Hepatitis B Vaccination For Adults

Recording Two Coadministered Doses Of Energix

• Order two doses of Engerix-B 20 mcg/mL for one 40mcg dose
• Administer two doses of Engerix-B 20mcg/mL at the same visit using separate injection sites.
• Record the vaccination in the PMS immunisation section by selecting the DLK eligibility and recording the batch number, expiry date and injection site used for one dose and writing “Engerix-B 20mcg x 2 given” in the note section.
• Record the vaccination in the PMS clinical notes, explain that two Engerix-B 20mcg doses were co-administered because a single 40mcg dose was not available, record the details of both injection sites and, if they are different, both vaccine batch numbers and/or expiry dates.

Advisory Committee On Immunization Practices

The Centers for Disease Control and Preventions Advisory Committee on Immunization Practices provide recommendations for the hepatitis B vaccine. The following include persons recommended to receive the hepatitis B vaccination :

• Adults aged 60 years and older with risk factors for hepatitis B:

• Persons at risk for infection by sexual exposure

• Sex partners of persons testing positive for HBsAg
• Sexually active persons who are not in a long-term, mutually monogamous relationship
• Persons seeking evaluation or treatment for a sexually transmitted infection
• Men who have sex with men

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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:

If your child is undergoing hemodialysis, your healthcare provider may recommend that they receive additional doses of the HBV vaccine.

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How Does The Hepatitis B Vaccine Series Work

The vaccine protects you from the hepatitis B virus by getting your bodys immune system to make antibodies. Those antibodies protect you by fighting off the virus if it ever gets into your body.

Usually, the vaccine is spaced out into three different shots called a hepatitis B vaccine schedule. One month after your first shot, you get the second shot. Six months after your first shot, you get the third shot. If you miss your second or third dose, get it as soon as you remember.

The hepatitis vaccine is super effective. Its worked really well to lower the number of people who get hepatitis B every year.

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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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.

If I Already Have Hepatitis B Can The Vaccine Treat It

No. The hepatitis vaccine prevents hepatitis, but doesnt cure it if you already have it. If you have hepatitis B, there are other treatment options.

However, if you recently got exposed to the hepatitis B virus and you havent had the vaccine yet, tell your doctor right away. The vaccine and possibly other treatment can reduce your chances of getting hepatitis B if you get it within 2 weeks after you came into contact with the virus. The sooner you seek care after being exposed to hepatitis B, the better, so try to get there right away.

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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.

Managing Fever After Immunisation

Common side effects following immunisation are usually mild and temporary . Specific treatment is not usually required.

There are a number of treatment options that can reduce the side effects of the vaccine such as giving extra fluids to drink and not overdressing if there is a fever.

Although routine use of paracetamol after vaccination is not recommended, if fever is present, paracetamol can be given check the label for the correct dose or speak with your pharmacist, especially when giving paracetamol to children.

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Site Of Injection For Vaccination And Antibody Response

Hepatitis B vaccination should be given in the upper arm or the anterolateral aspect of the thigh and not in the buttock. There are over 100 reports of unexpectedly low antibody seroconversion rates after hepatitis B vaccination using injection into the buttock. In one center in the USA a low antibody response was noted in 54% of healthy adult health-care personnel. Many studies have since shown that the antibody response rate is significantly higher in centers using deltoid injection than centers using the buttock. On the basis of antibody tests after vaccination, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention in the USA recommended that the arm be used as the site for hepatitis B vaccination in adults, as has the Department of Health in the UK.

These observations have important public health implications, well illustrated by the estimate that about 20% of the 60 000 people immunized against HBV in the buttock in the USA by March 1985 had failed to attain a minimum level of antibody of 10 IU/l and were therefore not protected.

Hepatitis B surface antibody titers should be measured in all people who have been immunized against HBV by injection in the buttock, and when this is not possible a complete course of three injections of vaccine should be administered into the deltoid muscle or the anterolateral aspect of the thigh, the only acceptable sites for HBV immunization.

Dean A. Blumberg, in, 2012

Indications For Hepatitis B Vaccine

HepB vaccine is a routine childhood vaccination .

HepB vaccine also is indicated for adults who have not been previously vaccinated when any of the following is present:

• A desire for protection from hepatitis B in people who have not been previously vaccinated

• A sexually active lifestyle in people who are not in a long-term, mutually monogamous relationship

• Need for evaluation or treatment of a sexually transmitted infection

• Current or recent use of illicit injection drugs

• Sex between men

• Employment in which workers may be exposed to blood or other potentially infectious body fluids

• Diabetes in people < 60 years and sometimes in those 60 years

• End-stage renal disease

• A chronic liver disorder

• Household contact and/or sexual contact with people who are positive for hepatitis B surface antigen

• Travel to endemic areas

• Time spent in correctional facilities or in facilities that provide sexually transmitted infection treatment, HIV testing and treatment, drug abuse treatment and prevention services, services to injection-drug users or men who have sex with men, or care for patients with developmental disabilities or with end-stage renal disease

• Pregnant women if at risk of infection or severe outcome resulting from infection during pregnancy

The combination HepA and HepB vaccine can be used in people 18 years who have indications for either hepatitis A or hepatitis B vaccine and who have not been previously vaccinated with one of the vaccine components.

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Immunisation Against Hepatitis B For People At Risk

In Victoria free hepatitis B vaccine is provided for people who are at increased risk, including:

• Men who have sex with men.
• People living with HIV.
• People living with hepatitis C.
• People no longer in a custodial setting who commenced, but did not complete, a free vaccine course while in custody.
• Aboriginal and Torres Strait Islander people.
• People born in priority hepatitis B endemic countries who arrived in Australia in the last 10 years priority countries include China, Philippines, Malaysia, Vietnam, Afghanistan, Thailand, South Korea, Myanmar , Indonesia, Singapore, Hong Kong, Taiwan and Cambodia.
• Vulnerable citizens people who have experienced hardship that prevented them from accessing the vaccine earlier. Vulnerable citizens are vaccinated based on an individual assessment by an immunisation provider.

Immunisation is also recommended, but not free, for people who are at increased risk including:

If you think you have been exposed to hepatitis B, see a doctor immediately. Your doctor can give you treatment that, in some instances, can greatly reduce your risk of infection with hepatitis B.

Remember that being immunised against hepatitis B does not protect you against HIV, hepatitis C or other diseases spread by blood or bodily fluids. It is important that you take precautions to make sure you are not exposed to these diseases.

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.

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What Is Hepatitis B

Hepatitis B is a highly contagious liver infection caused by the hepatitis B virus . The infection can range in severity from mild to acute. It may last just a few weeks or become a serious, chronic, and potentially fatal health condition.

The best way to prevent this infection is to get the hepatitis B vaccine. Heres what you need to know.

Immunisation Against Hepatitis B For Children

Vaccination is the best protection against hepatitis B infection and is recommended for all infants and young children, adolescents and those in high-risk groups. Vaccination can be with a vaccine against hepatitis B alone or with a combination vaccine.

Protection against hepatitis B is available free of charge under the National Immunisation Program Schedule.

In Victoria, vaccination against hepatitis B is free for all babies and children including:

• Babies at birth vaccinate with hepatitis B vaccine as soon as possible after birth.
• Babies at 2, 4 and 6 months immunisation in the form of a diphtheria, tetanus, whooping cough, hepatitis B, polio and Haemophilus influenzae type b vaccine .
• Premature babies at 12 months premature babies born under 32 weeks gestation or under 2,000g birth weight receive a single booster dose.
• Children up to and including 20 years of age.

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How Can I Contract Hepatitis B

You can contract hepatitis B by coming into contact with the bodily fluids of an infected person.

Resort activities that may put you at risk for hepatitis B include:

Getting a manicure, pedicure, tattoo, piercing, or acupuncture with improperly sterilized tools

Having sexual contact with an infected partner

Giving first aid to, or receiving it from, an infected person

Receiving a medical or dental procedure with contaminated equipment

Sharing personal grooming items with an infected person

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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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.

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.

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Technically Speaking: Hepatitis B Vaccination For Adults Who Needs It And When

Hepatitis B vaccination recommendations vary by a persons age and risk factors. In the Technically Speaking column in August, we discussed routine hepatitis B vaccination of infants, children and teens. This month, lets review hepatitis B vaccination of adults, including vaccination guidance for high-risk groups. In an upcoming column, we will review the issues surrounding hepatitis B serologic tests and vaccination, including who needs testing and when.

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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Before Taking This Medicine

Hepatitis B vaccine will not protect against infection with hepatitis A, C, and E, or other viruses that affect the liver. It may also not protect against hepatitis B if you are already infected with the virus, even if you do not yet show symptoms.

You should not receive this vaccine if you have ever had a life-threatening allergic reaction to any vaccine containing hepatitis B, or if you are allergic to yeast.

If you have any of these other conditions, your vaccine may need to be postponed or not given at all:

• kidney disease

• a bleeding or blood clotting disorder such as hemophilia or easy bruising

• weak immune system

• an allergy to latex or

• a neurologic disorder or disease affecting the brain .

You can still receive a vaccine if you have a minor cold. If you have a more severe illness with a fever or any type of infection, your doctor may recommend waiting until you get better before you receive this vaccine.

Tell your doctor if you are pregnant or breastfeeding.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of this vaccine on the baby.