Who Should Not Get The Hepatitis B Vaccine
Hepatitis B is a safe vaccine that does not contain a live virus.
However, there are some circumstances in which doctors advise against getting the HBV vaccine.
You should not receive the hepatitis B vaccine if:
- youve had a serious allergic reaction to a previous dose of the hepatitis B vaccine
- you have a history of hypersensitivity to yeast or any other HBV vaccine components
Serologic Testing Of Vaccine Recipients
Prevaccination Serologic Testing
Vaccination of persons immune to HBV because of current or previous infection or HepB vaccination does not increase the risk for adverse events. However, in populations that have high rates of previous HBV infection, prevaccination testing might reduce costs by avoiding vaccination of persons who are already immune. Prevaccination testing consists of testing for HBsAg, anti-HBs, and anti-HBc. Serologic testing should not be a barrier to vaccination of susceptible persons, especially in populations that are difficult to access. Testing is not a requirement for vaccination, and in settings where testing is not feasible, vaccination of recommended persons should continue. The first dose of HepB vaccine should typically be administered immediately after collection of the blood for serologic testing. Prevaccination testing is recommended for household, sexual, or needle-sharing contacts of HBsAg-positive persons HIV-positive persons persons with elevated ALT/ AST of unknown etiology hemodialysis patients MSM and past or current PWID.
Serologic testing is not recommended before routine vaccination of infants, children, or adolescents.
Postvaccination Serologic Testing
Vaccine Nonresponse
- Persons who do not respond to the first HepB series should complete a second series on a 0, 1, 6 month schedule
- Retest anti-HBs 12 months after completion of second series
Vaccine Nonresponse
The Impact Of Worldwide Hepatitis B Vaccination Programs: Model Of Success
A, Immunization coverage with third dose of hepatitis B in infants in 2019. B, Global immunization 19892019 HepB3 coverage in infants. Global coverage was 84% in 2019. Abbreviations: AFR,African region AMR,Americas region EMR,Eastern Mediterranean region EUR,European region SEAR,South-East Asia region WPR,Western Pacific region. Source: United Nations Children’s Fund /World Health Organization.
The success of HBV vaccination programs has been clearly demonstrated over the recent years in several regions around the world. Countries that have adopted the recommendation had a marked reduction in carrier rates as well as complications from HBV, including HCC. The low prevalence of chronic HBV infection in children younger than 5 years, reducing from 4.7% in the prevaccine era to less than 1% in 2019, can be attributed to the widespread use of hepatitis B vaccine. Due to the implementation of routinely birth-dose vaccination the greatest decrease appears to be in the Western Pacific region, from 8.3% HBsAg prevalence in the prevaccine era to 0.93% in 20022015 . Among health care workers, hepatitis B vaccination is highly effective for the prevention of healthcare associated HBV infection and chronic infection. Using mathematical models, it was estimated that since their implementation, HBV vaccination programs have averted 210 million new HBV infections globally .
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Is It Okay To Get An Extra Dose Of Hepatitis B Vaccine
Yes. Although extra doses of vaccine are not recommended, you can think of the extra dose as another chance for the immune system to see the hepatitis B virus. A vaccine is not the only time the immune system will see the virus or bacteria contained in it. People may be exposed to the virus or bacteria at school or the store or when visiting family or friends. An extra dose of vaccine is like one more exposure, except the difference is that the virus or bacteria in any vaccine has been made safe, so it wont make you ill.
Potential Challenges With Implementing Updated Hepatitis B Vaccination Guidelines
Potential challenges with implementing the updated CDC ACIP guidelines for hepatitis B vaccination are summarized in Table 2. Ensuring effective HBV screening is essential for expanding hepatitis B vaccine coverage. Although current HBV screening guidance remains risk-based,5 cost-effectiveness models have found that universal one-time testing of adults 18 to 69 years old with hepatitis B surface antigen, compared with current practice, would prevent an additional 7 cases of compensated cirrhosis, 3 cases of decompensated cirrhosis, 5 cases of hepatocellular carcinoma, 2 liver transplants, and 10 HBV-related deaths, with a savings of $263,000 per 100,000 adults screened.24 Although universal one-time testing with hepatitis B surface antigen may be effective in identifying cases of chronic HBV,24 the additional tests of antibody to hepatitis B surface antigen and immunoglobulin G antibody to the hepatitis B core antigen will identify individuals who may benefit from receiving the hepatitis B vaccine, require additional testing to determine whether they are infected, or may need education regarding potential risk for HBV reactivation in the future.25
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Rationale For Expanding Hepatitis B Vaccination Recommendations
A summary of the updated and former CDC ACIP recommendations for hepatitis B vaccination is provided in Table 1. The CDC ACIP Hepatitis Vaccines Work Group used 2 guiding principles when considering expansion of hepatitis B vaccination recommendations.23 First, a risk-based strategy for hepatitis B vaccination may not be successful in meeting the goal of the US Department of Health and Human Services for elimination of viral hepatitis by 2030. Notably, incident cases of acute HBV infection have plateaued at 20,000 cases annually over the past 10 years, and among all cases, only one-third had an identifiable risk factor. Rates of acute HBV infection are highest among individuals 30 to 59 years old, and rates have increased among individuals age 40 years and older. Hepatitis B vaccination coverage, defined as 3 or more doses of a hepatitis B vaccine, among adults age 19 years and older was low at 30% overall, and only 33% to 39% among individuals with risk factors, including travelers and patients with chronic liver diseases or diabetes. Expansion and simplification of adult hepatitis B vaccination recommendations as outlined by the National Academies of Sciences, Engineering, and Medicine also may improve health care access, as a risk-based approach to vaccination may favor individuals with access to health care, who trust to disclose stigmatizing risk factors, who are aware of their risk, and who have a higher health literacy.
How Is Hepatitis B Diagnosed
Because clinical manifestations of hepatitis B are indistinguishable from other causes of viral hepatitis, a definitive diagnosis requires serological testing . This testing uses different serologic markers to identify different phases of HBV infection and to conclude whether a person has acute or chronic HBV infection, or is immune to HBV as a result of prior HBV infection or vaccination, or is susceptible to infection . In Table 1 an interpretation of hepatitis B serologic test results is given.
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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.
Immunisation Against Hepatitis B For People At Risk
In Victoria free hepatitis B vaccine is provided for people who are at increased risk, including:
- Men who have sex with men.
- People living with HIV.
- People living with hepatitis C.
- People no longer in a custodial setting who commenced, but did not complete, a free vaccine course while in custody.
- Aboriginal and Torres Strait Islander people.
- People born in priority hepatitis B endemic countries who arrived in Australia in the last 10 years priority countries include China, Philippines, Malaysia, Vietnam, Afghanistan, Thailand, South Korea, Myanmar , Indonesia, Singapore, Hong Kong, Taiwan and Cambodia.
- Vulnerable citizens people who have experienced hardship that prevented them from accessing the vaccine earlier. Vulnerable citizens are vaccinated based on an individual assessment by an immunisation provider.
Immunisation is also recommended, but not free, for people who are at increased risk including:
If you think you have been exposed to hepatitis B, see a doctor immediately. Your doctor can give you treatment that, in some instances, can greatly reduce your risk of infection with hepatitis B.
Remember that being immunised against hepatitis B does not protect you against HIV, hepatitis C or other diseases spread by blood or bodily fluids. It is important that you take precautions to make sure you are not exposed to these diseases.
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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.
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.
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Why Do You Need A Hepatitis B Shot
Hepatitis B is a viral infection that cant be transferred person-to-person unless you have contact with an infected persons bodily fluids. Annual infection rates of HBV are going down in the United States thanks to vaccines. So you might be wondering if you or your child needs a shot to protect against hepatitis B.
What Is The Morphology Of Hbv
HBV is an oncogenic DNA virus that belongs to the Hepadnaviridae family. The discovery of the etiologic agent of hepatitis B remains a remarkable scientific achievement. It was discovered in 1965 by Dr Blumberg, who won the Nobel Prize in Medicine for his discovery in 1976 . HBV virus, initially called the Dane particle, is a 42-nm virus . HBV is composed of a nucleocapsid core, surrounded by an outer lipoprotein coat . The virus contains 3 primary structural antigens: surface , core , and e . HBsAg is produced in excess amounts and found in the blood of infected individuals in the form of spherical and tubular particles . These immunogenic, but noninfectious, subviral particles lack genomic DNA and paved the way to develop hepatitis B vaccines . HBV is divided into 4 major phenotypic subtypes based on antigenic epitopes presented on its envelope proteins, and comprises 10 major genotypes that differ at the nucleotide level across full-length genotypes by> 8% . The HBV genotypes have distinct virological characteristics and geographical distributions however, the licensed HBV vaccines are effective against all genotypes .
A, Electron micrograph of hepatitis B virus : Dane particles and spherical and tubular surface antigen particles . Source: Centers for Disease Control and Prevention. As a work of the U.S. federal government. B, A simplified figure of the HBV particle and surface antigens.
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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.
How Common Is Hepatitis B
One U.S. study following trends in hepatitis B infection over a three-year periodfound that 4.3% of the population had a past or present HBV infection.
Estimates suggest that about 240 million people around the world have chronic hepatitis B. Up to 1.89 million people in the United States have a chronic HBV infection.
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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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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 .
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The Duration Of Protection And The Need For Booster Doses
In vaccine efficacy studies, immunocompetent children and adults who developed anti-HBs concentrations of 10 mIU/mL or higher after vaccination had complete protection against both acute disease and chronic infection for decades , even if subsequently, over time, anti-HBs concentrations declined to less than 10 mIU/mL . Indeed, the protective efficacy of hepatitis B vaccination is related to the induction of anti-HBs antibodies, but it also involves the induction of memory B and T cells. Ongoing surveillance of vaccinees is required to clarify whether hepatitis B vaccination can confer longer, or even lifelong, protection . Based on currently available scientific evidence, different advisory groups do not recommend routine booster doses of hepatitis B vaccine in immunologically competent persons who have received a full primary course, because the majority of previously vaccinated people with an anti-HBs antibody concentration of 10 mIU/mL or less mount an anamnestic response when they receive a booster dose or are exposed to HBV, indicating that they remained protected by memory B and T cells .
Who Should Get The Hepatitis B Vaccine
Most babies now get the HBV vaccine from their doctor as a regular part of their checkups.
Hepatitis B is really contagious. You can easily get it through unprotected sex or contact with infected blood or urine. So if youve never had the vaccine, its a good idea to talk to your doctor about getting it.
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Secular Trends In The United States
Hepatitis B became nationally notifiable as a distinct entity during the 1970s after serologic tests to differentiate different types of hepatitis became widely available.
In 2018, a total of 3,322 cases of acute hepatitis B were reported to CDC, for an overall incidence rate of 1.0 cases per 100,000 population. After adjusting for under-ascertainment and under-reporting, an estimated 21,600 acute hepatitis B cases occurred in 2018. The rate of reported acute HBV infections declined approximately 90% since recommendations for HepB vaccination were first issued, from 9.6 cases per 100,000 population in 1982 to 1.0 cases per 100,000 population in 2018.
During 2009 through 2013, the combined incidence of acute HBV infection in three states increased 114% and was associated with increasing injection-drug use. Incidence is greatest for persons age 40 through 49 years persons age 19 years or younger have the lowest incidence , likely a result of routine infant vaccination.
Although HBV infection is uncommon among adults in the general population , it is highly prevalent in certain groups. Generally, the highest risk for HBV infection is associated with lifestyles, occupations, or environments in which contact with blood from infected persons is frequent. Chronic HBV infection has been identified in 3.5% to 20.0% of persons who inject drugs in a variety of settings, and 22.6% of PWID have evidence of past infection.
What Are The Side Effects
The most common of the hepatitis B vaccine are mild and include:
- Sore arm from the shot.
Prepare for your child’s vaccine visit and learn about how you can:
- Research vaccines and ready your child before the visit
- Comfort your child during the appointment
- Care for your child after the shot
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