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New Hepatitis B Vaccine Recommendations

Hepatitis B Vaccine New Recommendations For Vaccinating Infants

Federal Implementation of Updated Hepatitis B Vaccination Recommendations | May 23rd 2022

The American Academy of Pediatrics is now recommending that infants receive their first dose of the hepatitis B vaccine within 24 hours of birth. This recommendation is in line with the guidance of the CDC.

Hepatitis B is a serious disease that is easily preventible with the vaccine. Yet, the hepatitis B vaccine is one of the most vilified of the vaccines by the anti-vaccine crowd.

This article will take a look at hepatitis B, the vaccine, and some of the nonsensical claims of the anti-vaccine world.

Contents

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.

Indications For Hepatitis B Vaccine

HepB vaccine is a routine childhood vaccination .

HepB vaccine also is indicated for all adults aged 19 through 59 years who have not been previously vaccinated.

HepB vaccine also is indicated for adults aged 60 years and older who have not been previously vaccinated and who have any of the following:

  • A desire for protection from hepatitis B

  • A sexually active lifestyle in people who are not in a long-term, mutually monogamous relationship

  • Need for evaluation or treatment of a sexually transmitted infection

  • Current or recent use of illicit injection drugs

  • Sex between men

  • Employment in which workers may be exposed to blood or other potentially infectious body fluids

  • Diabetes in people < 60 years and sometimes in those 60 years

  • End-stage renal disease

  • A chronic liver disorder

  • Household contact and/or sexual contact with people who are positive for hepatitis B surface antigen

  • Travel to endemic areas

  • 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

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.

Also Check: How Do You Treat Hepatitis B

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.
  • See Vaccine Administration and SIRVA infographic for more information about proper IM vaccine administration.
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    Sbp Adjuvant For Hepatitis B Vaccine

    Hepatitis vaccination update

    Wang and colleagues stated that although adjuvants are a common component of many vaccines, there are few adjuvants licensed for use in humans due to concerns about their toxic effects. There is a need to develop new and safe adjuvants, because some existing vaccines have low immunogenicity among certain patient groups. In this study, SBP, a hepatitis B surface antigen binding protein that was discovered through screening a human liver cDNA expression library, was introduced into hepatitis B vaccine. A good laboratory practice, non-clinical safety evaluation was performed to identify the side effects of both SBP and SBP-adjuvanted hepatitis B vaccine. The results indicated that SBP could enhance the HBsAg-specific immune response, thus increasing the protection provided by the hepatitis B vaccine. The authors concluded that given the encouraging safety data obtained in this study, further evaluation of SBP as a vaccine adjuvant for human use is warranted. They stated that this research has the potential to accelerate adjuvant development for HBV vaccine and for other vaccine types in the future.

    Code Code Description

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    Cdc Hepatitis B Vaccination Recommendations For The Community Pharmacist

    This article was sponsored by Dynavax.

    Community pharmacists and pharmacy technicians are uniquely positioned on the front lines of patient care to substantially improve vaccination awareness and accessibility, ultimately supporting better patient and population health. Through a pharmacists access to important patient information and direct conversations with patients, they can identify eligible individuals for vaccine-preventable diseases, like hepatitis B, which can have serious acute and chronic health consequences.1 Chronic hepatitis B can lead to cirrhosis, liver cancer, and death1 15% of cirrhoses are caused by hepatitis B virus .2

    Beginning in 1991, infants began getting vaccinated against HBV at birth.3 While this led to a dramatic reduction of hepatitis B infection rates among children, many adults born before the 1991 hepatitis B universal vaccination of infants recommendation remain unprotected and at risk for infection.NEW AND UPDATED 2022 CDC RECOMMENDATIONS

    In February 2022, the Centers for Disease Control & Prevention recommended universal hepatitis B vaccination for all adults aged 19 to 59. Additionally, adults 60 years and older who do not have additional risk factors for HBV infection are recommended for vaccination. This announcement comes as hepatitis B rates among adults are on the rise.4

    Effective vaccination and completion of the hepatitis B vaccine series is essential to achieving protective immunity.5,6

    Clinical Efficacy

    Safety

    INDICATION

    Vaccination Is The Best Way To Prevent Hepatitis A And B Infection

    Narrator: ÃYou are a travellerà .

    Narrator: Ãand you are already dreaming of your next getaway.Ã .

    Disclaimer on-screen reads: TWINRIX is a combined hepatitis A and hepatitis B vaccine used in adults, adolescents, children, and infants over the age of 1 year to prevent hepatitis A and hepatitis B diseases

    Narrator: ÃWhile your travel plans probably donÃt include hepatitis A or hepatitis BÃ .

    Disclaimer reads: 100% protection cannot be guaranteed and booster doses may be required.

    Narrator: Ãyou know that many common travel activities can put you at risk of acquiring these two serious liver diseasesà .

    Disclaimer reads: TWINRIX does not protect against hepatitis C or E, and is not indicated to treat or reduce the severity of hepatitis A or B infections. .

    Narrator: Ãwhich is why you plan on talking to your doctor about TWINRIX, right? Of course, rightà Ãbecause you are a traveller.Ã

    Video concludes with TWINRIX logo, GSK logo, You are a traveller slogan, and safety information: Very commonly reported adverse events in adults were pain or discomfort, redness at the infection site, headache, and tiredness. Common adverse events were swelling at the injection site, diarrhea, nausea and vomiting, and generally feeling unwell. Allergic reactions may also occur. Full product information can be found on Twinrix.ca. If you need to report an adverse event, please call 1-800-387-7374.

    Twinrix.ca

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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.

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    Potential Challenges With Implementing Updated Hepatitis B Vaccination Guidelines

    Why I Recommend Hepatitis B Vaccination to All My Patients

    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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    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

    Immunization With Hepatitis B Immunoglobulin

    Machaira et al stated that the cost-effectiveness of augmenting immunization against hepatitis B infection with hepatitis B immune globulin remains controversial, particularly for the subpopulation of babies of HBsAg+/HBeAg- mothers that are considered as low-infective. These researchers evaluated the effectiveness of vaccine alone compared with vaccine plus HBIG for the immunization of babies of HBsAg+/HBeAg- mothers. They searched PubMed, Scopus and Cochrane Central Register of Controlled Trials databases to identify studies comparing the effectiveness of combined immunization with vaccine alone in neonates of HBsAg+/HBeAg- mothers. A systematic review and meta-analysis of eligible studies was performed. A total of 9 eligible studies were identified . No difference was found regarding the primary outcome of this meta-analysis, namely occurrence of hepatitis B infection, between neonates who received vaccine only, compared with those who received both vaccine and HBIG . This finding was consistent with regards to sero-protection rate . Safety data were not reported in the included studies. The authors concluded that available limited published evidence suggested that vaccine alone seems to be equally effective to the combination of HBIG and hepatitis B vaccine for neonates of HBsAg+/HBeAg- mothers in preventing infection. They stated that further studies are needed in order to clarify the potential benefit of combined immunization to this specific subgroup of patients.

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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
    • Developmentally disabled persons in long-term care facilities
    • People in prison or jail
    • Travelers to areas with high rates of hepatitis B
  • Anyone who wants to be protected from hepatitis B
  • Facts About Hepatitis B

    Hepatitis B Vaccination Practices in Hospital Newborn Nurseries Before ...
    • Two billion people, or one in three, have been infected with hepatitis B worldwide. Of these, almost 300 million live with chronic hepatitis B. This means about 1 of every 26 people throughout the world are living with a chronic hepatitis B infection.
    • Each year about 900,000 people die from hepatitis B worldwide, and about 2,000 of these deaths occur in the United States.
    • Hepatitis B is transmitted through blood and is 100 times more infectious than HIV. An estimated one billion infectious viruses are in one-fifth of a teaspoon of blood of an infected person, so exposure to even a very small amount, such as on a shared toothbrush, can cause infection.
    • Hepatitis B is sometimes referred to as the silent epidemic because most people who are infected do not experience any symptoms.
    • Liver cancer accounted for about 5% of cancer deaths in the U.S. during 2020.
    • Almost half of liver cancers are caused by chronic infection with hepatitis B.
    • The World Health Organization recommends the inclusion of hepatitis B vaccine in immunization programs of all countries in 2019, more than 8 of 10 infants born throughout the world received three doses of hepatitis B vaccine.

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    What Is The Recommended Vaccine Schedule For Hepatitis B

    The recommended vaccine schedule for PreHevbrio includes three doses over the course of 6 months. The first dose is at 0 months, the second dose is at 1 month, and the third and final dose is at 6 months.

    Heplisav-B is also approved for adults 18 years of age and older. It requires two doses administered 1 month apart.

    Engerix-B and Recombivax HB are approved starting at birth, and for pediatric and adult populations. Administration varies between 2 to 3 doses depending on age but generally follows a schedule of 6 months.

    Depending on the number of doses, these vaccines are typically administered at 0, 12, and 46 months following the start of the vaccination process.

    New Hepatitis B Vaccination Recommendations Praised Amid Low Awareness

    Nancy A. Melville

    An updated recommendation from the Centers for Disease Control and Preventions Advisory Committee on Immunization Practices calling for universal hepatitis B vaccination of all adults aged 59 and younger has boosted the call to improve clinicians awareness of the increasing infection and low vaccination rates and raise the issue with patients.

    Dr Rita Kaur Kuwahara

    This new recommendation from ACIP will be instrumental raising adult hepatitis B vaccination rates in the US to levels that will allow us to finally eliminate hepatitis B in this country, said Rita K. Kuwahara, MD, a primary care internal medicine physician and health policy fellow at Georgetown University, in Washington, DC, in addressing the issue at the US Conference on HIV/AIDS this month.

    We have the tools to prevent hepatitis B, and since we have such safe and highly effective vaccines to protect against community , we should not have a single new infection in our nation, she asserted.

    The unanimously approved updated ACIP recommendation was issued in November and still requires adoption by the CDC director. The ACIP specifically recommends that adults aged 19 to 59 and those 60 years and older with risk factors for infection should receive the hepatitis B vaccine, and it further stipulates that those 60 years and older without known risk factors for hepatitis B may receive the vaccine.

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    Universal Hepatitis B Vaccine Recommended By Cdc

    The federal agency’s new guidelines for adults between 19-59 years replaces risk-based recommendations.

    After several years of data and a well-established safety profile, the US Centers for Disease Control and Prevention has released new guidelines for hepatitis B virus vaccination, calling for universal HBV vaccination for all adults aged 19-59 years in the US.

    The CDC said in the Morbidity and Mortality Weekly Report that the decision is based on 4 decades of safety, immunogenicity, and efficacy data on the HBV vaccine, but with suboptimal coverage in the US.This article was originally published on HCPLive.

    How Do You Catch Hepatitis B Virus

    Jan 12, 2022 ACIP Meeting – Hepatitis Vaccines

    Blood from a person infected with hepatitis B virus is heavily contaminated with the virus. As a result, contact with blood is the most likely way to catch hepatitis B. Even casual contact with the blood of someone who is infected can cause infection.

    Healthcare workers are at high risk of catching the disease, as are intravenous drug users and newborns of mothers infected with the virus. Sexual contact can also expose people to infection. The virus is also present in low levels in saliva.

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    Us Infant 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 Infants

    Since 1991, ALL medically stable infants with a birth weight of at least 2,000 g in the U.S. are recommended to receive the first dose of hepatitis B vaccine within 24 hours of birth. The additional 2 doses are given at 1 month and 6 months of age.

    4-Dose Vaccine Combination Series for Infants

    Combination vaccines, such as the pentavalent and hexavalent vaccines, include protection against 5 or 6 diseases, including hepatitis B. The first shot is usually given at 6 weeks of age, but in order to protect infants from hepatitis B beginning at birth, a monovalent or single dose of the hepatitis B vaccine is also recommended within 24 hours of birth. The hepatitis B vaccine series can then be completed with the pentavalent or hexavalent vaccine with the recommended schedule.

    Committee Also Passed New Recommendations On Vaccines Against Ebola Orthopoxviruses

    byMolly Walker, Deputy Managing Editor, MedPage Today November 3, 2021

    Adults ages 59 and younger, and adults ages 60 and up who have risk factors for hepatitis B virus , are recommended to be vaccinated against HBV, the CDC Advisory Committee on Immunization Practices said in a unanimous vote Wednesday.

    ACIP voted 15-0 to recommend this split philosophy for HBV vaccination, and also voted to recommend expanded use of vaccines against Ebola and orthopoxviruses, and approved the 2022 adult and childhood immunization schedules.

    HBV Vaccine

    The initial recommendation from CDC staff was universal HBV vaccination for all adults ages 18 and up, but an amendment to separate out the age groups, and retain the risk-based recommendation for older age groups, passed 8-7 earlier in the day.

    The current risk-based recommendation applies to:

    • People at risk for infection by sexual exposure or percutaneous or mucosal exposure, such as injection-drug users
    • Other risk groups, such as international travelers with high or intermediate levels of endemic HBV infection
    • People with chronic liver disease
    • Incarcerated people
    • People living with HIV

    This would be consistent with the current immunization schedule, with CDC staff adding that any adult who wishes to receive protection may receive the vaccine, meaning all adults ages 60 and up who do not have any HBV risk factors.

    “The cost is high for people over 60,” added Beth Bell, MD, of the University of Washington in Seattle.

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