How Do Doctors Test For Hepatitis B Immunity
Doctors may order a panel of blood tests to check if someone has HBV:
- Hepatitis B surface antigen : This test looks for the presence of HBV in the blood by looking for antigens found on the virus. A positive result means that a person has HBV.
- Hepatitis B surface antibody : This test can show if a person is immune and protected against HBV. A positive result indicates that the person has overcome a past HBV infection or it is the result of receiving the hepatitis B vaccine.
- Hepatitis B core antibody : This test looks for another antibody in the HBV, but this one does not provide protection. A positive result indicates that a person had a past infection or currently has HBV.
Some people with certain risk factors for hepatitis B infection, such as those who inject drugs, pregnant people, and other populations, may require testing postvaccination to check their immunity.
Whats The Difference Between Acute And Chronic Hepatitis B
Hepatitis B can be either acute or chronic:
- Acute hepatitis B lasts for a short period of time. If you have acute hepatitis B, you may be asymptomatic or have symptoms and develop icteric hepatitis. It can transition into chronic hepatitis B if the virus doesnt naturally go away after 6 months.
- Chronic hepatitis B lasts for at least 6 months. If you have this type of hepatitis, you may carry the hepatitis B virus for the rest of your life. Its possible to have chronic hepatitis B that started as acute, but many people dont have acute hepatitis B first.
Most people with acute hepatitis B make a full recovery. Some may never even show any symptoms. But those with chronic hepatitis B often need treatment to help manage the infection. Chronic hepatitis B also increases your risk of developing cirrhosis and certain types of liver cancer.
Your risk of developing chronic hepatitis B depends on when you first received your diagnosis of the virus. Children who receive a diagnosis of hepatitis B, especially those under the age of 5 years old, have a higher risk of the infection becoming chronic. Adults are less likely to develop chronic hepatitis B. Around 90 percent of adults who develop it will fully recover.
Keep in mind that hepatitis B can be present for years before you start to show any symptoms.
How Safe Is The Hepatitis B Vaccine
The hepatitis B vaccine is totally safe for most people. Most babies, kids, and adults have no problems at all when they get the vaccine. In fact, more than 100 million people in the U.S. have gotten the hepatitis B vaccine.
Like all medicines, the hepatitis B vaccine may have some mild side effects: soreness, change in skin color, swelling, or itching around where you get the shot, or a slight fever. But these things arent serious and usually go away pretty quickly. Theres an extremely small risk of having an allergic reaction to the vaccine.
If you get dizzy, feel your heart beating really fast, have a high fever, feel weak, break out in hives, or have trouble breathing, get medical help right away. But again, the risk of having an allergy is super small.
You CANT get hepatitis from the hepatitis vaccine.
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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.
Adequate Response After Hbv Vaccination
Several possible questions can be raised concerning the characteristics of anti-HBs antibodies:15 A) Is there a titer effect ? B) Is there a delay in the antibody response? C) Is the antibody persistent or boosters required? D) Does the vaccine-stimulated anti-HBs offer the same protection as naturally arising anti-HBs?
Several clinical trials have been performed to investigate the most optimal and effective vaccine dose and schedule of vaccination in different subject groups like adults, infants and neonates, and immune-suppressed patients.16 The ideal vaccine will produce sufficient titer with minimal delay, remain persistent and offer the same protection as naturally acquired anti-HBs.17 The antibody titer after vaccine administration ranges from < 10 IU/L to > 10000 IU/L.18 At least three doses are necessary for a minimally acceptable immune response .19 The anti-HBs titer declines very fast, within 12 months, and comparatively slowly thereafter.16 Advanced models with mathematical algorithms can predict such a declining trend.20
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For How Long Is The Hepatitis B Vaccine Effective
The duration of immunity to hepatitis B virus from plasma-derived vaccine was generally believed to be around 10 years. However, rigorous determination of the upper time limit for immunity has not been carried out. Such information could be useful in devising vaccination schedules and possibly for developing public health policy with respect to the rationale for and timing of booster vaccinations.
McMahon and colleagues at the Centers for Disease Control and Prevention studied 1578 Alaska Natives vaccinated at age 6 months or older between 1981 and 1982. Subjects received three doses of plasma-derived hepatitis B vaccine appropriate for their age, and were tested annually for antibodies to hepatitis B surface antigen and HBV infection markers for the first 11 years.
Anti-HBs levels decreased in the study population from a mean concentration of 822 mIU/mL after vaccination to 27 mIU/mL at 15 years. Higher levels of anti-HBs were noted in males, individuals with higher initial anti-HB levels, and those who were older at the time of vaccination. After adjusting for initial anti-HBs level and sex, the lowest HBs levels at 15 years post-vaccination were observed in those vaccinated between 6 months and 4 years of age.
Researchers detected asymptomatic breakthrough infections in 16 participants. Infection occurred more frequently in vaccine non-responders than in responders .
Action Points
Primary Source
Annals of Internal Medicine
Do The Benefits Of The Hepatitis B Vaccine Outweigh Its Risks
Every year in the United States about 2,000 people die following an overwhelming hepatitis B virus infection. In addition, every year about 22,000 people are infected with hepatitis B. Some of them will remain chronically infected, putting them at high risk of the long-term consequences of hepatitis B virus infection: cirrhosis and liver cancer. In fact, with the exception of influenza and COVID-19 viruses, hepatitis B virus causes more severe disease and death in the United States than any other vaccine-preventable disease. On the other hand, the hepatitis B vaccine is an extremely rare cause of a severe allergic reaction called anaphylaxis. To date, no one has died from this reaction, but it is theoretically possible that this could occur.
Because hepatitis B virus is a common cause of severe disease and death in the United States, and because the hepatitis B vaccine does not cause permanent damage or death, the benefits of the hepatitis B vaccine clearly outweigh its risks.
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Clinical Development Of The Hbv Vaccine
The HBV vaccine trials are carried out in individuals who are anti-HB or HBsAg negative.17 An ideal population to study an HBV vaccine is the one with a higher risk of infection that can be attributed mainly to environmental circumstances. Further, the infected individuals should develop and retain the antigen for a sufficient time. HBsAg detection could help to identify any infection and the subjects would not develop anti-HB without producing HBsAg first.17 An HBV vaccine developmental plan should consider the target population and the sociocultural aspects, the risk for the target disease and vaccine, the incidence of HBV infection and related environmental factors, the proper dose and route of administration, induction of herd immunity, and regulatory requirements.40
Complications Of Hepatitis B
A small proportion of people who become infected with the hepatitis B virus develop a long-term hepatitis B infection. They may have the virus in their bloodstream for most of their life without realising they are infected.
People with chronic hepatitis B infection may not notice any health problems until they develop liver problems such as liver disease or liver cancer later in life. Treatment for hepatitis B is essential because it is not possible to be a healthy carrier of the hepatitis B virus. Chronic hepatitis B infection occurs more commonly in some communities, including:
- Aboriginal and Torres Strait Islander communities.
- In people from parts of the world where hepatitis B is more common, such as:
- North-East Asia
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Regulatory Recommendations For Clinical Development Of Recombinant Hbv Vaccines
The WHO guidelines on clinical investigation of HBV immunoglobulins recommends that new or significantly modified recombinant HBV vaccine formulations should have extensive product characterization, immunogenicity testing, safety testing and proof-of-concept studies in animals. Variations in manufacturing, alteration in vaccine formulation or change in the route of administration require immunogenicity studies together with adequate animal safety/toxicological studies.39,44 Pre-clinical investigation of HBV vaccines should follow WHO guidelines.39 As no effects, apart from those on immunity, are expected with sole HBV vaccines, safety pharmacological studies are also not required. Toxicology studies should be performed as per WHO guidelines.39 Such studies should also reflect the intended clinical use of the vaccine in special populations like neonates and children. The assessment of immune responses should rely on the anti-HBsAg antibody titer in serum, using a validated and standardized assay.
What Is Hepatitis B Vaccine
Hepatitis B vaccine gives protection against infection from the hepatitis B virus. The vaccine works by causing the body to produce antibodies against the virus responsible for hepatitis B infection and in this way protects against the disease. Hepatitis B is a virus that is easily spread through contact with the blood or bodily fluids of an infected person. For example, it can be passed on through unprotected sex, by sharing injection gear, through a needle stick injury or from mother to child during childbirth. Hepatitis B infection can cause serious problems including liver failure, cirrhosis, and liver cancer. Preventing infection can prevent these problems. Read more about hepatitis B.
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Hepatitis B Vaccine Side Effects
The hepatitis B vaccine is considered a very safe and effective vaccine. Its made with an inactivated virus, so most types of the vaccine are even safe for pregnant people.
The hepatitis B vaccine may cause some mild side effects. The most common symptom is redness, swelling, or soreness where the injection was given. Some people also experience headache or fever. These effects usually last a day or two .
Rarely, some people have a serious and potentially life threatening allergic reaction to the vaccine. Call 911 or get to a hospital immediately if you experience any of the following symptoms after vaccination:
Who Should Get A Hepatitis B Vaccine
Vaccination against hepatitis B is recommended for everyone. But, some groups are at an increased risk. These include the following individuals:
- Men who have sex with men
- Inject drugs or share needles
- Live with a person with chronic hepatitis B
- Hemodialysis patients
- Travellers to regions with hepatitis B transmission.
Those who are allergic to products within the vaccine and some individuals with certain health conditions. Consult with a travel health specialist to learn if the vaccine is right for you and your situation.
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Does The Hepatitis B Vaccine Have Side Effects
Some children will develop pain or soreness in the local area of the shot, and low-grade fever.
There is one extremely rare, but serious, side effect. About 1 out of every 600,000 doses of the hepatitis B vaccine will cause a severe allergic reaction, called anaphylaxis, with symptoms including swelling of the mouth, difficulty breathing, low blood pressure or shock. Anaphylaxis usually occurs within 15 minutes of receiving the vaccine. Although anaphylaxis can be treated, it is quite frightening. People should remain at the doctors office for about 15 minutes after getting the vaccine.
Although the hepatitis B vaccine is made in yeast cells, no one has ever been shown to be allergic to the yeast proteins contained in the hepatitis B vaccine .
If I Already Have Hepatitis B Can The Vaccine Treat It
No. The hepatitis vaccine prevents hepatitis, but doesnt cure it if you already have it. If you have hepatitis B, there are other treatment options.
However, if you recently got exposed to the hepatitis B virus and you havent had the vaccine yet, tell your doctor right away. The vaccine and possibly other treatment can reduce your chances of getting hepatitis B if you get it within 2 weeks after you came into contact with the virus. The sooner you seek care after being exposed to hepatitis B, the better, so try to get there right away.
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Adjuvants In Recombinant Hbv Vaccines
Modern recombinant vaccines are very refined and contain less antigenic components . As a result, adding adjuvants is essential to induce a better immune response. Among the adjuvants, aluminum salts are widely used. These salts can form insoluble particles, cause retention and release of vaccine antigens gradually like a depot, and thereby induce innate immunity.14 The various adjuvant systems used with recombinant HBV vaccines are AS01B , AS01E , AS02A , AS02B , AS02V , AS03 , AS04 , etc.14
Indications For Hepatitis B Vaccine
HepB vaccine is a routine childhood vaccination .
HepB vaccine also is indicated for adults who have not been previously vaccinated when any of the following is present:
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A desire for protection from hepatitis B in people who have not been previously vaccinated
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A sexually active lifestyle in people who are not in a long-term, mutually monogamous relationship
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Need for evaluation or treatment of a sexually transmitted infection
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Current or recent use of illicit injection drugs
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Sex between men
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Employment in which workers may be exposed to blood or other potentially infectious body fluids
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Diabetes in people < 60 years and sometimes in those 60 years
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End-stage renal disease
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A chronic liver disorder
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Household contact and/or sexual contact with people who are positive for hepatitis B surface antigen
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Travel to endemic areas
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Time spent in correctional facilities or in facilities that provide sexually transmitted infection treatment, HIV testing and treatment, drug abuse treatment and prevention services, services to injection-drug users or men who have sex with men, or care for patients with developmental disabilities or with end-stage renal disease
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Pregnant women if at risk of infection or severe outcome resulting from infection during pregnancy
The combination HepA and HepB vaccine can be used in people 18 years who have indications for either hepatitis A or hepatitis B vaccine and who have not been previously vaccinated with one of the vaccine components.
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Pregnancy And Hepatitis B
Doctors must closely monitor pregnant people who have HBV.
There is a risk that the virus can pass from parent to child during delivery without the correct treatment. Therefore, all people should receive hepatitis B testing during pregnancy. A person with chronic hepatitis B should talk with a doctor about the risks and benefits of antiviral treatment while pregnant.
According to the Hepatitis B Foundation, if someone has HBV, their newborn must immediately receive the first dose of the hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth. The infant should then receive the second and third doses of the vaccine according to the standard childhood immunization schedule.
Pregnant people unsure of their vaccination status can receive the hepatitis B vaccine during pregnancy and breastfeeding or chestfeeding.
However, there is currently not enough safety information about Heplisav-B and PreHevbrio, so pregnant people
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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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
- 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.