Opioid Use A Key Factor In Rising Infection Rates
Importantly, a large proportion of opioid users are among the population of patients born before the mid-90s and those adults have a particularly high risk of transmission, with data indicating that 36% of new hepatitis B infections are the result of the opioid epidemic, Kuwahara noted.
In the opioid epidemic, we have seen some of the greatest increases in acute hepatitis B presenting in adults aged 30 to 49 years old, as most adults in this age range would not have been vaccinated as children in the US, she said.
Approximately two thirds of individuals with chronic hepatitis B are reportedly not even aware of their infection status due to ineffective prevention and vaccination programs, adding to the spread of infection, Kuwahara said.
Meanwhile, COVID-19 has only exacerbated the problem, with record-high instances of overdoses and overdose-related deaths during the pandemic, she explained.
However, the pandemic, and specifically the sweeping innovations that have been implemented in desperate efforts to bring COVID-19 vaccines to the public, could in fact represent a critical opportunity for hepatitis B prevention, Kuwahara said.
Significant resources and federal funding have already been invested to develop a robust infrastructure for multi-dose COVID-19 vaccine administration during the pandemic, which has resulted in millions of people across the US receiving the COVID-19 vaccine in easily accessible settings within their communities, she said.
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 virus, 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.
Persons New To Canada
Health care providers who see persons newly arrived in Canada should review the immunization status and update immunization for these individuals, as necessary. In many countries outside of Canada, HB vaccine is in limited use.
All persons from a country that is endemic for HB should be assessed and vaccinated against HB if not immune and not infected. Individuals born in developing countries are more likely to be carriers of HB, necessitating vaccination of their sexual and household contacts based on review of their serologic test results. HB vaccine is recommended for all household contacts whose families have immigrated to Canada from areas in which there is a high prevalence of HB and who may be exposed to HB carriers through their extended families or when visiting their country of origin.
Children adopted from countries in which there is a high prevalence of HB infection should be screened for HBsAg and, if positive, household or close contacts in the adopting family should be immunized before adoption or as soon as possible thereafter. Adults going to pick-up children from these countries should be vaccinated before departure. Refer to Immunization of Persons New to Canada in Part 3 for additional information.
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What Is Hepatitis B
Hepatitis B is a contagious liver infection with potentially severe symptoms. It can lead to lifelong illness if it becomes chronic.
The two most common forms of hepatitis B are:
- Acute Hepatitis B A short-term illness occurring 6 months after exposure. It can lead to chronic hepatitis infection.
- Chronic Hepatitis B A long-term illness that affects the liver. Nearly 250 million people worldwide have chronic infection.
Why Should I Vaccinate My Newborn Child If I Know That I Am Not Infected With Hepatitis B Virus
Before the hepatitis B vaccine, every year in the United States about 18,000 children were infected with hepatitis B virus by the time they were 10 years old. This statistic is especially important because people are much more likely to develop liver cancer or cirrhosis if they are infected early in life, rather than later in life .
About 9,000 of the 18,000 children infected in the first 10 years of life caught the virus from their mother during birth. However, many young children didn’t catch the disease from their mother. They caught it from either another family member or someone else who came in contact with the child. Because hepatitis B can be transmitted by relatively casual contact with items contaminated with blood of an infected person, and because many people who are infected with hepatitis B virus don’t know that they have it, it is virtually impossible to be “careful enough” to avoid this infection.
For these reasons, all young children are recommended to receive the hepatitis B vaccine. The best time to receive the first dose is right after birth. This will ensure that the child will be protected as early as possible from catching hepatitis B from people who dont know that they are infected with the virus.
Listen to Dr. Offit explain why newborns get the hepatitis B vaccine by watching this short video, part of the series Talking About Vaccines with Dr. Paul Offit.
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Invention Of The Hepatitis B Vaccine
It is likely that the most important outcome of the research on Au and HBV has been the invention, development, and application of the vaccine against HBV. This came about as a consequence of a series of events that coalesced in 1969. The data confirming the hypothesis that Au was a component of HBV were accumulating. Because I had experience in preventive medicine, primarily because of my work in Suriname and elsewhere in the tropics, the advantages of a vaccine were obvious. The experience of the South American jungles, where large segments of the population were devastated by infectious diseases provided the motivation to find a vaccine that would prevent large-scale infection.
The arrival of Millman in our laboratory in June 1967 was a major factor in the invention of the vaccine. He was trained as a microbiologist and had developed a purified pertussis vaccine while working for Merck in its vaccine facility near Philadelphia. His reaction to the data were influenced by his experience with other infectious agents. We had calculated the amount of Au in the serum of carriers and estimated that in some it amounted to about 1% of the serum proteins. His immediate response was that if this was all virus it would be incompatible with the life of the carrier. This became of considerable importance later when we devised the vaccine.
Before Taking This Medicine
Hepatitis A and B vaccine will not protect you against infection with hepatitis C or E, or other viruses that affect the liver. It will also not protect you from hepatitis A or B if you are already infected with the virus, even if you do not yet show symptoms.
You should not receive this vaccine if you are allergic to yeast or neomycin, or if you have ever had a life-threatening allergic reaction to any vaccine containing hepatitis A or hepatitis B.
Before receiving this vaccine, tell the doctor if you have:
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an allergy to latex rubber or
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a weak immune system caused by disease, bone marrow transplant, or by using certain medicines or receiving cancer treatments.
You can still receive a vaccine if you have a minor cold. In the case of a more severe illness with a fever or any type of infection, wait until you get better before receiving this vaccine.
FDA pregnancy category C. Tell your doctor if you are pregnant. It is not known whether hepatitis A and B vaccine will harm an unborn baby. However, not vaccinating the mother could be harmful to the baby if the mother becomes infected with a disease that this vaccine could prevent. Your doctor will decide whether you should receive this vaccine, especially if you have a high risk of infection with hepatitis.
If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of this vaccine on the baby.
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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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Australia Antigen And Hbv
The hypothesis that new polymorphic systems could be discovered by the use of blood from transfused persons had proven to be productive. We continued the search for additional antibodies and antigens. In 1963, we found an iso-precipitin that reacted with an antigen that appeared to be different from the lipoprotein Ag system we had initially discovered. It had fewer or no lipid-staining characteristics, and the antigen had a much different distribution than the Ag antigens. The new antigen was very rare in Western populations, but common among Australian Aborigines, Micronesians, Vietnamese, and Taiwanese. We made the curious and interesting observation that it was also common in patients in the United States with leukemia. Thisnew antigen-antibody reaction had been initially seen by H. Alter, who was then working in my laboratory at the National Institutes of Health in Bethesda and subsequently has become one of the leading hepatitis researchers.
The next year my laboratory moved to the Institute for Cancer Research at the Fox Chase Cancer Center in Philadelphia. A research group was formed that continued the investigation. It included W. T. London, A. Sutnick, I. Millman, B. Werner, L. Melartin, B. Smith, H.-W. Hann, and others. The studies I will now describe was the result of our mutual efforts.
Individuals with Au have an increased susceptibility to leukemia, and this susceptibility is inherited.
Leukemia causes Au.
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Hepatitis B Vaccine Side Effects
As with any medication, the hepatitis B vaccine may cause some side effects. Most people dont experience any unwanted effects. The most common symptom is a sore arm from the injection site.
When receiving the vaccination, youll likely receive information or a pamphlet regarding the side effects that you might expect, and others that warrant medical attention.
Mild side effects usually last only . Mild side effects of the vaccine include:
- redness, swelling, or itching at the injection site
- a purple spot or lump at the injection site
Preparations Of Hepatitis B Vaccine
Hepatitis B vaccine is produced using recombinant DNA technology. A plasmid containing the gene for hepatitis B surface antigen is inserted into common bakers yeast, which then produces HBsAg. The HBsAg is harvested and purified. This vaccine cannot cause hepatitis B virus infection because no potentially infectious viral DNA or complete viral particles are produced during this process.
Single-antigen and a combination formulation that combines hepatitis A and hepatitis B vaccines are available. Two single-antigen vaccines, Engerix-B® and Recombivax HB®, are conjugated with aluminum. A newer formulation, HepB-CpG , uses the immune-stimulating adjuvant, cytidine-phosphate-guanosine oligodeoxynucleotide .
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What Are Dosages Of Hepatitis B Vaccine
Dosages of Hepatitis B Vaccine:
Intramuscular suspension
- 40 mcg/ml
Intramuscular suspension
- 5 mcg/0.5 ml
- 10 mcg/0.5 mg
Dosage Considerations Should be Given as Follows:
- Engerix B: 1 mL intramuscularly at 0, 1, and 6 months
- Recombivax HB: 1 mL intramuscularly at 0, 1, and 6 months
- Adults receiving dialysis or other immunocompromising conditions
- Recombivax HB : 40 mcg intramuscularly at 0, 1, and 6 months, OR
- Engerix-B : 40 mcg intramuscularly at 0, 1, and 6 months
Routine vaccination
Catch-up vaccination
- Unvaccinated children should complete a 3-dose series
- Children aged 11-15 years: 2-dose series of adult formulation Recombivax HB is licensed for use in children aged 11 through 15 years
Dosing Considerations
Administration
- Administer intramuscularly in the deltoidmuscle
- Do not give IV/intradermal
Pediatric:
- low blood pressure
- pain when urinating
Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System , 1-800-822-7967
This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.
Common And Local Adverse Events
HB vaccine
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.
HAHB vaccine
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.
DTaP-HB-IPV-Hib vaccine
Reactions are usually mild and transient, and include fever, irritability, restlessness and injection site reactions .
HBIg
Headache, diarrhea, fever, urticaria, angioedema and injection site reactions may occur.
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Persons With Inadequate Immunization Records
Evidence of long term protection against HB has only been demonstrated in individuals who have been vaccinated according to a recommended immunization schedule. Independent of their anti-HBs titres, children and adults lacking adequate documentation of immunization should be considered susceptible and started on an immunization schedule appropriate for their age and risk factors. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information.
Implementation Of Vaccine Recommendations Key
Kuwahara outlined key measures that will be important in implementing the hepatitis B vaccine recommendations:
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Awareness of the hepatitis B vaccination recommendations at the primary care level: The first step in implementing universal will be to ensure that healthcare providers, particularly in primary care, are aware of the new ACIP guidelines so that they can speak with their patients about this and appropriately order hepatitis B testing and vaccination, she said.
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Availability of vaccines: In addition to making sure primary care clinics are well stocked with hepatitis B vaccines, the vaccines should also be available in pharmacies and other convenient nonclinical settings through community outreach, similar to COVID-19 vaccines.
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Follow-up: Systems should be established to remind patients to receive follow-up doses.
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Public funding for vaccines: Policy changes will need to occur to allocate appropriate Section 317 funding to provide hepatitis B vaccines to adults without health insurance coverage, Kuwahara said, underscoring concerns about health equity in vaccination.
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Track vaccinations: Communication should be established between places administering vaccines and primary care providers to make sure that vaccination status can be documented in a reliable setting.
Frank Hood
Hood further underscored the need for continued diligence in improving measures to prevent and eradicate HBV as well as other infectious diseases.
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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.
3-Dose Vaccine Series for Children and Adults
The hepatitis B vaccine is an injection that is generally given in the arm as a three-dose series on a 0, 1, and 6-month schedule. Alternative schedules may be considered, noting that a third dose at 6 months, meeting minimum intervals between doses, is needed for maximum, long-term protection. 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.
There are three, 3-dose vaccine brands approved in the U.S.
2-Dose Vaccine Series
How Is This Vaccine Given
This vaccine is given as an injection into a muscle. You will receive this injection in a doctor’s office or other clinic setting.
The hepatitis A and B vaccine is given in a series of 3 shots. The booster shots are given 1 month and 6 months after the first shot.
If you have a high risk of hepatitis infection, you may be given 3 shots within 30 days, and a fourth shot 12 months after the first.
Your individual booster schedule may be different from these guidelines. Follow your doctor’s instructions or the schedule recommended by the health department of the state you live in.
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