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.
Why I Recommend Hepatitis B Vaccination To All My Patients
Sandra Adamson Fryhofer, MD
Editors Note: This report has been updated to reflect information on hepatitis B vaccines that became available after the video was recorded.
This transcript has been edited for clarity.
Hello. I’m Dr Sandra Fryhofer. Welcome to Medicine Matters. The topic: the new hepatitis B vaccination recommendations for 2022. Here’s why it matters.
Each year, more than 20,000 people in the United States contract acute hepatitis B, with healthcare costs of more than a billion dollars. As many as 40% of them have complications. Hepatitis B can lead to chronic hepatitis infection and liver cancer, and 15%-25% of those infected will die prematurely of cirrhosis or liver cancer. This is needless suffering and death.
Hepatitis B infection is vaccine preventable. We have several vaccine versions to choose from, and they work. The older, three-dose hepatitis B vaccine preparations are more than 90% protective. Immunity is durable, lasting at least three decades.
Two newer vaccines are now available, but only for those aged 18 or older. One of them, Heplisav, contains a new adjuvant, CpG 1018. Its two-dose series can be completed in just 1 month.
For Medicine Matters. I’m Dr. Sandra Fryhofer.
Routine Administration Schedule For Hepatitis B Vaccine In Adults
- The dosing schedule is 0, 1 to 2 months, and 4 to 6 months.
- There is some flexibility in the schedule, but be sure to keep in mind the minimum intervals between doses:
- At least four weeks between doses #1 and #2
- At least eight weeks between doses #2 and #3
- At least 16 weeks between doses #1 and #3
- If your patient falls behind on the hepatitis B vaccination schedule , continue vaccinating from where your patient left off. The series does NOT need to be restarted.
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What Occupations Have Increased Risk Of Hepatitis B
In general, occupational groups with increased risk include:
- Health-care workers repeatedly exposed to blood or blood products or those who are at risk of needlestick injury.
- Pathologists, laboratory personnel, or embalmers.
- Dentists, dental assistants, and dental hygienists.
- Certain staff members of institutions for the developmentally handicapped.
- Staff of institutions where workers may be exposed to aggressive, biting residents.
Travellers to regions with intermediate or high rates of endemic HBV infection may also consider being vaccinated.
What Are The Possible Reactions After The Vaccine
Vaccines are very safe. It is much safer to get the vaccine than to get hepatitis B.
Common reactions to the vaccine may include soreness, redness and swelling where the vaccine was given. Some may experience a mild fever.
For more information on Reye Syndrome, see HealthLinkBC File #84 Reye Syndrome.
It is important to stay in the clinic for 15 minutes after getting any vaccine because there is an extremely rare possibility, less than 1 in a million, of a life-threatening allergic reaction called anaphylaxis. This may include hives, difficulty breathing, or swelling of the throat, tongue or lips. Should this reaction occur, your health care provider is prepared to treat it. Emergency treatment includes administration of epinephrine and transfer by ambulance to the nearest emergency department. If symptoms develop after you leave the clinic, call 9-1-1 or the local emergency number.
It is important to always report serious or unexpected reactions to your health care provider.
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Poor Response To Hbv Vaccination
Unresponsiveness to HBV vaccination is considered as a serum anti-HBs titer < 10 IU/L after an initial course of vaccination.25 A flaw in the T cell compartment-specific for HBsAg is the principal factor.16 Hindering effect on anti-HBs response is caused by old age, smoking, body mass index, gender, concomitant chronic disease,16 gluteal vaccination, hemodialysis, immunodeficiency,15,26 chronic HBV infection, celiac disease, inappropriate storage conditions, etc.27 Cirrhotic patients might be at higher risk for flares from immune-mediated hepatitis after HBV vaccination.4 The absence of a satisfactory response may be due also to genetic predispositions linked to the major histocompatibility complex. Considering the other factors, a meta-analysis has shown that there was no statistical correlation between alcoholism or different vaccination schedules and response to HBV vaccination.26
What Is The Hepatitis A Vaccine
The hepatitis A vaccine is a dose of inactive virus that stimulates your natural immune system. After the hepatitis A vaccine is given, your body makes antibodies that will protect you against the hepatitis A virus.
Vaccination for hepatitis A requires 2 shots, 6 months apart. The vaccine is given with an injection, into the muscle of the upper arm. If for some reason the second injection doesn’t take place at 6 months, you can receive the second dose at a later time.
If you need hepatitis B vaccination in addition to hepatitis A, you can do these individually or as a combined vaccine that covers both. The combination vaccine is given as 3 injections over a 6-month period–an initial dose, followed by a second dose 1 month later, and then a third dose 5 months after the second.
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For Adults At High Risk Of Exposure
Adults who have not received the hepatitis B vaccine series should be immunized when they have an increased risk of exposure. Job, travel, health condition, or lifestyle all may increase a person’s risk of contracting hepatitis B.
People who live or work where there is risk of exposure include:
- Health care and public safety workers who are likely to be exposed to blood or blood products.
- Clients and staff of institutions or residential settings with known or potential HBV carriers.
- People planning extended travel to China, Southeast Asia, Africa, and other areas where hepatitis B infection is high.
People who have health conditions that put them at high risk for exposure or a severe infection include:
- People who have a severe kidney disease that requires them to have their blood filtered through a machine .
- People who have chronic liver disease.
- People who have hemophilia and other conditions in which they need to have blood products on an ongoing basis.
- People who had a stem cell transplant.
People whose lifestyle puts them at high risk for exposure include:
- People who inject illegal drugs.
- Men who have sex with men.
- People who have had more than one sex partner in the past 6 months or who have a history of sexually transmitted infection.
- Household contacts and sex partners of hepatitis B carriers.
- Prison inmates.
Who Should Not Receive The Hepatitis B Vaccine
Talk to your healthcare provider before getting the hepatitis B vaccine if:
- You have had a severe allergic reaction to the hepatitis B vaccine or any of its ingredients in the past.
- You have had an allergic reaction to yeast in the past.
- You are moderately or severely ill.
- You are currently taking immunosuppressive medications.
In addition, pregnant people should not receive the Heplisav-B or PreHevbrio vaccines until more safety information is available.
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Who Should Receive The Hepatitis B Vaccine
For most people, the hepatitis B vaccine is safe and effective. About 90% of people who receive three vaccine doses are protected against hepatitis B for over 30 years.
The CDC’s Advisory Committee on Immunization Practices recommends the hepatitis B vaccine for the following groups:
- All babies, starting just after birth
- Children and adolescents under 19 years old
- Adults ages 1959 who have not previously completed vaccination
- Adults ages 60 and over with a high risk of contracting HBV
Adults ages 60 and over who do not have any hepatitis B risk factors can receive the hepatitis B vaccine, but it is optional.
Hepatitis B spreads when the bodily fluids of an infected person enter another person’s body. Sexual contact is one way it can be spread. A person with HBV can spread it to their baby during childbirth. Other ways in which HBV may be transmitted include:
- Sharing medical equipment, whether at home or in a hospital setting, with a person who has an HBV infection
- Sharing syringes with a person who has hepatitis B, such as during injection drug use or at-home piercing or tattooing
- Sharing personal items, such as razors or toothbrushes, with someone who has hepatitis B
- Coming into contact with the sores or blood of a person who has hepatitis B
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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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.
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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Hepatitis B Immune Globulin Side Effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives difficult breathing swelling of your face, lips, tongue, or throat.
Hepatitis B immune globulin may cause serious side effects. Call your doctor at once if you have:
fever, mouth sores, red or swollen gums
a light-headed feeling, like you might pass out
liver problems–upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice
symptoms of fluid buildup around your lungs–chest pain, pain when you breathe, rapid heart rate, feeling light-headed or short of breath or
symptoms of a blood clot or stroke–sudden numbness or weakness chest pain, trouble breathing, rapid heart rate, coughing up blood or pain, swelling, warmth, or redness in your arms or legs.
Common side effects of hepatitis B immune globulin may include:
mild rash or
pain, redness, bruising, or tenderness where the medicine was injected.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What Is Hepatitis B Virus
Hepatitis B virus attacks the liver. Hepatitis B virus infections are known as the “silent epidemic” because many infected people don’t experience symptoms until decades later when they develop hepatitis , cirrhosis , or cancer of the liver . Every year in the United States about 22,000 new hepatitis B infections occur and about 2,000 people die from their infections.
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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.
Hepatitis B Vaccination Schedule For Children And Infants
The Centers for Disease Control and Prevention recommends that babies and children receive three 0.5 milliliter doses of either Engerix-B or Recombivax HB, starting just after birth.
The current recommended hepatitis B vaccine schedule for children and infants is as follows:
|Hepatitis B Vaccination Schedule for Infants and Children|
|Hepatitis B Vaccine Dose|
|3||618 months old|
If your child is undergoing hemodialysis, your healthcare provider may recommend that they receive additional doses of the HBV vaccine.
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I Am A Healthcare Worker Who Did Not Develop Hepatitis B Antibodies After Immunization What Should I Do
Two versions of hepatitis B vaccine are available. One, called Heplisav-B, contains a novel adjuvant that was not present in previous versions used by adults . Some people did not respond to the older version hepatitis B vaccine. In fact, in a group of adults younger than 40 years of age who received two doses of the older version vaccine 75 of 100 were protected. Following the third dose, this number increased to 90 of 100. However, people older than 40 years of age were less likely to respond to the vaccine with increasing age. On the other hand, 90 to 100 of 100 adults 18 years of age and older respond to Heplisav-B, which was approved for use in 2018.
About 5-10 of every 100 children and adults younger than 40 years of age do not respond to the third dose of the hepatitis B vaccine. Some of these people will be recommended to get vaccinated again. About 5 of 100 people will still not respond after getting all recommended doses of both series. Note that children younger than 18 years of age cannot get Heplisav-B.
If the people who do not respond to vaccination are determined not to have chronic hepatitis B, they will be reliant on taking precautions to reduce the chance of exposure and relying on those around them for protection. In other words, these people will be reliant on herd immunity.
Other Reported Adverse Events And Conditions
While serious events and chronic illnesses such as chronic fatigue syndrome, multiple sclerosis, Guillain-Barré syndrome, rheumatoid arthritis and sudden infant death syndrome have been alleged or reported following HB vaccination, no evidence of a causal association has been demonstrated in a number of studies.
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Common And Local Adverse Events
HB vaccine is well tolerated. Reactions are generally mild and transient, and include: irritability, headache, fatigue and injection site reactions in 10% or more of recipients.
There is no increase in adverse events when HAHB vaccine is compared with HA vaccine given alone or concomitantly with HB vaccine at a different injection site. When the adult formulation of HAHB vaccine is given to children in the 2 dose schedule, there is no increase in adverse events compared with those occurring after administration of the pediatric formulation of HAHB vaccine.
Reactions are usually mild and transient, and include fever, irritability, restlessness and injection site reactions .
Headache, diarrhea, fever, urticaria, angioedema and injection site reactions may occur.
Vaccines For Hepatitis A & B
You may have a family member who has viral hepatitis. Or perhaps you recently saw a news brief about a celebrity who contracted hepatitis A or B. Whatever the reason, you want information about a viral illness that you may not have thought much about. What is viral hepatitis? Are you at risk for it? Do you need viral hepatitis vaccines?
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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