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.
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 four, 3-dose vaccine brands approved in the U.S.
- PreHevbrio PreHevbrio is only approved for adults age 18 and over.
2-Dose Vaccine Series
Hepatitis A Vaccine: Canadian Immunization Guide
For health professionals
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
Who Should Get The Hepatitis B Vaccine
The CDC recommends it for all babies, who should get their first dose as newborns.
Other people who need it include:
- People younger than age 19 who haven’t been vaccinated
- Anyone who has a sex partner with hepatitis B
- People who are sexually active but arenât in a long-term relationship in which both partners are monogamous
- Anyone being evaluated or treated for an STD
- Men who have sex with men
- People who share needles used to inject drugs
- Anyone who lives with someone who has hep B
- Anyone whose job routinely puts them at risk for coming in contact with blood or blood-contaminated body fluids
- People with end-stage kidney disease
- People who live and work in facilities for people who are developmentally disabled
- Travelers to regions with moderate to high rates of hepatitis B
- People with chronic liver disease
- People with HIV infections
You should not get the vaccine if you had a severe allergic reaction to an earlier dose or are allergic to yeast, because yeast is used to make the vaccine.
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Transporting Storing And Handling Vaccines
Transport according to National Vaccine Storage Guidelines: Strive for 5.87 Store at +2°C to +8°C. Do not freeze. Protect from light.
Infanrix hexa must be reconstituted. Add the entire contents of the syringe to the vial and shake until the pellet completely dissolves. Use reconstituted vaccine as soon as practicable. If it must be stored, hold at room temperature for no more than 8 hours.
Is There A Hepatitis C Vaccine
Currently, no vaccine protects you against hepatitis C. But research is ongoing. A promising study is currently researching a possible vaccine for both hepatitis C and HIV.
However, there are vaccines for other hepatitis viruses, including hepatitis A and hepatitis B. If you have hepatitis C, your doctor may suggest that you get these vaccines. Thats because hepatitis A or B infection can lead to further complications when treating hepatitis C.
Preventing other forms of hepatitis is especially important if your liver has already been damaged.
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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.
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.
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Which Adults Should Receive The Hepatitis A Vaccine
The CDC recommends that adults have the hepatitis A vaccine if you:
- Are traveling to or working in countries where hepatitis A is common this disease is much more common than cholera or typhoid among international travelers.
- Will have close contact with an international adoptee from a country where hepatitis A is common
- Are a man who has sex with men
- Use street drugs
- You are pregnant because it may affect the outcome of your pregnancy
- Work with primates infected with hepatitis A or with the virus in a research lab
Also, if you work with food, you should consider getting the hepatitis A vaccine.
Hepatitis C Virus Particle Composition
HCV is a positive-sense, enveloped, single-stranded RNA virus that is part of the genus Hepacivirus in the Flaviviridae family . The viral genome is roughly 9 kb long and encodes a single polyprotein that is cleaved into multiple functional segments by viral and cellular proteases . The functional segments can be further divided into structural and nonstructural components . While many of the functions of these components are known, the full understanding is still incomplete .
HCV contains three structural proteins that are located in the lipid envelope that covers the virus . The structural proteins main functions are to facilitate assembly of the capsid structure and entry into cells . The NS proteins, of which there are seven , are the main targets for current DAA therapies and perform a variety of functions that allow the virus to replicate within host cells .
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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
Screen For Contraindications And Precautions
- Do not administer Heplisav-B to individuals with a history of severe allergic reaction after a previous dose of any hepatitis B vaccine or to any component of Heplisav-B, including yeast.
- Consult the package insert for precautions, warnings, and contraindications and Hepatitis B Vaccine Safety for additional information and possible side effects.
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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
Limitations Of Models For Hepatitis C Virus Vaccination
The development of an HCV vaccination has proven to be a difficult task not only due to complex HCV virology that makes identifying a universal target for antibodies elusive, but also because of limited appropriate preclinical animal models. While humans are the natural reservoir of HCV, human and even chimpanzee experimental conditions for a vaccine are ethically challenging. Many animal studies use chimeric humanized mouse models and HCV analogues from the Hepacivirus genus, which are attempted simulations of the actual human-HCV relationship .
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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 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, HA vaccine is in limited use.
HA vaccination should be considered for all persons from HA-endemic countries. Individuals born in HA-endemic countries are more likely to be immune to HA therefore, serologic testing for immunity before HA immunization should be considered. If persons from HA-endemic countries are not immune, they should be offered HA immunization because they are at increased risk for HA exposure through visits to their country of origin, or when receiving friends and family from their country of origin.
In addition, persons new to Canada should be tested for hepatitis C antibody and susceptible persons chronically infected with hepatitis C should be vaccinated against HA and HB. Persons new to Canada should also be tested for HB and vaccinated against HA if found to be a HB carrier. Household or close contacts of children adopted from HA-endemic countries should be immunized with HA-containing vaccine. Adults travelling to pick up adopted children from HA-endemic countries should be vaccinated before departure.
Refer to Immunization of Persons New to Canada in Part 3 for additional information about vaccination of people who are new to Canada.
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Interchangeability Of Hepatitis A Vaccines
Vaccine manufacturers use slightly different methods to produce the vaccines and quantify the hepatitis A virusantigen content. All monovalent hepatitis A vaccines that are given as a 2-dose course are interchangeable. See Table. Recommended doses and schedules for monovalent hepatitis A vaccines.
Schedules that mix combination hepatitis A/hepatitis B vaccines with monovalent vaccines are not routinely recommended.
An adult dose of Twinrix 720/20 contains half the hepatitis A antigen content of an adult dose of Havrix adult vaccine. These vaccines are therefore not interchangeable.
The only absolute contraindications to hepatitis A vaccines are:
- anaphylaxis after a previous dose of any hepatitis A vaccine
- anaphylaxis after any component of a hepatitis A vaccine
Combination hepatitis A/hepatitis B vaccines are contraindicated in people with a history of anaphylaxis to yeast.
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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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.
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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Hepatitis C Virus Genome
The HCV genome is roughly 9 kb long with seven known genotypes, and there are at least 67 subtypes of HCV identified . Given this genetic diversity, producing a vaccine that is active against all genotypes and subtypes is a monumental task. Moreover, the HCV NS5B polymerase, the target of drugs such as sofosbuvir, can generate genetically distinct but related species within a single host known as quasispecies . This is largely due to the fact that NS5B does not have a proof-reading mechanism to correct errors in replication . This generation of quasispecies within an individual can select for viral resistance to host immune responses, further hindering development of a broadly reactive vaccine .
Are There Any Dangers Or Side Effects Associated With The Vaccine
It’s good to know you cannot become infected by getting the hepatitis A vaccine. But in very rare cases, people can have a severe allergic reaction to the hepatitis A vaccine. This occurs within a few minutes to hours of getting the shot. In extremely rare cases, this reaction can be fatal. It’s important to remember that the risks from the disease are much greater than the risk from the vaccine itself.
Signs of a severe reaction to the hepatitis A vaccination include:
- High fever
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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