Hepatitis B Vaccine Schedule For Adults Missed Dose

Diphtheria Tetanus And Pertussis Vaccination

Routine vaccination

• 5-dose series at 2, 4, 6, 1518 months, 46 years
• Prospectively: Dose 4 may be administered as early as age 12 months if at least 6 months have elapsed since dose 3.
• Retrospectively: A 4th dose that was inadvertently administered as early as age 12 months may be counted if at least 4 months have elapsed since dose 3.

Catch-up vaccination

• Dose 5 is not necessary if dose 4 was administered at age 4 years or older and at least 6 months after dose 3.
• For other catch-up guidance, see Table 2.

Special situations

• Wound management in children less than age 7 years with history of 3 or more doses of tetanus-toxoid-containing vaccine: For all wounds except clean and minor wounds, administer DTaP if more than 5 years since last dose of tetanus-toxoid-containing vaccine. For detailed information, see www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm.

Meningococcal Serogroup B Vaccination

• Adolescents not at increased risk age 1623 years based on shared clinical decision-making:
• Bexsero: 2-dose series at least 1 month apart
• Trumenba: 2-dose series at least 6 months apart if dose 2 is administered earlier than 6 months, administer a 3rd dose at least 4 months after dose 2.

Special situations

Anatomic or functional asplenia , persistent complement component deficiency, complement inhibitor use:

• Bexsero: 2-dose series at least 1 month apart
• Trumenba: 3-dose series at 0, 12, 6 months

Bexsero and Trumenba are not interchangeable the same product should be used for all doses in a series. For MenB booster dose recommendations for groups listed under Special situations and in an outbreak setting and additional meningococcal vaccination information, see .

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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Interchangeability Of Hepatitis B Vaccines

The Engerix-B and H-B-Vax II vaccines are manufactured by different processes, and the hepatitis B surface antigen content of an equivalent dose of these vaccines is different. Switching vaccine brands is not recommended.

If the brand of vaccine used for previous doses is not known, use another age-appropriate equivalent dose brand. See:

For example, a study in healthy neonates showed comparable high levels of immunogenicity between 2 different mixed regimens that used 2 monovalent hepatitis B vaccines from different manufacturers.33

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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Hepatitis A Vaccine: Canadian Immunization Guide

For health professionals

• Next Page

Last partial chapter update

: The immunoglobulin dosage for Hepatitis A pre-exposure and post-exposure prophylaxis was increased based on the Product Monograph update for GamaSTAN®, which is available on Health Canada’s Drug Product Database.

Last complete chapter revision: March 2018

Compliance With Accelerated Vs Standard Vaccination Schedules In Different Populations

Table 2Overview of hepatitis B vaccine uptake according to vaccination schedule, in different atrisk populations

*Schedule expressed in months 0 1/4 3/4 therefore corresponds to 0.7.21days type of vaccination schedule: coded as S , SS , A or SA parentheses indicate schedules without the final dose numbers and percentages either reported in the paper, or calculated from the reported values

SW/MSM/Multiple partners/STI clinic attendants

Several studies have reported being able to administer three doses of hepatitis B vaccine to a higher proportion of the population targeted, when an accelerated or a superaccelerated schedule was used, at least the primary part of it. Unfortunately, few of these studies report immunogenicity data this is mainly due to the difficulties to administer three vaccine doses, and thus the low proportion that can actually be tested afterwards.,,,,,,,

A recent paper that did report immunogenicity data studied a shortened standard schedule as an alternative option, in a setting where other strategies are used to improve the compliance. Even if the 0.1.4months schedule failed to significantly improve the compliance, it offered equal protection within a shorter interval.

Drug users

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Global Burden Of Disease

Approximately two billion people worldwide had been exposed to HBV in 1995. In 2015, based on serological data, around 3.5 percent of the general population globally were infected with HBV and more than 250 million people were estimated to have chronic infection and these people remain at risk of developing cirrhosis and hepatocellular carcinoma. More than 90 percent of individuals with chronic HBV resided in the AsiaPacific region, where most countries have high prevalence rates of HBV infection and more than 99 percent of HBV-infected people in this region acquired infection through vertical transmission from their mother or in early childhood. As an example of this risk, 22.8 million out of 80 million people living in China with chronic HBV infection are women of child-bearing age. Acquisition of HBV during adulthood is associated with a high rate of symptomatic hepatitis but a low rate of chronic infection.

Haemophilus Influenzae Type B Vaccination

Special situations

• Anatomical or functional asplenia : 1 dose if previously did not receive Hib if elective splenectomy, 1 dose, preferably at least 14 days before splenectomy
• Hematopoietic stem cell transplant : 3-dose series 4 weeks apart starting 612 months after successful transplant, regardless of Hib vaccination history

Routine vaccination

• Not at risk but want protection from hepatitis A: 2-dose series HepA or 3-dose series HepA-HepB

Special situations

• At risk for hepatitis A virus infection: 2-dose series HepA or 3-dose series HepA-HepB as above
• Chronic liver disease
• HIV infection

Routine vaccination

• Not at risk but want protection from hepatitis B: 2- or 3-dose series or 3-dose series HepA-HepB

Special situations

• At risk for hepatitis B virus infection: 2-dose or 3-dose series or 3-dose series HepA-HepB as above
• Chronic liver disease
• HIV infection
• Sexual exposure risk
• Current or recent injection drug use
• Percutaneous or mucosal risk for exposure to blood
• Incarcerated persons
• Travel in countries with high or intermediate endemic hepatitis B
• Pregnancy if at risk for infection or severe outcome from infection during pregnancy. Heplisav-B not currently recommended due to lack of safety data in pregnant women

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Vaccine For Hepatitis B

Hepatitis B Vaccine

It takes only a few shots to protect yourself and your loved ones against hepatitis B for a lifetime.

The hepatitis B vaccine is a safe and effective vaccine that is recommended for all infants at birth and for children up to 18 years. The hepatitis B vaccine is also recommended for adults living with diabetes and those at high risk for infection due to their jobs, lifestyle, living situations, or country of birth. Since everyone is at some risk, all adults should seriously consider getting the hepatitis B vaccine for a lifetime protection against a preventable chronic liver disease.

The hepatitis B vaccine is also known as the first anti-cancer vaccine because it prevents hepatitis B, the leading cause of liver cancer worldwide.

You cannot get hepatitis B from the vaccine. All hepatitis B vaccines that have been used since 1986 are made synthetically meaning the hepatitis B vaccines do not contain any blood products. Learn more.

If you have a current HBV infection or have recovered from a past HBV infection, the hepatitis B vaccine series will not benefit you or clear the virus. However, the vaccine can provide a lifetime of protection for loved ones who do not have hepatitis B and get the vaccine as soon as possible. Testing is the only way to know if you or your loved ones have a current infection or have recovered from a past infection.

Hepatitis B Vaccine Recommendations

Three-Dose Hepatitis B Vaccine Schedule

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.

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Interchangeability And Dosing Schedule

• 2-dose HepB vaccine series only applies when both doses consist of HepB-CpG, administered at least 4 weeks apart.
• Series consisting of a combination of 1 dose of HepB-CpG and a vaccine from a different manufacturer should do the following:
• Adhere to the 3-dose schedule minimum intervals of 4 weeks between dose 1 and 2, 8 weeks between dose 2 and 3, and 16 weeks between dose 1 and 3. However, if HepB-CpG is substituted for dose 2 of HepB-alum, a provider has the option of administering the next dose of HepB-CpG a minimum of 4 weeks from the previous dose for a complete series.

Which Adults Should Be Vaccinated Against Hepatitis B

According to CDC recommendations, adults in the following groups are recommended to receive hepatitis B vaccine:

General

• All people age 18 years and younger.
• Anyone 19 years and older who wants to be protected from hepatitis B.

People at risk for infection by sexual exposure

• Sex partners of people who are hepatitis B surface antigen -positive.
• Sexually active people who are not in long-term, mutually monogamous relationships.
• People seeking evaluation or treatment for a sexually transmitted disease.
• Men who have sex with men.

People at risk for infection by percutaneous or permucosal exposure to blood or body fluids

• Current or recent illegal injection drug users.
• Household contacts of people who are HBsAg-positive.
• Residents and staff of facilities for developmentally challenged people.
• Healthcare and public safety workers with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids.
• People with end-stage renal disease, including predialysis, hemo-, peritoneal- and home-dialysis patients.

Others

• International travelers to regions with intermediate or high levels of endemic HBV infection.
• People with chronic liver disease.
• People with HIV infection.
• People with diabetes who are age 19 through 59 years. For those age 60 and older, clinicians should make a determination of need for
• vaccination based on their patients’ situation.

In a future issue, we will review the various hepatitis B serologic tests, who needs testing, and when they need it .

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Burden Of Chronic Hepatitis B In Australia

Chronic infection and its sequelae, including cirrhosis and hepatocellular carcinoma, contribute to most of the hepatitis B disease burden in Australia. The burden from chronic disease has been increasing with the increasing number of immigrants from regions of high hepatitis B prevalence.62

First-generation immigrants from countries of high hepatitis B endemicity usually retain the prevalence of chronic hepatitis B virus infection of the country they are from. Migrants born in Asian, Pacific islands, North African, Middle Eastern and Mediterranean countries have a significantly higher prevalence of chronic hepatitis B virus infection than the Australian-born population.62

Other population groups with higher prevalence of hepatitis B virus infection include:63,64

• Aboriginal and Torres Strait Islander people
• people with HIV
• people who injected drugs between 1980 and 1990
• household contacts of someone diagnosed with hepatitis between 1980 and 1990

Notification of chronic hepatitis B virus infection depends on hepatitis B testing and reporting. Many people with chronic hepatitis B virus infection remain undiagnosed. Mathematical modelling suggests that, in Australia in 2015:64

• about 230,000 people were living with hepatitis B virus infection
• about 419 deaths were due to hepatitis B virus infection

People At Occupational Risk

Hepatitis B vaccine is recommended for people who work in any occupation that involves any of:

• direct patient care
• handling human tissue, blood or body fluids
• handling used needles or syringes

These people should also routinely follow standard precautions against exposure to human tissue, blood or body fluids.19

The risk to people in certain occupations differs considerably between settings in different parts of Australia. Workers who have an increased risk of acquiring hepatitis B include:

• healthcare workers
• police, members of the armed forces, emergency services staff and staff of correctional facilities, if they are assigned to duties that may involve exposure to human tissue, blood or body fluids
• funeral workers, embalmers and other workers who have regular contact with human tissue, blood or body fluids, or used needles or syringes
• staff involved in both residential and non-residential care of people with developmental disabilities, because of the high prevalence of markers of past or current infection in people in this setting16-18
• workers who perform skin penetration procedures, such as tattooists and body-piercers

Early childhood educators and carers are normally at minimal risk of hepatitis B transmission. The local public health authority can provide advice about risk if needed.

Adult-formulation hepatitis B vaccine should be given in a 3-dose schedule. See Table. Monovalent hepatitis B vaccines for adolescents and adults in Vaccines, dosage and administration.

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Advisory Committee On Immunization Practices Recommendations

In February 2018, ACIP approved recommendations for Heplisav-B vaccine as an option for previously unvaccinated or incompletely vaccinated persons, including:

• Adults 18 years of age and older who have a specific risk, or lack a risk factor but want protection. See ACIP Recommended Immunization Schedule for Adults for risk factors.

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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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.

Incidence Of Acute Hepatitis B In Australia

Newly acquired cases of hepatitis B virus infection in Australia mostly occur in young adults, through:65

• injecting drug use
• skin penetration procedures
• sexual contact

Between 2006 and 2015, the notification rate of newly acquired hepatitis B in Australia declined from 1.4 to 0.6 per 100,000 population.64

Since 2001, the rate of diagnosis of newly acquired infections has declined substantially among people aged < 29 years. The decline has been less among people aged 30 years.64,66,67 However, some new hepatitis B virus infections are asymptomatic and may go undetected.

Similar to chronic infection, the incidence of, and hospitalisation rates due to, acute hepatitis B are higher among Aboriginal and Torres Strait Islander people than the general Australian population.64

Hepatitis B vaccines are prepared using recombinant technology. After purification, the hepatitis B surface antigen protein is adsorbed onto elemental aluminium . Hepatitis B vaccines may contain up to 1% yeast proteins (but no yeast DNA

The Engerix-B and H-B-Vax II vaccines are manufactured by different processes, and the HBsAg content of equivalent doses of these 2 vaccines is different. The HBsAg content of the paediatric formulations of these 2 vaccines is half that of the corresponding manufacturers adult formulation.

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Immunogenicity And Effectiveness/efficacy Of Accelerated Vaccination Schedules In Different Populations

Table 1Overview of immunogenicity results according to vaccination schedule, in different populations

*Bold values refer to a higher antigen dosage schedule expressed in months 1/4 1/3 1/2 3/4 3/4 therefore correspond to 7, 10, 14, 21days, and 1.5months , respectively type of vaccination schedule: coded as S , SS , A , SA or P parentheses indicate schedules without the final dose § M/F: male/female ratio NA: not applicable ¶numbers and percentages either reported in the paper or calculated from the reported values.

Healthy adolescents

Few studies have examined the use of accelerated hepatitis B vaccination schedules in adolescents. Nevertheless, since the immunogenicity of many vaccines, including hepatitis B vaccines, is higher in younger persons, the results of studies in healthy adults can safely be extrapolated to younger age groups.

Healthy adults

Travellers to areas of intermediate or high endemicity

Drug users

Lugoboni et al found a similar immunogenicity as compared with the general population, using the combined vaccine according to a standard vaccination schedule against hepatitis A and B in a population of drug users.