Hepatitis B Shots For Adults

Recommended Adult Dosing Volume Of Monovalent Hepatitis B Vaccine

• Age 19 years and younger: Use 0.5 mL per dose .
• Age 20 years and older: 1.0 mL per dose .

For a one-page sheet reviewing the hepatitis B dosing schedule for children and adults, consult IACs Hepatitis A and B Vaccines: Be Sure Your Patients Get the Correct Dose. For complete dosing information, consult the ACIP hepatitis B vaccine recommendations for adults.

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.

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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Origin Of Antiviral Resistance

The genetic makeup of viruses is constantly changing, which can cause a virus to become resistant to currently available treatments. Viruses can become resistant through spontaneous or intermittent mechanisms throughout the course of an antiviral treatment. Immunocompromised patients, more often than immunocompetent patients, hospitalized with are at the highest risk of developing oseltamivir resistance during treatment. Subsequent to exposure to someone else with the flu, those who received oseltamivir for “post-exposure prophylaxis” are also at higher risk of resistance.

Multiple strains of one virus can be present in the body at one time, and some of these strains may contain mutations that cause antiviral resistance. This effect, called the , results in immense variation in any given sample of virus, and gives the opportunity for natural selection to favor viral strains with the highest fitness every time the virus is spread to a new host. Also, recombination, the joining of two different viral variants, and , the swapping of viral gene segments among viruses in the same cell, play a role in resistance, especially in influenza.

Antiviral resistance has been reported in antivirals for herpes, HIV, hepatitis B and C, and influenza, but antiviral resistance is a possibility for all viruses. Mechanisms of antiviral resistance vary between virus types.

What Are Warnings And Precautions For Hepatitis B Vaccine

Warnings

This medication contains the hepatitis b vaccine. Do not take Engerix B or Recombivax HB if you are allergic to the hepatitis b vaccine or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• See “What Are Side Effects Associated with Using Hepatitis B Vaccine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Hepatitis B Vaccine?”

Cautions

• Not protective against hepatitis A, C, or E
• Gluteal muscle injection is not recommended
• Heptavax B is no longer used in the US

Pregnancy and Lactation

• Use the hepatitis B vaccine during pregnancy with caution if the benefits outweigh the risks. Animal studies show risk and human studies are not available, or neither animal nor human studies were done.
• It is not known if the hepatitis B vaccine is excreted in breast milk. Consult your doctor before breastfeeding.

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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 bakers yeast

Why Is The Hepb Vaccine Recommended

People who dont know they’re infected can spread the hepatitis B virus. So it cant be avoided just by being careful. That’s 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.

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How Common Is Hepatitis B

One U.S. study following trends in hepatitis B infection over a three-year periodfound that 4.3% of the population had a past or present HBV infection.

Estimates suggest that about 240 million people around the world have chronic hepatitis B. Up to 1.89 million people in the United States have a chronic HBV infection.

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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Many People With Hbv Dont Know They Have It

HBV infections are becoming less common in the United States. But HBV is still widespread in other parts of the world. Around 257 million people living around the world currently have HBV, and many of them dont know it. Chronic HBV is often asymptomatic, and even when it isnt, it can take months for symptoms to show up.

HBV can be transmitted through sexual contact and the use of IV drugs , and other risk factors. Although rare, there

Safety Of Hepatitis Vaccines

Hepatitis vaccines have been given to millions of people all across the world without any evidence of serious side effects. “They’re very safe, and they’re extremely effective,” says Poland.

If you are not sure whether you should have hepatitis vaccines, talk with your doctor about your specific concerns.

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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 :

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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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.

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.

Theres no evidence of any risk from vaccinating pregnant or breastfeeding women against hepatitis B.

And, as its an inactivated vaccine, the risk to the unborn baby is likely to be negligible .

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The Hepatitis B Vaccine Is The Best Way To Prevent Getting The Virus Other Ways To Reduce Infection Risk Include:

• Ask about the hepatitis B status of any sexual partner. Use a new latex or polyurethane condom if the partner’s health status is unknown. Condoms reduce the risk of contracting hepatitis B, but don’t eliminate the risk.
• Don’t use illegal drugs and never share needles.
• Be cautious about body piercing and tattooing. Ask how the equipment is cleaned, and ensure sterile needles are used.
• Ask about the hepatitis B vaccine before traveling. When visiting a region with high rates of hepatitis B, talk to a travel medicine specialist about the vaccine at least six months before traveling.

Victoria Louwagie is a physician assistant in Gastroenterology, and Jessica Sheehy is a physician assistant in Infectious Diseases, both in Mankato, Minnesota.

For the safety of our patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a non-patient care area where social distancing and other safety protocols were followed.

Topics in this Post

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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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.

What Does Syphilis Unspecified Mean

What is the diagnosis code for syphilis?

ICD-10-CM Code for Syphilis, unspecified A53. 9.

What is the Medicare administration code for hepatitis A vaccine?

Limitations

Why do I need hep 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.

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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.

How Is This Vaccine Given

This vaccine is given as an injection into a muscle. A healthcare provider will give you this injection.

The hepatitis B vaccine is given in a series of 2 to 4 shots. The booster shots are sometimes given 1 month and 6 months after the first shot. If you have a high risk of hepatitis B infection, you may be given an additional booster 1 to 2 months after the third shot.

Your individual booster schedule may be different from these guidelines. Follow your doctor’s instructions or the schedule recommended by the health department of the state you live in.

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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.