When To Delay Or Avoid Hepb Immunization
Doctors delay giving the vaccine to babies who weigh less than 4 pounds, 7 ounces at birth whose mothers do not have the virus in their blood. The baby will get the first dose at 1 month of age or when the baby is discharged from the hospital.
The vaccine is not recommended if your child:
- is currently sick, although simple colds or other minor illnesses should not prevent immunization
- had a serious allergic reaction after an earlier dose of the vaccine or is allergic to baker’s yeast
How Is Hepatitis B Prevented
Testing & Vaccination
- The hepatitis B vaccine offers excellent protection against HBV. The vaccine is safe and highly effective. Vaccination consists of 3 doses of vaccine over the course of 6 months. Protection lasts for 20 years to life.
- The American Academy of Pediatrics recommends that all children should receive hepatitis B vaccine starting at birth. .
- The CDC recommends hepatitis B vaccine for persons traveling to countries where HBV is common .
- If you have one or more risk factors for hepatitis B infection, you should get a simple HBV blood test. The blood test will determine whether you are:
- immune to hepatitis B or
- susceptible to hepatitis B and need vaccination or
- infected with hepatitis B and need further evaluation by a physician
- California law requires testing of all pregnant women for hepatitis B infection
- If the mother is HBV-infected, she will pass the infection to the baby during the birth process, unless the baby gets immunized within hours of birth
- Giving the infant HBIG and HBV vaccine right away will reliably prevent infection of the infant
- Other family members should best tested for hepatitis B too, and given vaccine if they are not already infected or immune
After Exposure to Hepatitis B
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
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Accelerated 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.
In some instances, it may be necessary to vaccinate within a short period of time to ensure protection before travel. There are accelerated schedules to provide the highest level of protection over a short period of time. Individuals who need an accelerated schedule must have a booster dose at 1 year to ensure long-term protection. Note that the 2-dose Heplisav-B vaccine will also ensure maximum protection over a 1-month period without the need for a booster dose at 1 year.
4-Dose Vaccine Series for Children and Adults
Engerix-B is a 3-dose vaccine that can be given on an accelerated, four-dose schedule, with 3 shots administered within 2 months, and a booster dose at 1 year to provide maximum long-term protection.
4-Dose Combination Hepatitis A and B Vaccine Series
Twinrix is a 4-dose vaccine that can be given on an accelerated schedule to provide protection against hepatitis A and B. Three doses are administered within 1 month, followed by a booster shot at 1 year. This is a common choice of vaccine for those travelling on short-notice outside the U.S. It is important to complete the booster dose at 1 year, to ensure long-term protection.
2-Dose Vaccine Series
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
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Concurrent Administration Of Vaccines
HB-containing vaccines may be administered concomitantly with other vaccines or with HBIg. Different injection sites and separate needles and syringes must be used for concurrent parenteral injections.
Refer to Timing of Vaccine Administration in Part 1 for additional information about concurrent administration of vaccines.
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.
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.
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Which Adults Should Be Vaccinated Against Hepatitis B
According to CDC recommendations, adults in the following groups are recommended to receive hepatitis B vaccine:
- All people age 18 years and younger.
- Anyone 19 years and older who wants to be protected from hepatitis B.
People at risk for infection by sexual exposure
- Sex partners of people who are hepatitis B surface antigen -positive.
- Sexually active people who are not in long-term, mutually monogamous relationships.
- People seeking evaluation or treatment for a sexually transmitted disease.
- Men who have sex with men.
People at risk for infection by percutaneous or permucosal exposure to blood or body fluids
- Current or recent illegal injection drug users.
- Household contacts of people who are HBsAg-positive.
- Residents and staff of facilities for developmentally challenged people.
- Healthcare and public safety workers with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids.
- People with end-stage renal disease, including predialysis, hemo-, peritoneal- and home-dialysis patients.
- International travelers to regions with intermediate or high levels of endemic HBV infection.
- People with chronic liver disease.
- People with HIV infection.
- People with diabetes who are age 19 through 59 years. For those age 60 and older, clinicians should make a determination of need for
- vaccination based on their patients’ situation.
In a future issue, we will review the various hepatitis B serologic tests, who needs testing, and when they need it .
Where Is The Hepatitis B Virus Found And How Is It Transmitted
Blood is the major source of the hepatitis B virus in the workplace. It can also be found in other tissues and body fluids, but in much lower concentrations. The risk of transmission varies according to the specific source. The virus can survive outside the body for at least 7 days and still be able to cause infection.
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Complications Of Hepatitis B Infection In Infants And Children
Mothers who are infected with hepatitis B can pass the virus to their baby at the time of birth. Hepatitis B virus can also be spread through exposure of broken skin or mucous membranes to the blood or other body fluids of an infected person.
Babies born to mothers with hepatitis B are recommended a dose of hepatitis B vaccine within 12 hours of birth as well as another medicine called hepatitis B immunoglobulin. These 2 injections provide extra protection for babies born to women living with hepatitis B.
Many people who are infected with hepatitis B have no symptoms. Babies and children who are infected with hepatitis B are less likely than adults to have symptoms of infection, but are more likely to develop chronic hepatitis B.
Symptoms of hepatitis B include:
- Yellow skin and eyes
- Aching muscles or joints arthritis.
A child who contracts chronic hepatitis B has an increased risk of developing chronic liver disease and cancer later in life. A small proportion of adults who become infected with the hepatitis B virus develop chronic hepatitis B infection.
Measurement Of Infections As A Way To Measure Long
gives an overview of follow-up studies using anti-HBc, HBsAg, or HBV DNA to measure infections and protection in vaccine recipients.
Breakthrough infections occur in 0%17.7% of the general population and in up to 33.3% in children of carrier mothers after 15 years of follow-up . In long-term follow-up studies, breakthrough infections do occur, illustrated by the seroconversion of anti-HBc antibodies, but few clinically significant infections are diagnosed and few new carriers are reported .
From a public health point of view, the likelihood of becoming a hepatitis B carrier is even more important. Viviani et al recently published the evaluation of 24 years of a hepatitis B vaccination program in The Gambia: 67% vaccine efficacy against development of anti-HBc and 96.6% vaccine efficacy against carriage was reported. The impact on hepatocellular cancer had already been seen: the risk of hepatocellular carcinoma attributable to HBV at age < 50 years was 70%80% lower than that for historical cohorts.
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Adults Recommended To Receive Hepb Vaccine:
TheAdvisory Committee on Immunization Practices recommends that the following people should receive hepatitis B vaccination:
- All infants
- Unvaccinated children aged < 19 years
- Adults aged 19 through 59 years
- Adults aged 60 years and older with risk factors for hepatitis B
The following groups may receive hepatitis B vaccination:
- Adults aged 60 years and older without known risk factors for hepatitis B
Risk factors for hepatitis B
- Persons at risk for infection by sexual exposure
- Sex partners of persons who test positive for hepatitis B surface antigen
- 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
A Look At Each Vaccine: Hepatitis B Vaccine
View larger image The hepatitis B vaccine is given to prevent the severe liver disease that can develop when children or adults are infected with hepatitis B virus. The hepatitis B vaccine is given as a series of three shots. The first dose is given within 24 hours of birth. The second dose is given one to two months after the first dose, and the third dose is given between 6 months and 18 months of age. The vaccine is also recommended for those up to 60 years of age who have not previously received it and those 60 years and older who are at increased risk or who simply want the protection afforded by vaccination.
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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.
Guidance On Reporting Adverse Events Following Immunization
Vaccine providers are asked to report, through local public health officials, any serious or unexpected adverse event temporally related to vaccination. An unexpected AEFI is an event that is not listed in available product information but may be due to the immunization, or a change in the frequency of a known AEFI.
Refer to Reporting Adverse Events Following Immunization in Canada and Adverse events following immunization in Part 2 for additional information about AEFI reporting.
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Why Is The Hepb Vaccine Recommended
People who dont know they’re infected can spread the hepatitis B virus. So it cant be avoided just by being careful. That’s why health experts recommend that all babies get the vaccine right from birth.
The HepB injection usually creates long-term immunity. Most infants who get the HepB series are protected from hepatitis B infection beyond childhood, into their adult years.
Eliminating the risk of infection also decreases risk for cirrhosis of the liver, chronic liver disease, and liver cancer.
What Hepatitis B Immunisation Involves
Full protection involves having 3 injections of the hepatitis B vaccine at the recommended intervals.
Babies born to mothers with hepatitis B infection will be given 6 doses of hepatitis B-containing vaccine to ensure long-lasting protection.
If you’re a healthcare worker or you have kidney failure, you’ll have a follow-up appointment to see if you have responded to the vaccine.
If you have been vaccinated by your employer’s occupational health service, you can request a blood test to see if you have responded to the vaccine.
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Many People With Hbv Dont Know They Have It
HBV infections are becoming less common in the United States. But HBV is still widespread in other parts of the world. Around 257 million people living around the world currently have HBV, and many of them dont know it. Chronic HBV is often asymptomatic, and even when it isnt, it can take months for symptoms to show up.
HBV can be transmitted through sexual contact and the use of IV drugs , and other risk factors. Although rare, there
For Adults And Children
This vaccine schedule involves three doses within 2 months, followed by a booster dose at 1 year.
The initial accelerated doses provide immediate protection from HBV, and the booster dose helps provide long-term protection.
Below is the accelerated vaccination schedule approved for both adults and children:
|2 months after the first dose||1 year after the first dose|
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How Common Is It
In 2006, the Public Health Agency of Canada reported the incidence of HBV as 2.0 cases for every 100,000 or about 650 cases reported annually in Canada. In the year 2013, the incident rate was 0.5 per 100,000 . Incidence of the disease varies from region to region but has been declining due to increasing use of the vaccine and universal immunization programs.
How Hepatitis Is Spread
Hepatitis A: About 20,000 people in the U.S. contract hepatitis A each year. The hepatitis A virus is found in the stool of the infected person. It is spread through contaminated food or water or by certain types of sexual contact.
Children who get hepatitis A often don’t have symptoms, so they can have the virus and not know it. However, they can still spread it easily. Fortunately, children are now routinely vaccinated against hepatitis A.
Most people who get hepatitis A recover completely within two weeks to six months and don’t have any liver damage. In rare cases, hepatitis A can cause liver failure and even death in older adults or people with underlying liver disease.
Hepatitis B: Every year, about 40,000 people in the U.S. become infected with hepatitis B. Acute hepatitis lasts from a few weeks to several months. Many infected people are able to clear the virus and remain virus-free after the acute stage. However, for others, the virus remains in the body, and they develop chronic hepatitis B infection, which is a serious, lifelong condition. About 1.2 million people in the U.S. have chronic hepatitis B. Of these, 15% to 25% will develop more serious health problems, such as liver damage, cirrhosis, liver failure, and liver cancer, and some people die as a result of hepatitis B-related disease.
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