Healthcare Workers Might Not Need Hbv Booster Vaccines
NEW YORK – For most healthcare workers, hepatitis B protective antibody levels persist long after their initial immunization and so they don’t need a booster, new research suggests.
“Hepatitis B vaccination provides long-term protection against hepatitis. In our study, roughly 75% of health care workers vaccinated as adults had protective anti-HBsAg levels. Among the approximately 25% of subjects with low or absent levels of antibody, 94% developed a rapid and robust response to a single booster vaccine within three weeks, suggesting a long-lasting amnestic response,” wrote senior author Dr. Marc G. Ghany in an email to Reuters Health.
“Based on these findings, we concluded that booster vaccinations do not appear to be necessary in healthcare workers, even in those with no or low levels of anti-HBs,” added Dr. Ghany, a staff clinician at the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland.
“The results suggest that healthcare workers who are not immunosuppressed do not require a booster vaccine against hepatitis B virus at least for an average of 18 years after vaccination, and they support current recommendations by the Advisory Committee on Immunization Practices/Centers for Disease Control and Prevention and the European Consensus Group that a booster dose of HBV is not required for healthcare workers,” he wrote.
Intradermal Vaccination In Non
Intradermal vaccination in non-responders
Some small observational studies report that some non-responders may respond to intradermal vaccination against hepatitis B.30-32 These results apply to hepatitis B surface antigennegative healthcare workers who are non-responders to a 3-dose course of vaccination and to subsequent additional intramuscular doses .
These studies used up to 4 doses of Engerix-B .30 Younger age and longer duration since the last intramuscular dose may be associated with a better chance of responding.31
If a person receives an intradermal dose, it is recommended that the anti-HBs levels are measured before each subsequent dose to check for seroconversion.
Healthcare Workers May Need Hbv Boosters As Titers Drop
Daniel M. Keller, PhD
BOSTON In a study from the National Institutes of Health of healthcare workers previously vaccinated against hepatitis B virus as adults, antibody titers to HBV surface antigen waned over time, according to new research.
Naveen Gara, MD, a former research fellow in the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, and now a gastroenterology fellow at the Washington Hospital Center in Washington, DC, reported in a poster session here at Liver Meeting 2012: American Association for the Study of Liver Diseases 63rd Annual Meeting that negative anti-HBs titers were associated with older age at vaccination.
Universal HBV vaccination has greatly reduced the incidence of HBV and hepatocellular carcinoma worldwide. Studies in endemic areas have shown that many children vaccinated at birth have lost anti-HBs. This study explored the durability of the response to the vaccine in individuals vaccinated as adults from a nonendemic area.
The mean age at first vaccination was 31 years in group 1, 32 years in group 2, and 34 years in group 3. Most participants were female and white . The 3 groups’ baseline characteristics were similar except that in group 3 there was a higher rate of needlestick injury and smoking .
Of the 159 HCWs, 23% were anti-HBs negative . None was positive for HbsAg, which would indicate current infection.
Booster Dose Increases Anti-HBs Titers
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Common And Local Adverse Events
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.
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.
Reactions are usually mild and transient, and include fever, irritability, restlessness and injection site reactions .
Headache, diarrhea, fever, urticaria, angioedema and injection site reactions may occur.
Babies And Hepatitis B Vaccination
Pregnant women have a routine blood test for hepatitis B as part of their antenatal care.
Babies born to mothers infected with hepatitis B need to be given a dose of the hepatitis B vaccine within 24 hours of their birth, followed by further doses at 4, 8, 12 and 16 weeks of age, plus a final dose when they’re 1 year old.
Babies of mothers identified by the blood test as particularly infectious might also be given an injection of HBIG at birth on top of the hepatitis B vaccination to give them rapid protection against infection.
All babies born to mothers infected with hepatitis B should be tested at 1 year of age to check if they have become infected with the virus.
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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.
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.
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.
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Measles Mumps And Rubella
Measles: Protection against measles requires proof of receiving 2 doses of a measles vaccine or proof that you have had laboratory-confirmed measles in the past. Those born before 1957 have probably had measles and are considered immune.
Measles is a highly contagious disease that can be more severe in infants, children and adults who have weakened immune systems. Complications from measles include pneumonia, which is an infection of the lungs, and encephalitis, which is an inflammation of the brain. Encephalitis can lead to seizures, deafness or brain damage.
Mumps: Protection against mumps requires proof of having had laboratory-confirmed mumps in the past, or proof of having received the recommended number of doses of mumps vaccine for your age. People born between 1957 and 1969 need 1 dose of mumps vaccine while those born after 1969 need 2 doses. Individuals born before 1957 have probably had mumps and are considered immune.
Mumps is generally a mild disease. However, complications, including encephalitis, are more common in adults.
Rubella: Health care workers are considered protected against rubella infection if they have proof of having received 1 dose of rubella vaccine, regardless of their year of birth, or proof they have had laboratory-confirmed rubella disease.
What Hepatitis B Immunisation Involves
Full protection involves having 3 injections of the hepatitis B vaccine at the recommended intervals.
Babies born to mothers with hepatitis B infection will be given 6 doses of hepatitis B-containing vaccine to ensure long-lasting protection.
If you’re a healthcare worker or you have kidney failure, you’ll have a follow-up appointment to see if you have responded to the vaccine.
If you have been vaccinated by your employer’s occupational health service, you can request a blood test to see if you have responded to the vaccine.
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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.
Who Should Get Hepatitis B Vaccine
All infants should get their first dose of hepatitis B vaccine within 24 hours of birth and will usually complete the series at 6 months of age.
All unvaccinated children and adolescents younger than 19 years of age should also get vaccinated.
All adults 19 through 59 years of age are recommended to get vaccinated.
Adults 60 years and older with risk factors should get vaccinated. Risk factors include:
- People whose sex partners have hepatitis B
- People who live with someone with hepatitis B
- Sexually active people who are not in a long-term relationship
- People getting evaluated or treated for a sexually transmitted infection
- Men who have sex with men
- People who share needles, syringes, or other drug-injection equipment
- Health care and public safety workers at risk for exposure to blood or body fluids
- People with chronic liver disease, who are on dialysis, have HIV infection, or hepatitis C infection
- People with diabetes should ask their health care provider
- Developmentally disabled persons in long-term care facilities
- People in prison or jail
- Travelers to areas with high rates of hepatitis B
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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.
Study Design Setting And Population
This was a cross sectional study done in Lira and Gulu regional referral hospitals in northern Uganda from October to December 2020. In Uganda, regional referral hospitals offer specialist clinical services such as psychiatry, Ear, Nose and Throat , ophthalmology, higher level surgical and medical services, and ancillary services . They also provide general healthcare services including, preventive, promotive, curative, maternity, in-patient health services, surgery, blood transfusion, laboratory and medical imaging services. The regional referral hospitals are also involved in teaching and research. Hepatitis B screening and management services are also offered in regional referral hospitals in Uganda. Gulu and Lira regional referral hospital has 320, 420 healthcare workers respectively.
The study was conducted among adult vaccinated healthcare workers in Lira and Gulu regional referral hospitals in northern Uganda. We enrolled healthcare workers who had previously received primary Hepatitis B vaccine irrespective of when the vaccination was received.
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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.
How To Get Vaccinated Against Hepatitis B
All babies in the UK born on or after 1 August 2017 are given 3 doses of hepatitis B-containing vaccine as part of the NHS routine vaccination schedule.
These doses are given at 8, 12 and 16 weeks of age.
Babies at high risk of developing hepatitis B infection from infected mothers are given extra doses of the hepatitis B vaccine at birth, 4 weeks and 1 year of age.
If you think you’re at risk and need the hepatitis B vaccine, ask your GP to vaccinate you, or visit any sexual health or genitourinary medicine clinic.
If your job places you at risk of hepatitis B infection, it’s your employer’s responsibility to arrange vaccination for you, rather than your GP. Contact your occupational health department.
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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.
Recommended Vaccines For Healthcare Workers
Healthcare workers are at risk for exposure to serious, and sometimes deadly, diseases. If you work directly with patients or handle material that could spread infection, you should get appropriate vaccines to reduce the chance that you will get or spread vaccine-preventable diseases. Protect yourself, your patients, and your family members. Make sure you are up-to-date with recommended vaccines.
Healthcare workers include physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, pharmacists, hospital volunteers, and administrative staff.
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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 .
What Routine Immunizations Are Recommended In Bc
The vaccines recommended for health care workers are diphtheria and tetanus, polio, hepatitis B, measles, mumps and rubella , varicella and influenza. All are provided free to health care workers in B.C.
Immunization of employees is the responsibility of the Occupational Health department or assigned staff in the workplace. The employer and employee should keep records of all immunizations and laboratory test results.
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Immunisations For Health Care Workers
Immunisation is especially important for health care workers because they have a high risk of catching diseases from infected people. They can then easily pass them on to other people.
Find information for the general public
People who work in health care and aged care risk catching diseases that are preventable through vaccination from infected patients and other contacts.
They can pass these diseases on to vulnerable people in their care, such as young children or older people.
If health care workers get immunised, it helps reduce these risks.
The Australian Immunisation Handbook lists the immunisations recommended for health care workers. They are summarised in the table below. Employers should take all reasonable steps to encourage workers to be vaccinated.
All health care workers
Includes all workers and students directly involved in patient care or the handling of human tissue, blood or body fluids
Vaccines listed for ‘All health care workers’, plus hepatitis A
Health care workers who may be at high risk of exposure to drug-resistant cases of tuberculosis
Vaccines listed for ‘All health care workers’, plus consider BCG
Diphtheria Tetanus And Polio
Polio: Primary immunization with polio vaccine is recommended for all health care workers. Most adults will have completed a primary series of polio vaccine as children. If you think that you have not received the vaccine, then a primary series of polio vaccine is recommended. Health care workers should have a booster dose of the vaccine 10 years after completion of the primary series.
Due to immunization, polio has been eliminated in most parts of the world. In 1994, Canada was certified as a polio free country. Individuals at risk of getting polio in Canada are those who come in contact with people from countries where polio still exists. Individuals travelling to these countries may be exposed to polio and should be immunized. While most polio infections may not result in symptoms, others can result in paralysis and even death.
Diphtheria and Tetanus: Immunization against diphtheria and tetanus is recommended for all adults in Canada. A booster dose of the tetanus and diphtheria vaccine is recommended every 10 years. The booster may be given sooner if you get a dirty or major wound, including a bite.
Diphtheria is a serious communicable disease, causing death in 5 to 10 per cent of cases, with the highest rates among the very young and the elderly.
Tetanus is an acute and often fatal disease, but is rare in Canada. Cases are associated with dirty wounds, animal bites and contaminated drug injection equipment.
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