Experimental And Investigational Or Not Medically Necessary
Footnote1*Note: Aetna generally does not cover immunizations required for travel or because of work-related risk. Check contract language, limitations and exclusions for coverage details.
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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:
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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Who Should Not Receive The Hepatitis B Vaccine
Talk to your healthcare provider before getting the hepatitis B vaccine if:
- You have had a severe allergic reaction to the hepatitis B vaccine or any of its ingredients in the past.
- You have had an allergic reaction to yeast in the past.
- You are moderately or severely ill.
- You are currently taking immunosuppressive medications.
In addition, pregnant people should not receive the Heplisav-B or PreHevbrio vaccines until more safety information is available.
Dosage And Vaccination Schedule
Dosage varies according to age and type of vaccine used: follow manufacturer’s instructions.
Child: one dose = 5 to 10 micrograms
Adult: one dose = 10 to 20 micrograms
- Standard schedule
- Neonate and infant:
- One dose as soon as possible after birth then a 2nd dose at 6 weeks and a 3rd dose at 14 weeks
- One dose as soon as possible after birth then 3 doses administered 4 weeks apart with the 1st at 6 weeks, the 2nd at 10 weeks and the 3rd at 14 weeks
- Child, adolescent, adult: schedule 0-1-6
2 doses 4 weeks apart, then a 3rd dose 6 months after the 1st dose
- Accelerated schedule, when rapid protection is required in the event of post-exposure prophylaxis
3 doses administered during the same month on D0-D7-D21, then a 4th dose one year after the 1st dose
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Hepatitis B Doctors Consultation Service And Vaccination For Adults
What is Hepatitis B?Hepatitis B is a viral liver infection spread through blood, transfusion of blood products and sharing of bodily fluids.
Hepatitis B can range from a mild illness lasting a few weeks to a serious, lifelong illness . Possible symptoms include fever, nausea, vomiting, dark urine and jaundice. Carriers of Hepatitis B can develop scarring of the liver, liver failure or liver cancer. The younger a person is when infected with hepatitis B virus, the greater the chance of developing a chronic infection. Hepatitis B is estimated to cause 80 per cent of primary liver cancers worldwide and vaccination will reduce risk of liver cancer through preventing Hepatitis B infection.
Hepatitis B vaccination is part of the Singapore National immunisation Schedule
A blood test to screen for Hepatitis B antibodies can be conducted to assess if vaccination is needed.
Who is the vaccine recommended for?
How many doses are required?Three doses are required . No booster is required after three doses.
Price is applicable for three doses only and includes practice cost and doctors consultation charge at first visit. Price excludes any related serology tests.
Who Should Not Get The Hepatitis B Vaccine
Hepatitis B is a safe vaccine that does not contain a live virus.
However, there are some circumstances in which doctors advise against getting the HBV vaccine.
You should not receive the hepatitis B vaccine if:
- youve had a serious allergic reaction to a previous dose of the hepatitis B vaccine
- you have a history of hypersensitivity to yeast or any other HBV vaccine components
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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.
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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How Is The Hepatitis B Vaccine Made
People are protected against hepatitis B virus infection by making an immune response to a protein that sits on the surface of the virus. When hepatitis B virus grows in the liver, an excess amount of this surface protein is made. The hepatitis B vaccine is made by taking the part of the virus that makes surface protein and putting it into yeast cells. The yeast cells then produce many copies of the protein that are subsequently used to make the vaccine. When the surface protein is given to children in the vaccine, their immune systems make an immune response that provides protection against infection with the hepatitis B virus.
The first hepatitis B vaccine was made in the 1980s by taking blood from people infected with hepatitis B virus and separating or purifying the surface protein from the infectious virus. Because blood was used, there was a risk of contaminating the vaccine with other viruses that might be found in blood, such as HIV. Although contamination with HIV was a theoretical risk of the early, blood-derived hepatitis B vaccine, no one ever got HIV from the hepatitis B vaccine. That is because the blood used to make vaccine was submitted to a series of chemical treatments that inactivated any possible contaminating viruses. Today, there is no risk of contaminating the vaccine with other viruses because the surface protein is manufactured in the laboratory.
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.
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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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What Are The Uses For Hepatitis B Vaccine
Hepatitis B vaccine is used to prevent hepatitis B, a serious infection that affects the liver.
Most children are given their first shot at birth, followed by a 2nd shot at 1-2 months of age, and a 3rd shot at 6-18 months of age. Also, anyone who is 18 years of age or younger and hasnât received the vaccine should be vaccinated.
Additionally, all unvaccinated adults at risk for hepatitis B infection should be vaccinated. This includes:
- Partners or people infected with hepatitis B
- Men who have sex with men
- People who inject street drugs
- People with more than one sex partner
- People with chronic liver or kidney disease
- People under the age of 60 who have type 1 or 2 diabetes
- People with jobs that expose them to human blood or other body fluids
- People who live with a family member infected with hepatitis B
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Who Should Receive The Hepatitis B Vaccine
For most people, the hepatitis B vaccine is safe and effective. About 90% of people who receive three vaccine doses are protected against hepatitis B for over 30 years.
The CDC’s Advisory Committee on Immunization Practices recommends the hepatitis B vaccine for the following groups:
- All babies, starting just after birth
- Children and adolescents under 19 years old
- Adults ages 1959 who have not previously completed vaccination
- Adults ages 60 and over with a high risk of contracting HBV
Adults ages 60 and over who do not have any hepatitis B risk factors can receive the hepatitis B vaccine, but it is optional.
Hepatitis B spreads when the bodily fluids of an infected person enter another person’s body. Sexual contact is one way it can be spread. A person with HBV can spread it to their baby during childbirth. Other ways in which HBV may be transmitted include:
- Sharing medical equipment, whether at home or in a hospital setting, with a person who has an HBV infection
- Sharing syringes with a person who has hepatitis B, such as during injection drug use or at-home piercing or tattooing
- Sharing personal items, such as razors or toothbrushes, with someone who has hepatitis B
- Coming into contact with the sores or blood of a person who has hepatitis B
Guidance On Reporting Adverse Events Following Immunization
Vaccine providers are asked to report, through local public health officials, any serious or unexpected adverse event temporally related to vaccination. An unexpected AEFI is an event that is not listed in available product information but may be due to the immunization, or a change in the frequency of a known AEFI.
Refer to Reporting Adverse Events Following Immunization in Canada and Adverse events following immunization in Part 2 for additional information about AEFI reporting.
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Facts About Hepatitis B
- Two billion people, or one in three, have been infected with hepatitis B worldwide. Of these, almost 300 million live with chronic hepatitis B. This means about 1 of every 26 people throughout the world are living with a chronic hepatitis B infection.
- Each year about 900,000 people die from hepatitis B worldwide, and about 2,000 of these deaths occur in the United States.
- Hepatitis B is transmitted through blood and is 100 times more infectious than HIV. An estimated one billion infectious viruses are in one-fifth of a teaspoon of blood of an infected person, so exposure to even a very small amount, such as on a shared toothbrush, can cause infection.
- Hepatitis B is sometimes referred to as the silent epidemic because most people who are infected do not experience any symptoms.
- Liver cancer accounted for about 5% of cancer deaths in the U.S. during 2020.
- Almost half of liver cancers are caused by chronic infection with hepatitis B.
- The World Health Organization recommends the inclusion of hepatitis B vaccine in immunization programs of all countries in 2019, more than 8 of 10 infants born throughout the world received three doses of hepatitis B vaccine.
Can Hepatitis B Become Negative
It can happen, especially in older adults after a long period of âinactiveâ hepatitis B infection. About 1 to 3 percent of people with chronic hepatitis B lose HBsAg each year, and about half of all people with chronic infections who live up to age 75 will lose HBsAg, depending on the amount of HBV DNA in their blood.
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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.
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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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.