Hepatitis B Immunoglobulin Dosage For Adults

The Hepatitis B Vaccine Is Recommended For:

• People who live with someone who has hepatitis B
• People with chronic liver disease or end-stage kidney disease
• Adults ages 1959
• Adults, 60 and older, with or without known risk factors for hepatitis B infection

People who have not completed the vaccine series should contact their primary care provider to discuss the vaccine.

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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 bakerâs yeast

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 dont 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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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

A Look At Each Vaccine: Hepatitis B Vaccine

View larger image 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. The vaccine is also recommended for those up to 60 years of age who have not previously received it and those 60 years and older who are at increased risk or who simply want the protection afforded by vaccination.

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What Is Hepatitis B

Hepatitis B is a virus that attacks the liver. It can cause serious disease including permanent liver damage, also known as cirrhosis. Hepatitis B is also one of the main causes of liver cancer, which can be fatal. Hepatitis B virus is spread from one infected person to another by contact with blood or body fluids. After the virus enters your body, it usually takes 2 to 3 months to develop symptoms or signs of illness.

Symptoms of hepatitis B may include fatigue, fever, nausea and vomiting, loss of appetite, abdominal pain, dark urine, pale stools and jaundice . Many people who get hepatitis B show no symptoms and may not know they have the disease. Whether there are signs of illness or not, you can pass the virus on to others.

Persons With Inadequate Immunization Records

Evidence of long term protection against HB has only been demonstrated in individuals who have been vaccinated according to a recommended immunization schedule. Independent of their anti-HBs titres, children and adults lacking adequate documentation of immunization should be considered susceptible and started on an immunization schedule appropriate for their age and risk factors. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information.

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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.

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:

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Why Is The Hepb Vaccine Recommended

People who dont know theyâre infected can spread the hepatitis B virus. So it cant be avoided just by being careful. Thatâs why health experts recommend that all babies get the vaccine right from birth.

The HepB injection usually creates long-term immunity. Most infants who get the HepB series are protected from hepatitis B infection beyond childhood, into their adult years.

Eliminating the risk of infection also decreases risk for cirrhosis of the liver, chronic liver disease, and liver cancer.

Other Reported Adverse Events And Conditions

While serious events and chronic illnesses such as chronic fatigue syndrome, multiple sclerosis, Guillain-Barré syndrome, rheumatoid arthritis and sudden infant death syndrome have been alleged or reported following HB vaccination, no evidence of a causal association has been demonstrated in a number of studies.

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Is Hepatitis B Immune Globulin Safe

Yes. HBIg is prepared from donated human blood that has been tested to ensure its safety. All blood donors are screened for exposure to viruses such as HIV and hepatitis. Each blood donation is also tested for the presence of blood-borne viruses prior to being used to make HBIg. A number of chemical and physical steps are included when preparing HBIg to inactivate and remove viruses and bacteria that can cause disease. The final preparation of HBIg undergoes additional testing to ensure that there are no known infectious viruses present. However, there is an extremely small risk that some blood-borne infections could be passed on through the use of HBIg. Since blood screening and testing began, there have been no reports of blood-borne infections such as HIV, hepatitis B or hepatitis C in people who received HBIg.

Who Should Receive The Hepatitis B Vaccine

Vaccination is the most reliable way to prevent getting hepatitis B or developing serious related medical complications.

The CDCs Advisory Committee on Immunization Practices recommends that people in all age groups get the hepatitis B vaccine, including:

• All infants within 24 hours after birth
• Children and teens who have not previously been vaccinated against hepatitis B
• Adults ages 19 to 59
• Adults ages 60 and older with at least one risk factor for hepatitis B

Adults over 60 who are not at risk of developing hepatitis B can also receive the HepB vaccine if they choose.

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Accelerated 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.

In some instances, it may be necessary to vaccinate within a short period of time to ensure protection before travel. There are accelerated schedules to provide the highest level of protection over a short period of time. Individuals who need an accelerated schedule must have a booster dose at 1 year to ensure long-term protection. Note that the 2-dose Heplisav-B vaccine will also ensure maximum protection over a 1-month period without the need for a booster dose at 1 year.

4-Dose Vaccine Series for Children and Adults

Engerix-B is a 3-dose vaccine that can be given on an accelerated, four-dose schedule, with 3 shots administered within 2 months, and a booster dose at 1 year to provide maximum long-term protection.

4-Dose Combination Hepatitis A and B Vaccine Series

Twinrix is a 4-dose vaccine that can be given on an accelerated schedule to provide protection against hepatitis A and B. Three doses are administered within 1 month, followed by a booster shot at 1 year. This is a common choice of vaccine for those travelling on short-notice outside the U.S. It is important to complete the booster dose at 1 year, to ensure long-term protection.

2-Dose Vaccine Series

Additional Resource Links:

• Hepatitis B Vaccine Q& A

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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Immunisation Against Hepatitis B

The current Australian immunisation program provides free hepatitis B vaccine to protect all children against the hepatitis B virus.

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 of age, as a combination vaccine.

Vaccination 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 but not limited to Aboriginal and Torres Strait Islander peoples, 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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Who Should Not Get Hepatitis B Immune Globulin

Speak with your health care provider if you have:

• had a life-threatening reaction to a previous dose of any immune globulin or any of its components
• a condition called isolated immunoglobulin A deficiency
• a history of thrombosis or risk factors for thrombosis or
• been immunized against measles, mumps, rubella or chickenpox within the past 14 days.

There is no need to delay getting immunized because of a cold or other mild illness. However, if you have concerns speak with your health care provider.

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For Adults At High Risk Of Exposure

Adults who have not received the hepatitis B vaccine series should be immunized when they have an increased risk of exposure. Job, travel, health condition, or lifestyle all may increase a persons risk of contracting hepatitis B.

People who live or work where there is risk of exposure include:

• Health care and public safety workers who are likely to be exposed to blood or blood products.
• Clients and staff of institutions or residential settings with known or potential HBV carriers.
• People planning extended travel to China, Southeast Asia, Africa, and other areas where hepatitis B infection is high.

People who have health conditions that put them at high risk for exposure or a severe infection include:

• People who have a severe kidney disease that requires them to have their blood filtered through a machine .
• People who have chronic liver disease.
• People who have hemophilia and other conditions in which they need to have blood products on an ongoing basis.
• People who had a stem cell transplant.

People whose lifestyle puts them at high risk for exposure include:

• People who inject illegal drugs.
• Men who have sex with men.
• People who have had more than one sex partner in the past 6 months or who have a history of sexually transmitted infection.
• Household contacts and sex partners of hepatitis B carriers.
• Prison inmates.

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.

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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:

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

* 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.

Note:

• 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

Combination Vaccines:

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Common And Local Adverse Events

HB vaccine

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.

HAHB vaccine

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.

DTaP-HB-IPV-Hib vaccine

Reactions are usually mild and transient, and include fever, irritability, restlessness and injection site reactions .

HBIg

Headache, diarrhea, fever, urticaria, angioedema and injection site reactions may occur.

Screen For Contraindications And Precautions

• Do not administer Heplisav-B to individuals with a history of severe allergic reaction after a previous dose of any hepatitis B vaccine or to any component of Heplisav-B, including yeast.
• Consult the package insert for precautions, warnings, and contraindications and Hepatitis B Vaccine Safety for additional information and possible side effects.

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How Do You Catch Hepatitis B Virus

Blood from a person infected with hepatitis B virus is heavily contaminated with the virus. As a result, contact with blood is the most likely way to catch hepatitis B. Even casual contact with the blood of someone who is infected can cause infection.

Healthcare workers are at high risk of catching the disease, as are intravenous drug users and newborns of mothers infected with the virus. Sexual contact can also expose people to infection. The virus is also present in low levels in saliva.