Which Adults Should Be Vaccinated Against Hepatitis B
According to CDC recommendations, adults in the following groups are recommended to receive hepatitis B vaccine:
General
- All people age 18 years and younger.
- Anyone 19 years and older who wants to be protected from hepatitis B.
People at risk for infection by sexual exposure
- Sex partners of people who are hepatitis B surface antigen -positive.
- Sexually active people who are not in long-term, mutually monogamous relationships.
- People seeking evaluation or treatment for a sexually transmitted disease.
- Men who have sex with men.
People at risk for infection by percutaneous or permucosal exposure to blood or body fluids
- Current or recent illegal injection drug users.
- Household contacts of people who are HBsAg-positive.
- Residents and staff of facilities for developmentally challenged people.
- Healthcare and public safety workers with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids.
- People with end-stage renal disease, including predialysis, hemo-, peritoneal- and home-dialysis patients.
Others
- International travelers to regions with intermediate or high levels of endemic HBV infection.
- People with chronic liver disease.
- People with HIV infection.
- People with diabetes who are age 19 through 59 years. For those age 60 and older, clinicians should make a determination of need for
- vaccination based on their patients’ situation.
In a future issue, we will review the various hepatitis B serologic tests, who needs testing, and when they need it .
Why Do You Need A Hepatitis B Shot
Hepatitis B is a viral infection that cant be transferred person-to-person unless you have contact with an infected persons bodily fluids. Annual infection rates of HBV are going down in the United States thanks to vaccines. So you might be wondering if you or your child needs a shot to protect against hepatitis B.
Why Is The Hepatitis B Vaccine Important
Because of the vaccine, cases of acute hepatitis B have decreased by a lot in the United States. But chronic hepatitis B is still common up to 2.2 million people in the United States have it. Chronic hepatitis B can lead to serious liver problems and even death.
Getting vaccinated is the best way to prevent hepatitis B.
Hepatitis B is a liver disease caused by a virus. There are 2 types of hepatitis B:
- Acute hepatitis B
- Chronic hepatitis B
Many children who get acute hepatitis B dont have any symptoms, but most adults do. Symptoms may include:
- Dark pee or clay-colored poop
- Pain in the muscles, joints, and stomach
Acute hepatitis B symptoms usually last a few weeks but they can last as long as 6 months.
If the acute hepatitis B infection does not go away after 6 months, its considered a chronic hepatitis B infection. Most people who have chronic hepatitis B dont have symptoms at first. But chronic hepatitis B is a lifelong illness that can lead to serious and possibly deadly liver problems, like:
- Has sex with a person who has hepatitis B
- Touches the blood or open sores of a person who has hepatitis B
All children and most adults need to get the hepatitis B vaccine.
Infants and children
All children need to get the hepatitis B vaccine as part of their routine vaccine schedule.
Children need 3 doses of the vaccine at the following ages:
- Birth for the first dose
- 1 through 2 months for the second dose
- 6 through 18 months for the third dose
Adults
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Hepatitis B Vaccine On The Nhs
A hepatitis B-containing vaccine is provided for all babies born in the UK on or after 1 August 2017. This is given as part of the 6-in-1 vaccine.
Hospitals, GP surgeries and sexual health or GUM clinics usually provide the hepatitis B vaccination free of charge for anyone at risk of infection.
GPs are not obliged to provide the hepatitis B vaccine on the NHS if you’re not thought to be at risk.
GPs may charge for the hepatitis B vaccine if you want it as a travel vaccine, or they may refer you to a travel clinic for a private vaccination. The current cost of the vaccine is around £50 a dose.
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.
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For Adults And Children
This vaccine schedule involves three doses within 2 months, followed by a booster dose at 1 year.
The initial accelerated doses provide immediate protection from HBV, and the booster dose helps provide long-term protection.
Below is the accelerated vaccination schedule approved for both adults and children:
| Vaccine series | |
|---|---|
| 2 months after the first dose | 1 year after the first dose |
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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Silent Infections In Hbsag Negative Babies
The six subjects who remained positive for anti-HBc during the follow up were considered to have been infected at birth or during infancy, although the exact time of infection could not be assessed from these results. For the 231 neonates who did become anti-HBc negative during the study, anti-HBc reappeared in 14 blood samples among 6.1% of subjects . Therefore, when considering the number of subjects who were either continuously anti-HBc positive or who had reappearance of anti-HBc, 20 silent infections occurred during the follow up. Five of the 14 anti-HBc reappearances were without a simultaneous anti-HBs rise : one child in group 1 B was positive at months 60 and 61 one child in group 1 NB was positive at months 60, 84, and 96 another in group 2 NB was positive at months 24, 36, 48 and then lost to follow up and the remaining two children were positive at months 36, 60, and subsequently lost to follow up . In the five blood samples from five neonates before the reappearance of anti-HBc, 60% had anti-HBs titres below 100 mU/ml, with a GMT of 75 mU/ml. In the nine neonates who had an anti-HBc reappearance also accompanied by an anti-HBs rise , 78% had anti-HBs titres < 100 mU/ml with a GMT of 36 mU/ml.
Vaccinated neonates experiencing permanent anti-HBc re-emergence without an accompanying rise in anti-HBs
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.
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Hepatitis B Vaccine: Canadian Immunization Guide
For health professionals
Last partial content update : May 2022
The footnotes in and the accompanying text description for the figure have been revised to align with the corresponding figure in Protocole d’immunisation du Québec, 5e édition from which it was adapted.
Last complete chapter revision :
Us Infant 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 Infants
Since 1991, ALL medically stable infants with a birth weight of at least 2,000 g in the U.S. are recommended to receive the first dose of hepatitis B vaccine within 24 hours of birth. The additional 2 doses are given at 1 month and 6 months of age.
4-Dose Vaccine Combination Series for Infants
Combination vaccines, such as the pentavalent and hexavalent vaccines, include protection against 5 or 6 diseases, including hepatitis B. The first shot is usually given at 6 weeks of age, but in order to protect infants from hepatitis B beginning at birth, a monovalent or single dose of the hepatitis B vaccine is also recommended within 24 hours of birth. The hepatitis B vaccine series can then be completed with the pentavalent or hexavalent vaccine with the recommended schedule.
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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.
A Note About Sex And Gender
Sex and gender exist on spectrums. This article will use the terms male, female, or both to refer to sex assigned at birth. .
It is important that infants who are born to females with hepatitis B receive accurate doses of the hepatitis B vaccine. They may also be required to receive hepatitis B immunoglobulin if it is available.
The WHO also recommends using antiviral prophylaxis to help prevent hepatitis B transmission.
The table below outlines the two recommended hepatitis B vaccine schedules for infants born to those who have hepatitis B:
| Vaccine series |
|---|
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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
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.
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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.
How And When Do Doctors Give Vaccines
For the hepatitis A vaccine:
You should get two doses, given as shots, 6 months apart for complete protection. The virus in the vaccine is killed .
Children should get the first dose between 12 and 23 months of age. Children older than age 2 can get the first dose at their next doctorâs visit.
If you need the vaccine because of upcoming travel, get it at least 1 month before you go.
For the hepatitis B vaccine:
For long-lasting immunity, you need three to four doses, depending on which type of vaccine is used. You get them as shots.
Children should get their first dose at birth and complete the series by age 6 months. Usually, the baby would get a second dose at 1 month old and the third dose at 6 months.
Babies born to women who have hepatitis B need a shot of hep B antibodies, as well as their first hep B vaccine shot, when theyâre born. They will also need follow-up blood tests to make sure theyâre OK.
Catch-up vaccinations are recommended for children and teens who were never vaccinated or who did not get all three shots.
If you’re an adult who wants to be vaccinated, you should talk about it with your doctor or pharmacist. If you are considering both vaccines, ask your doctor about vaccines that combine hep A and B.
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What Is Hepatitis B
Hepatitis B is a contagious liver disease caused by the hepatitis B virus. When a person is first infected with the virus, he or she can develop an acute infection. Acute hepatitis B refers to the first 6 months after someone is infected with the hepatitis B virus. This infection can range from a very mild illness with few or no symptoms to a serious condition requiring hospitalization. Some people are able to fight the infection and clear the virus.
For others, the infection remains and is chronic, or lifelong. Chronic hepatitis B refers to the infection when it remains active instead of getting better after 6 months. Over time, the infection can cause serious health problems, and even liver cancer.
Who Should Get The Hepatitis B Vaccine
The CDC recommends it for all babies, who should get their first dose as newborns.
Other people who need it include:
- People younger than age 19 who haven’t been vaccinated
- Anyone who has a sex partner with hepatitis B
- People who are sexually active but arenât in a long-term relationship in which both partners are monogamous
- Anyone being evaluated or treated for an STD
- Men who have sex with men
- People who share needles used to inject drugs
- Anyone who lives with someone who has hep B
- Anyone whose job routinely puts them at risk for coming in contact with blood or blood-contaminated body fluids
- People with end-stage kidney disease
- People who live and work in facilities for people who are developmentally disabled
- Travelers to regions with moderate to high rates of hepatitis B
- People with chronic liver disease
- People with HIV infections
You should not get the vaccine if you had a severe allergic reaction to an earlier dose or are allergic to yeast, because yeast is used to make the vaccine.
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Results And Next Steps
The results of a hepatitis B titer panel can help a doctor determine a persons hepatitis B status. The results can be confusing if a person has never been through this type of testing before, but the doctor can explain the findings.
The results for the titer come back as either negative or positive on each subtest of the panel. Positive means that the virus or antibodies showed up on the test, while negative means that they did not.
The following table outlines what positive and negative results mean on different parts of the test and the possible next steps.
The information comes from the Immunization Action Coalition:
| Test |
|---|
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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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