endemicity usually retain the prevalence of chronic hepatitis B virus infection of the country they are from. Migrants born in Asian, Pacific islands, North African, Middle Eastern and Mediterranean countries have a significantly higher prevalence of chronic hepatitis B virus infection than the Australian-born population.62
Other population groups with higher prevalence of hepatitis B virus infection include:63,64
- Aboriginal and Torres Strait Islander people
- people with HIV
- people who injected drugs between 1980 and 1990
- household contacts of someone diagnosed with hepatitis between 1980 and 1990
Notification of chronic hepatitis B virus infection depends on hepatitis B testing and reporting. Many people with chronic hepatitis B virus infection remain undiagnosed. Mathematical modelling suggests that, in Australia in 2015:64
- about 230,000 people were living with hepatitis B virus infection
- about 419 deaths were due to hepatitis B virus infection
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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.
Side Effects Of Hepatitis B Vaccines
Immunisations containing components to protect against hepatitis B are effective and safe, although all medication can have unwanted side effects.
Side effects from the vaccine are uncommon and usually mild, but may include:
- Localised pain, redness and swelling at the injection site.
- Low-grade temperature .
- In children being unsettled, irritable, tearful, generally unhappy, drowsy and tired.
- Occasionally, an injection-site lump that may last many weeks, but for which treatment is not needed.
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Prevalence Of Chronic Hepatitis B
The prevalence of chronic hepatitis B virus infection varies between and within countries:58-61
- < 0.5% among Caucasians in the United States, northern Europe and Australia
- 15% in Mediterranean countries, parts of eastern Europe, Africa, and Central and South America
- > 10% in many sub-Saharan African, East and Southeast Asian, and Pacific island populations
Regions where 2% of the population is positive to hepatitis B surface antigen are considered to have moderate to high prevalence. In these regions, people mainly acquire the infection perinatally or in early childhood.55
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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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.
Infants Are Recommended To Receive 4 Doses Of Hepatitis B Vaccine
Infants are recommended to receive 4 doses of hepatitis B vaccine:
- 1 dose of monovalent paediatric formulation hepatitis B vaccine at birth
- 3 doses of a paediatric hepatitis Bcontaining vaccine at 2, 4 and 6 months of age .
Infants can receive the dose scheduled at 2 months of age as early as 6 weeks of age. They should still receive their next scheduled doses at 4 months and 6 months of age.
Rationale for the birth dose
The rationale for the birth dose for all newborn infants is to prevent:1
- vertical transmission from a mother with chronic hepatitis B, recognising that there may be errors or delays in maternal testing, reporting, communication or appropriate response
- horizontal transmission to the infant in the first months of life from people with chronic hepatitis B who are household or other close contacts
Newborns should receive the birth dose as soon as they are medically stable, and preferably within 24 hours of birth, but the vaccine can be given within the first 7 days of life. Every effort should be made to give the vaccine before the baby is discharged from the obstetric hospital or delivery unit.
Alternative infant schedules
Although it is not routinely recommended in Australia, infants or toddlers who have received a 3-dose schedule of hepatitis B vaccine , with doses at birth, 12 months of age and 6 months of age, can also be considered fully vaccinated.
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Infants Born To Mothers Who Have Hepatitis B: 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.
Protecting Your Baby
Infants born to women with hepatitis B must receive accurate doses of hepatitis B vaccine and hepatitis B immune globulin to ensure complete protection. In order to protect these infants, medications should be given immediately after birth in the delivery room or within the first 12-24 hours of life*.
* See Testing and Treatment During Pregnancy section for details. Please note that testing of all pregnant women for hepatitis B is a global recommendation.
3-Dose Vaccine Series for Infants
The World Health Organization recommends that infants born to hepatitis B positive mothers receive the first dose of the hepatitis B vaccine within 24 hours of birth, and ideally a dose of hepatitis B immunoglobulin . These shots must be followed by the additional vaccine doses given on the recommended schedule. In the U.S., infants should follow a 1 month and 6-month schedule for the additional two doses.
4-Dose Combination Vaccine Series for Infants
What Is The Nip Schedule
The National Immunisation Program Schedule is a series of immunisations given at specific times throughout your life. The immunisations range from birth through to adulthood.
All vaccines listed in the NIP Schedule are free. Eligibility for free vaccines under the NIP is linked to eligibility for Medicare benefits.
To get the best possible protection, make sure you have your immunisations on time, every time. The NIP Schedule below shows which vaccines you should get and when.
This schedule card provides recommended vaccines and schedule points under the National Immunisation Program from 1 July 2020 .
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A Look At Each Vaccine: Hepatitis B Vaccine
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.
Interchangeability Of Hepatitis B Vaccines
The Engerix-B and H-B-Vax II vaccines are manufactured by different processes, and the hepatitis B surface antigen content of an equivalent dose of these vaccines is different. Switching vaccine brands is not recommended.
If the brand of vaccine used for previous doses is not known, use another age-appropriate equivalent dose brand. See:
For example, a study in healthy neonates showed comparable high levels of immunogenicity between 2 different mixed regimens that used 2 monovalent hepatitis B vaccines from different manufacturers.33
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When To Delay Or Avoid Hepb Immunization
Doctors delay giving the vaccine to babies who weigh less than 4 pounds, 7 ounces at birth whose mothers do not have the virus in their blood. The baby will get the first dose at 1 month of age or when the baby is discharged from the hospital.
The vaccine is not recommended if your child:
- is currently sick, although simple colds or other minor illnesses should not prevent immunization
- had a serious allergic reaction after an earlier dose of the vaccine or is allergic to baker’s yeast
Hepatitis B Vaccine Schedules
The newborn hepatitis vaccine is part of a three-dose series that begins at the hospital after birth and continues with pediatrician visits.
When it comes to vaccinating newborns, there are two schedules that can be followedone for babies of moms who have hepatitis B and one for babies where it is unknown or the mother had a negative hepatitis B blood test. The CDC, however, recommends the following vaccination schedule for all children.
| CDC Hepatitis B Vaccine Schedule | |
|---|---|
| Dose | |
| 1 to 2 months of age | |
| Third Dose | 6 to 18 months of age |
The Hepatitis B Foundation recommends the following vaccination schedule for moms who have hepatitis B and their newborns. They stress that babies with moms who test positive for hepatitis B receive the vaccine as well as 0.5 milliliters of hepatitis B immune globulin .
Here is an overview of the schedules they recommend when moms test positive for hepatitis B. One schedule is similar to the CDC’s schedule and the other uses combination vaccines. Talk to your baby’s pediatrician to determine what schedule they plan to follow.
| Hepatitis B Foundation Three-Dose Schedule |
|---|
| Dose |
| 14 weeks of age | |
| Fourth Dose | 24 weeks of age |
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Concerns About Immunisation Side Effects
If the side effect following immunisation is unexpected, persistent or severe, or if you are worried about yourself or your child’s condition after a vaccination, see your doctor or immunisation nurse as soon as possible or go directly to a hospital.
It is important to seek medical advice if you are unwell, as this may be due to other illness, rather than because of the vaccination.
Immunisation side effects may be reported to SAEFVIC, the Victorian vaccine safety and reporting service. Discuss with your immunisation provider how to report adverse events in other states or territories.
What About Simply Testing For Immunity With A Hepatitis B Surface Antibody Blood Test After One Or Two Doses
CDC does not recommend routine testing of children and teens who are vaccinated against hepatitis B.
If a child/teen who has had only one or two documented doses of hepatitis B vaccine is tested and found to be immune by anti-HBs serology, CDC still recommends that the child/teen receive three doses in order to assure long-term protection.
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Eligible Adults Aged 18 Years And Older
|
0, 1 and 6 months |
Adult dialysis or adult liver or kidney transplant patients
These adults may have a reduced response to HepB, so three higher doses are recommended and funded.
See section 9.5.7 for information about post-vaccination serology.
Adult HIV patients
Adult HIV patients should receive four doses of HepB at 0, 1, 2 and 12 months.
Other eligible adults
The optimal dosing regime is three doses of 20 µg HepB given at 0, 1 and 6 months. See the manufacturers data sheet for sub-optimal accelerated HepB schedules if dosing is time constrained. For other eligible adults, see Table 4.8, Other special groups in section 4.6.
Babies And Children Can Develop Chronic Hbv
You may be wondering why the recommendations for the HBV vaccine start on the first day of life.
Adults who contract HBV will likely not experience long-term complications from hepatitis B. But the same is not the case for babies. As many as of babies who contract an HBV infection at birth from their mothers become chronically infected with HBV.
Children between the ages of 1 and 5 who get an HBV infection have a 25 percent of people who become chronically infected during childhood will develop liver cancer or cirrhosis. Thats why pediatricians want children to have immunity from HBV from the earliest possible age. Many babies and children exposed to HBV receive post-exposure prophylaxis, which decreases chance of infection.
If youre pregnant, youll most likely have a blood test to see if youre positive for hepatitis B. This allows doctors to find out if theres a chance that you could pass on the virus. These tests are highly sensitive and have a good accuracy rate, but they arent perfect. Additionally, a pregnant person may become infected between the time of the test and giving birth. The first dose of the vaccine given at birth lowers the risk of a newborn baby contracting hepatitis B.
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