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.
Hepatitis B Vaccine Side Effects
Most people only experience mild, short-term side effects from the hepatitis B vaccine. Common side effects include:
- Pain, redness, or swelling at the site of injection
Severe allergic reactions to the hepatitis B vaccine are very rare. If you have symptoms of an allergic reaction shortly after getting the HepB vaccinesuch as difficulty breathing, facial swelling, or hivesseek medical help immediately.
The hepatitis B vaccine is safe and effective for most people. However, there are certain people who should not get the HepB vaccine, including:
- People who are moderately or severely ill at the time of vaccination
- People who have had a severe allergic reaction to yeast
- People who have had a severe allergic reaction to a hepatitis B vaccine in the past
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
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Active Vaccination To Prevent Infection
Hepatitis B vaccination is available for preexposure and postexposure prophylaxis and provides long-term protection. Hepatitis B vaccines are produced recombinantly in yeast cell systems. The vaccines contain noninfectious HBsAg , a small amount of yeast protein, and aluminum hydroxide as an adjuvant. Pediatric formulations contain trace or no thimerosal. Administration is via the intramuscular route. Adverse effects are generally mild and mainly consist of local tenderness and low-grade fever. After a vaccine series, more than 95% seroconversion is achieved, which results in > 90% efficacy. Studies are ongoing to determine length of immunity, but it is at least 20 years.
Two hepatitis B single antigen vaccines are available in the United States: Recombivax from Merck & Co. and Engerix-B from GlaxoSmithKline. Both vaccines come in doses for pediatric and adult populations. High-dose vaccines are available for adult hemodialysis and immunocompromised patients. Both vaccines are given in a three-dose series and are generally interchangeable. A fourth dose may be given if a birth dose was administered. The birth dose must be a single antigen formulation.
Booster doses of hepatitis B vaccine beyond the initial series are generally not recommended. The long incubation period of hepatitis B theoretically allows for the development of a protective anamnestic immune response after exposure.
Fabrizio Fabrizi MD, … Paul Martin MD, in, 2017
The Hepatitis B Vaccine And Immunosuppressants
If you are taking or about to start taking a medication that suppresses your immune response, let your healthcare provider know. Immunosuppressants may make certain vaccines less effective. Your healthcare provider may recommend that you get the hepatitis B vaccine at a particular time during your course of medication.
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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.
Are Hepatitis B Virus Infections Easily Avoided
Large quantities of hepatitis B virus are present in the blood of people with hepatitis B in fact, as many as one billion infectious viruses can be found in a milliliter of blood from an infected individual. Therefore, hepatitis B virus is transmitted in the blood of infected individuals during activities that could result in exposure to blood, such as intravenous drug use, tattooing, or sex with people who are infected. However, it is also possible to catch hepatitis B virus through more casual contact, such as sharing washcloths, toothbrushes or razors. In each of these cases, unseen amounts of blood can contain enough viral particles to cause infection. In addition, because many people who are infected don’t know that they are infected, it is very hard to avoid the chance of getting infected with hepatitis B virus.
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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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Hepatitis B Vaccination Schedule For Children And Infants
The Centers for Disease Control and Prevention recommends that babies and children receive three 0.5 milliliter doses of either Engerix-B or Recombivax HB, starting just after birth.
The current recommended hepatitis B vaccine schedule for children and infants is as follows:
|Hepatitis B Vaccination Schedule for Infants and Children
|Hepatitis B Vaccine Dose
|618 months old
If your child is undergoing hemodialysis, your healthcare provider may recommend that they receive additional doses of the HBV vaccine.
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Why It Is Used
Hepatitis B virus causes a liver infection that can lead to serious complications, including liver cancer. It is common in people throughout the world, particularly in Asia and sub-Saharan Africa.
The Canadian National Advisory Committee on Immunization recommends hepatitis B immunization for all children. Pregnant women and other adults who do not have immunity and who have a high chance of exposure should be vaccinated.
How Do I Know That I Am Protected Against Hepatitis B
If you have never been tested for hepatitis B, your doctor can arrange a blood test to check your hepatitis B status before you are given the vaccination course. The prescreening blood test will check you have not already had exposure to the hepatitis B virus.
If you have had a full course of hepatitis B vaccination in the past then there is a good chance that you are protected now. Also, if you have had hepatitis B before and cleared the infection you are immune to hepatitis B.
After vaccination, a post vaccination blood test is available to check that the vaccine has been effective. Your doctor can order this test for you. This blood test is not routinely recommended for children as the hepatitis B vaccine is highly effective.
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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:
Does The Hepatitis B Vaccine Have Side Effects
Some children will develop pain or soreness in the local area of the shot, and low-grade fever.
There is one extremely rare, but serious, side effect. About 1 out of every 600,000 doses of the hepatitis B vaccine will cause a severe allergic reaction, called anaphylaxis, with symptoms including swelling of the mouth, difficulty breathing, low blood pressure or shock. Anaphylaxis usually occurs within 15 minutes of receiving the vaccine. Although anaphylaxis can be treated, it is quite frightening. People should remain at the doctors office for about 15 minutes after getting the vaccine.
Although the hepatitis B vaccine is made in yeast cells, no one has ever been shown to be allergic to the yeast proteins contained in the hepatitis B vaccine .
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What Are My Next Steps Once I Get My Results
It can be difficult to understand what the results of your test mean. A healthcare provider can help you interpret your results and decide whether you need to take further action:
- If your results suggest that youre already immune to hepatitis B and arent contagious, you likely wont need to do anything.
- If your results suggest that youre not immune, a doctor may recommend vaccination, especially if youre somebody whos at a high risk of infection.
You may also need additional testing if more information is needed to interpret your results.
Emergency Hepatitis B Vaccination
If you have been exposed to the hepatitis B virus and have not been vaccinated before, you should get immediate medical advice, as you may benefit from having the hepatitis B vaccine.
In some situations, you may also need to have an injection of antibodies, called specific hepatitis B immunoglobulin , along with the hepatitis B vaccine.
HBIG should ideally be given within 48 hours, but you can still have it up to a week after exposure.
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International 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.
The hepatitis B vaccine is an injection that is generally given in the arm and as a three-dose series. The World Health Organization recommends a 0, 1, and 6-month vaccine schedule, though schedules may vary based on a countrys national immunization program. 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. Please note that the vaccine brand name, manufacturer and associated schedules for adults, children and infants may be unique to different countries, though there is a list of WHO prequalified vaccines.
3-Dose Vaccine Series for Infants
The World Health Organization recommends all infants receive the first dose of the hepatitis B vaccine within 24 hours of birth and to complete the vaccine series with additional shots at 1 month and 6 months of age. Beginning the hepatitis B vaccine at birth will ensure protection against hepatitis B for life.
3-Dose Vaccine Series for Children and Adults
4-Dose Combination Vaccine Series for Infants
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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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What To Do If You Miss A Scheduled Dose
The recommended schedule for the HBV vaccine follows a three-dose pattern, with all doses complete within 6 months. The good news is that if you miss a dose, you dont need to start the series of shots all over.
If you missed getting the second dose 1 month after the first, make an appointment as soon as possible. If you miss the third dose, you should also try to get it as quickly as possible. Keep in mind that the second and third doses
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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Whats The Hepatitis B Titer Test Used For
A hepatitis B titer test measures antibodies in your blood to see if youre immune either due to vaccination or previous infection.
Hepatitis B is a viral infection that targets your liver. It can be transmitted by coming into contact with the bodily fluids of an infected person. A person with the virus can also infect their child during birth.
Hepatitis B can develop into a chronic infection. Chronic infection occurs when your body cant fight off the virus within six months. Chronic hepatitis B infections most commonly develop less than six years old, especially in infants.
Hepatitis B titer tests can be used to evaluate:
- whether a high-risk person is immune to hepatitis B
- whether hepatitis B immunoglobulin is needed after a needle prick
- men who have sex with men
- people born in countries with a hepatitis B prevalence greater than 2 percent
- people born in the United States not vaccinated as children and with parents born in regions with more than 8 percent hepatitis B prevalence
You may need your titer test results as proof of hepatitis B immunity in order to get into healthcare programs at many schools for example, the nursing program at Lone Star College. In the United States, employers are not allowed to withdraw a job offer if they learn you have hepatitis B.
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.
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What To Think About
If you are exposed to HBV before you have received all three shots in the vaccination series, a dose of hepatitis B immune globulin usually will prevent infection until the vaccine takes effect.
If you have already had hepatitis B and have developed protective antibodies to the virus, you do not need the vaccine because you have lifetime protection against the infection. If you are not sure whether you have had hepatitis B, you can be tested, or you can be vaccinated without testing. The vaccine is not harmful for you if you are already immune.
If you have chronic HBV infection, the vaccine will be ineffective, although it is not harmful.
The vaccine is safe for women who are pregnant or breastfeeding.
General Information About Vaccination Outside The Us
In developing countries, the pentavalent vaccine, a combination 5-in-one vaccine that protects against five diseases, diphtheria, pertussis, tetanus, Hib and hepatitis B, may be given to babies more than 6 weeks of age, and can be given up to 1 year of age. The first dose is given at 6 weeks, and the second and third doses are given at 10 and 14 weeks of age. The pentavalent vaccine may be made available free of charge with the support of GAVI, the vaccine alliance. Check the GAVI country hub to see the resources and immunizations that may be available:
For babies born to mothers with hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from vertical or horizontal transmission of hepatitis B. Babies born to a mother with hepatitis B have a greater than 90% chance of developing chronic hepatitis B if they are not properly treated at birth.
WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Plan ahead and inquire about the availability and cost of the monovalent , birth dose of the vaccine, as it is not a GAVI provided immunization. This is particularly important to women who are positive for hepatitis B.
If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B!
*WHO does not recommend a birth dose of HBIG, which may not be available in all countries. Talk to your doctor if you have questions.
Page updated September 2022.
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