People With Other Medical Conditions
People with chronic liver disease and/or hepatitis C are recommended to receive hepatitis B vaccine if they are not immune
Hepatitis B vaccination is recommended for people with chronic liver disease and/or hepatitis C who are seronegative for hepatitis B. This is because they may have an increased risk of hepatitis B and/or severe liver disease after hepatitis B.11
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.
Levels of antibody to hepatitis B surface antigen should be checked after the vaccination course. See Serological testing after hepatitis B vaccination.
The combination hepatitis A-hepatitis B vaccine may be appropriate for people with chronic liver disease and/or hepatitis C if they are not immune to either disease. This is because they have an increased risk of hepatitis B and/or severe liver disease after hepatitis A and B. This is usually given in 3 doses using Twinrix . See Table. Combination hepatitis A-hepatitis B vaccines in Vaccines, dosage and administration.
Low-birthweight and preterm newborns do not respond as well to hepatitis Bcontaining vaccines as full-term infants.12-14
How Can I Prevent Spreading Hepatitis C To Others
If you have hepatitis C, follow the steps above to avoid spreading the infection. Tell your sex partner you have hepatitis C, and talk with your doctor about safe sex practices. In addition, you can protect others from infection by telling your doctor, dentist, and other health care providers that you have hepatitis C. Dont donate blood or blood products, semen, organs, or tissue.
Aboriginal And Torres Strait Islander People
Aboriginal and Torres Strait Islander people are recommended to:
- have their risks and vaccination status for hepatitis B reviewed
- receive testing for previous hepatitis B virus infection
- receive vaccination if non-immune
Aboriginal and Torres Strait Islander people have a higher risk of acquiring new hepatitis B virus infection than non-Indigenous Australians.2,3
Adult-formulation hepatitis B vaccine should be given in a 3-dose schedule.
Children with HIV are recommended to receive 3 doses of hepatitis B vaccine using an adult formulation. This is double the recommended dose for children. In a limited number of studies, children who were immunocompromised responded better when given higher doses in a 3-dose schedule.4,5
Levels of antibody to hepatitis B surface antigen should be checked after the vaccination course. See Serological testing after hepatitis B vaccination.
Adults with HIV are recommended to receive larger-than-usual doses of hepatitis B vaccine. They should receive 2 injections of the standard adult dose on each occasion at 0, 1, 2 and 6 months. Limited studies in adults with HIV have revealed an improved and accelerated serological response to a schedule that consists of 4 double doses.6,7
A 3-dose schedule at 6, 8 and 12 months after transplant is required using:
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Persons With Inadequate Immunization Records
Children and adults lacking adequate documentation of immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors. HA vaccine may be given, if indicated, regardless of possible previous receipt of the vaccine or pre-existing immunity, because adverse events associated with repeated immunization have not been demonstrated.
Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information about vaccination of people with inadequate immunization records.
How Do People Get Hepatitis C
Hepatitis C virus is found in the blood of people with HCV infection. It enters the body through blood-to-blood contact.
Until reliable blood tests for HCV were developed , people usually got hepatitis C from blood products and blood transfusions. Now that blood and blood products are tested for HCV, this is no longer the typical means of infection.
Currently, people usually get hepatitis C by sharing needles for injection drug use. An HCV-infected woman can pass the infection to her baby during birth. It is also possible to get hepatitis C from an infected person through sexual contact, an accidental needlestick with a contaminated needle, or improperly sterilized medical, acupuncture, piercing, or tattooing equipment.
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Are There Any Side Effects To Twinrix
Like any drug, the Twinrix vaccine can trigger side effects, but the chance of severe side effects is exceptionally low.
Very Common side effects felt in more than 10% of people receiving the vaccine are:
- Headache
- Pain and redness at the injection site
Common side effects felt between 1% and 10% of people receiving the vaccine are:
- Diarrhea
- Nerve disorders
Very rare in less than 0.01% of people receiving the vaccine are hives.
Still, you should call your doctor or hospital if you have critical or unusual reactions after receiving the vaccine.
International 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.
The hepatitis B vaccine is an injection that is generally given in the arm and as a three-dose series. The World Health Organization recommends a 0, 1, and 6-month vaccine schedule, though schedules may vary based on a countrys national immunization program. 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. Please note that the vaccine brand name, manufacturer and associated schedules for adults, children and infants may be unique to different countries, though there is a list of WHO prequalified vaccines.
3-Dose Vaccine Series for Infants
The World Health Organization recommends all infants receive the first dose of the hepatitis B vaccine within 24 hours of birth and to complete the vaccine series with additional shots at 1 month and 6 months of age. Beginning the hepatitis B vaccine at birth will ensure protection against hepatitis B for life.
3-Dose Vaccine Series for Children and Adults
4-Dose Combination Vaccine Series for Infants
Additional Resource Links:
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Side Effects Requiring Immediate Medical Attention
Along with its needed effects, hepatitis a adult vaccine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur while taking hepatitis a adult vaccine:
More common
- Fever more than 99.5 degrees F
- general feeling of discomfort or illness
- unusual tiredness or weakness
- difficulty with breathing or swallowing
- dryness or soreness of the throat
- ear congestion
- itching, especially of the feet or hands
- loss of voice
- swelling of the eyes, face, or inside of the nose
- swollen, painful, or tender lymph glands in the neck, armpit, or groin
- tender, swollen glands in the neck
- tightness in the chest
- unusual tiredness or weakness
- voice changes
How Many People Have Hepatitis C
During 2013-2016 it was estimated that about two and half million people were chronically infected with HCV in the United States. The actual number may be as low as 2.0 million or as high as 2.8 million.Globally, hepatitis C is a common blood-borne infection with an estimated 71 million people chronically infected according to the World Health Organization .
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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
Infants Born To Mothers Who Have Hepatitis B: 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.
Protecting Your Baby
Infants born to women with hepatitis B must receive accurate doses of hepatitis B vaccine and hepatitis B immune globulin to ensure complete protection. In order to protect these infants, medications should be given immediately after birth in the delivery room or within the first 12-24 hours of life*.
* See Testing and Treatment During Pregnancy section for details. Please note that testing of all pregnant women for hepatitis B is a global recommendation.
3-Dose Vaccine Series for Infants
The World Health Organization recommends that infants born to hepatitis B positive mothers receive the first dose of the hepatitis B vaccine within 24 hours of birth, and ideally a dose of hepatitis B immunoglobulin . These shots must be followed by the additional vaccine doses given on the recommended schedule. In the U.S., infants should follow a 1 month and 6-month schedule for the additional two doses.
4-Dose Combination Vaccine Series for Infants
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Opioid Use A Key Factor In Rising Infection Rates
Importantly, a large proportion of opioid users are among the population of patients born before the mid-90s and those adults have a particularly high risk of transmission, with data indicating that 36% of new hepatitis B infections are the result of the opioid epidemic, Kuwahara noted.
In the opioid epidemic, we have seen some of the greatest increases in acute hepatitis B presenting in adults aged 30 to 49 years old, as most adults in this age range would not have been vaccinated as children in the US, she said.
Approximately two thirds of individuals with chronic hepatitis B are reportedly not even aware of their infection status due to ineffective prevention and vaccination programs, adding to the spread of infection, Kuwahara said.
Meanwhile, COVID-19 has only exacerbated the problem, with record-high instances of overdoses and overdose-related deaths during the pandemic, she explained.
However, the pandemic, and specifically the sweeping innovations that have been implemented in desperate efforts to bring COVID-19 vaccines to the public, could in fact represent a critical opportunity for hepatitis B prevention, Kuwahara said.
Significant resources and federal funding have already been invested to develop a robust infrastructure for multi-dose COVID-19 vaccine administration during the pandemic, which has resulted in millions of people across the US receiving the COVID-19 vaccine in easily accessible settings within their communities, she said.
Protecting The Blood Supply
One of the main problems with preventing hepatitis C is that most people who are infected donât show symptoms at first. Many only find out when they have a blood test for an unrelated reason. Until relatively recently, this often led to infected blood and organs being used in transfusions and transplants.
As of July 1992, all blood and organ donations are screened for the hepatitis C virus. Although not perfect, only about 1 in 2 million blood transfusions may transmit hepatitis C. Anyone who received a blood transfusion or organ donation before July 1992 should be tested for the virus.
As of 1987, all blood products for the treatment of hemophilia are treated to remove infectious viruses, such as hepatitis C and HIV. The CDC recommends that anyone over the age of 18 get tested for Hepatitis C. If you haven’t been screened, you should consider having it done and if you took any of these blood products before 1987, you should be proactive in being tested for hepatitis C.
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Complications Of Hepatitis C
If the infection is left untreated for many years, some people with hepatitis C will develop scarring of the liver .
Over time, this can cause the liver to stop working properly.
In severe cases, life-threatening problems, such as liver failure, where the liver loses most or all of its functions, or liver cancer, can eventually develop.
Treating hepatitis C as early as possible can help reduce the risk of these problems happening.
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
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Preventing Hepatitis A B & C
The three most common types of hepatitis, a disease characterized by inflammation of the liver, are those caused by the hepatitis A, B, and C viruses. All viral types are contagiousthat is, they can be spread from one person to anotheralthough the methods of transmission vary.
NYU Langone doctors recommend specific preventive steps for each type to limit your risk of acquiring or spreading infection.
Other Risks Can Include:
- Sharing personal care items that may have come in contact with another persons blood, such as razors, toothbrushes or nail clippers
- Inoculation practices involving multiple use needles or immunization air guns
- Exposure of broken skin to HCV infected blood
- HIV infected persons
People with current or past risk behaviors should consider HCV testing and consult with a physician. HCV testing is currently not available at most public health clinics in Missouri. For information about HCV testing that is available, call the HCV Program Coordinator at 573-751-6439.
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Will My Immunization Be Recorded
Your immunization records are registered in a computerized network known as the Immunization Records and Yellow Cards. While this one is specific to Ontario, each province has their own.
They can use information obtained in these databases to:
- Maintain immunization data
- Inform you whether or when you or your family members need an immunization
- Track how well vaccinations perform to prevent vaccine-preventable infections
You can also share your immunization history with health care providers for the provision of social health services to aid with assessment and treatment and monitor the spread of infectious illnesses.
Regional Childhood Vaccination Of Hepatitis A
In some countries where the epidemiological pattern of hepatitis A is not homogenous in all regions, regional vaccination of HepA instead of UCVP is conducted among children. According to the WHO, four countries implement regional childhood vaccination of hepatitis A, including Canada, Italy, Romania and the Russian Federation. Due to a relatively high prevalence of hepatitis A in Puglia , HepA has been offered free to all children aged 1518 months and preadolescents aged 12 y by the local government in this region since 1998. Between 1998 and 2009, the incidence of acute hepatitis A declined from 14.8 to 0.8 per 100,000 in Puglia. The strategy of regional vaccination of HepA is based on the good operation of the surveillance system of hepatitis A. In countries where hepatitis A infection varies greatly with geographic location, regional vaccination of HepA is more economical than the UCVP.
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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 Of Hepatitis Vaccines
Hepatitis vaccines have been given to millions of people all across the world without any evidence of serious side effects. “They’re very safe, and they’re extremely effective,” says Poland.
If you are not sure whether you should have hepatitis vaccines, talk with your doctor about your specific concerns.
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Who Should Receive Twinrix
According to Canadian medical advice, the vaccine is required for all those seeking to minimize their hepatitis A and B infection risk. Twinrix is used for vaccinating adults, teenagers, youngsters and babies above one year of age.
In specific, vaccination against hepatitis A is suggested for:
- Travellers to countries or areas with a risk for hepatitis A
- The Canadian armed forces, emergency organization, or any other organization likely to be sent at short notice to high-risk areas for hepatitis A
- Zoo workers, veterinarians, and researchers
- People diagnosed with liver disease
- Hemophiliacs
Hepatitis B vaccination is prescribed for those who:
- Travellers to countries or areas with a risk for hepatitis B
- Nurses, including medical students
- People in contact with someone with hepatitis B
- People who use medication through injections
- Hemophiliacs
- Immigrants and students coming to Canada