Monday, May 16, 2022

Hepatitis B Vaccine Schedule For Adults

Emergency Hepatitis B Vaccination

HepB Immunization Schedule – Memory Palace – “Hippie Giving Birth at Home”

If you’ve 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.

Who Should Be Immunised Against Hepatitis B

Hepatitis B immunisation is recommended and funded for the following groups:

  • all children up to their 18th birthday
  • babies born to mothers with hepatitis B infection
  • people who live in close contact with someone infected with hepatitis B
  • anyone undergoing renal dialysis
  • people who have hepatitis C infection, or who are HIV positive, or who have had a needle stick injury.
  • anyone who has received immunosuppression therapy of at least 28 days or has had solid organ or bone marrow transplant.

Hepatitis B immunisation is also recommended, but not funded, for:

  • workers who are likely to come into contact with blood products, or who are at increased risk of needlestick injuries, assault, etc.
  • people who change sex partners frequently such as sex workers
  • people who regularly receive blood transfusions such as people with haemophilia
  • prison inmates
  • current or recent injecting drug users
  • migrants and travellers from or to areas with intermediate or high rates of hepatitis B such as the Asia and Pacific region.

Adults Recommended To Receive Hepb Vaccine:

  • Persons at risk for infection by sexual exposure
  • Sex partners of hepatitis B surface antigen positive persons
  • 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
  • Persons at risk for infection by percutaneous or mucosal exposure to blood
  • Current or recent injection-drug users
  • Household contacts of HBsAg-positive persons
  • Residents and staff of facilities for developmentally disabled persons
  • Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids
  • Hemodialysis patients and predialysis, peritoneal dialysis, and home dialysis patients
  • Persons with diabetes aged 1959 years persons with diabetes aged 60 years at the discretion of the treating clinician
  • Others
  • International travelers to countries with high or intermediate levels of endemic hepatitis B virus infection
  • Persons with hepatitis C virus infection
  • Persons with chronic liver disease
  • Persons with HIV infection
  • All other persons seeking protection from HBV infection
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    Selected Safety Information For Recombivax Hb

    Do not administer RECOMBIVAX HB® to individuals with a history of severe allergic or hypersensitivity reactions after a previous dose of any hepatitis B-containing vaccine or to any component of RECOMBIVAX HB, including yeast.

    The vial stopper and the syringe plunger stopper and tip cap contain dry natural latex rubber, which may cause allergic reactions in latex-sensitive individuals.

    Apnea following intramuscular vaccination has been observed in some infants born prematurely. Decisions about when to administer an intramuscular vaccine, including RECOMBIVAX HB, to infants born prematurely should be based on consideration of the individual infants medical status and the potential benefits and possible risks of vaccination. For RECOMBIVAX HB, this assessment should include consideration of the mothers hepatitis B antigen status and high probability of maternal transmission of hepatitis B virus to infants born to mothers who are HBsAg positive if vaccination is delayed.

    Hepatitis B vaccination should be delayed until 1 month of age or hospital discharge in infants weighing < 2000 g if the mother is documented to be HBsAg negative at the time of the infants birth. Infants weighing < 2000 g born to HBsAg positive or HBsAg unknown mothers should receive vaccine and hepatitis B immune globulin in accordance with ACIP recommendations if HBsAg status cannot be determined.

    Vaccination with RECOMBIVAX HB may not protect all individuals.

    Immunogenicity In Hemodialysis Patients:

    Recommended Adult Immunization Schedule

    Hemodialysis patients given hepatitis B vaccines respond with lower titers,12 which remain at protective levels for shorter durations than in normal subjects. In a study in which patients on chronic hemodialysis received 40 mcg of the plasma-derived vaccine at months 0, 1, and 6, approximately 50% of patients achieved antibody titers 10 mIU/mL.12 Since a fourth dose of ENGERIX-B given to healthy adults at month 12 following the 0-, 1-, and 2-month schedule resulted in a substantial increase in the GMT , a 4-dose regimen was studied in hemodialysis patients. In a clinical trial of adults who had been on hemodialysis for a mean of 56 months , 67% of patients were seroprotected 2 months after the last dose of 40 mcg of ENGERIX-B given on a 0-, 1-, 2-, and 6-month schedule the GMT among seroconverters was 93 mIU/mL.

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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.
  • Doses administered at less than the recommended minimum interval should be repeated.
  • 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.

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    What Are The Side Effects Of The Hepatitis B Vaccine

    Mild-to-moderate problems:

    • Soreness, redness, or swelling where the shot was given
    • Headache, tiredness, fever and loss of appetite

    Severe problems :

    • Dizziness

    Over-the-counter pain relievers such as acetaminophen or ibuprofen can help ease pain and reduce fever.

    It’s extremely rare for these vaccines to cause serious harm or death. If the person getting the vaccine has a serious reaction, call the doctor or seek immediate medical attention.

    The hepatitis B vaccine is available at Walgreens Pharmacy. Ages vary by state.*

    If you believe you have a medical emergency, please call 911.

    Tell your doctor or a healthcare provider if the person getting the vaccine has any severe allergies.

    Call the Centers for Disease Control and Prevention at 800-232-4636 or visit www.cdc.gov/vaccines for more vaccine information.

    Vaccine For Hepatitis B

    ACP and CDC issue recommendations for hepatitis B screening, vaccination, and care

    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

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    Table : Routine Childhood Immunization Schedule Infants And Children

    Table 6 – Footnote D

    Recombinant Zoster Vaccine : adults 50 years of age and older – 2 doses, 2 to 6 months apart and at least one year after LZV.

    Table 6 – Footnote E

    Influenza: recommended for all adults without contraindications, with focus on: adults at high risk of influenza-related complications adults capable of transmitting influenza to individuals at high risk adults who provide essential community services and people in direct contact during culling operations with poultry infected with avian influenza. One dose annually.

    What Other Drugs Interact With Hepatitis B Vaccine

    If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

    • Severe Interactions of Hepatitis B Vaccine include:
    • belimumab
  • Hepatitis B Vaccine has serious interactions with at least 37 different drugs.
  • Moderate Interactions of Hepatitis B Vaccine include:
  • daclizumab
  • chloroquine
  • This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.

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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.

    Interchangeability Of Hepatitis B Vaccines

    Recommended Adult Immunization Schedule

    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

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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.

    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:

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    Prevalence Of Chronic Hepatitis B

    The prevalence of chronic hepatitis B virus infection varies between and within countries:58-61

    • < 0.5% among Caucasians in the United States, northern Europe and Australia
    • 15% in Mediterranean countries, parts of eastern Europe, Africa, and Central and South America
    • > 10% in many sub-Saharan African, East and Southeast Asian, and Pacific island populations

    Regions where 2% of the population is positive to hepatitis B surface antigen are considered to have moderate to high prevalence. In these regions, people mainly acquire the infection perinatally or in early childhood.55

    Safety And Adverse Events

    Hepatitis B Vaccination in Younger Diabetes Patients

    Common and local adverse events

    HA vaccine

    HA vaccine is well tolerated. Reactions are generally mild and transient, and are usually limited to soreness and redness at the injection site. Other less frequent reactions include headache, irritability, malaise, fever, fatigue and gastrointestinal symptoms. Injection site reactions occur less frequently in children than in adults as do mild, systemic events . No significant difference in reactions is evident between initial and subsequent doses of vaccine or in the presence of pre-existing immunity.

    HAHB vaccine

    Refer to Hepatitis B Vaccine in Part 4 for information about HAHB vaccine.

    Ig

    Injection site reactions following receipt of standard human Ig include tenderness, erythema and stiffness of local muscles, which may persist for several hours. Mild fever or malaise may occasionally occur.

    Less common and serious or severe adverse events

    Less common side effects following receipt of standard human Ig include flushing, headache, chills and nausea. Urticaria, angioedema and anaphylactic reactions may occur rarely.

    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.

    Contraindications and precautions

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    What Are Dosages Of Hepatitis B Vaccine

    Dosages of Hepatitis B Vaccine:

    Intramuscular suspension

    • 40 mcg/ml

    Intramuscular suspension

    • 5 mcg/0.5 ml
    • 10 mcg/0.5 mg

    Dosage Considerations Should be Given as Follows:

    • Engerix B: 1 mL intramuscularly at 0, 1, and 6 months
    • Recombivax HB: 1 mL intramuscularly at 0, 1, and 6 months
    • Adults receiving dialysis or other immunocompromising conditions
    • Recombivax HB : 40 mcg intramuscularly at 0, 1, and 6 months, OR
    • Engerix-B : 40 mcg intramuscularly at 0, 1, and 6 months

    Routine vaccination

    Catch-up vaccination

    • Unvaccinated children should complete a 3-dose series
    • Children aged 11-15 years: 2-dose series of adult formulation Recombivax HB is licensed for use in children aged 11 through 15 years

    Dosing Considerations

    Administration

    Pediatric:

    Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System , 1-800-822-7967

    This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

    Important Information About Vaccine And Hepatitis B Immunoglobulin Shot Administration

    Where available, the hepatitis B birth-dose and HBIG should be administered within 24 hours of birth in order to prevent the transmission of hepatitis B from mother to child. It is very important that the shots be given in opposite limbs, to ensure the highest effectiveness. Please see chart above for more information.

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    Use With Other Vaccines:

    The ACIP states that, in general, simultaneous administration of certain live and inactivated pediatric vaccines has not resulted in impaired antibody responses or increased rates of adverse reactions.17 Separate sites and syringes should be used for simultaneous administration of injectable vaccines.

    Us Children And Adult Hepatitis B Vaccine Schedules

    Recommended Adult Immunization Schedule
    *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 Children and Adults

    The hepatitis B vaccine is an injection that is generally given in the arm as a three-dose series on a 0, 1, and 6-month schedule. Alternative schedules may be considered, noting that a third dose at 6 months, meeting minimum intervals between doses, is needed for maximum, long-term protection. 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.

    There are three, 3-dose vaccine brands approved in the U.S.

    2-Dose Vaccine Series

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