Is There A Possibility Of Coinfection
Both hepatitis B and C can be present at the same time. Hepatitis C may become more dominant, reducing hepatitis B levels in the bloodstream to low or undetectable levels.
Prior to starting hepatitis C treatment, people should have their blood tested for hepatitis B using the three-part blood test . According to the American Association for the Study of Liver Diseases treatment guidelines, people who are currently infected with hepatitis B or who have recovered from a previous infection should be managed carefully to avoid dangerous elevations in liver enzymes that can lead to liver failure.
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
How Is It Spread
Hepatitis B is spread through the blood and body fluids of an infected person. You can get hepatitis B if :
- You share personal care articles such as razors, scissors, nail clippers, or a toothbrush.
- Dirty equipment was used for your piercing or tattoo
- You have intimate contact with an infected person
- You share needles with an infected person
An infected mother can also pass hepatitis B to her child at birth.
You cannot get hepatitis B from casual contact such as hugging, or from using the same dishes as an infected person. It is not passed on when someone coughs or sneezes.
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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.
Emergency Hepatitis B Vaccination
If you’ve 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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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.
Who Should Not Get The Hepatitis B Vaccine
You or your child should not get the hepatitis B vaccine if either of you have had a serious reaction to the hepatitis B vaccine in the past. Check with your health care provider if you or your child has ever had an allergic reaction to another vaccine, aluminum, yeast, latex, or formaldehyde. The risk of serious illness from the hepatitis B virus is much greater than the risk of complications from the hepatitis B vaccine.
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Whats The Current Status Of A Hepatitis C Vaccine
Currently, theres not a vaccine available that can prevent hepatitis C. Developing a hepatitis C vaccine has been tough because the virus changes frequently, which makes it harder for our immune system to respond to it. In fact, weve currently identified seven main genotypes, or virus strains, and 67 estimated subtypes.
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.
Hepatitis B cannot be spread by contaminated water, food, cooking, or eating utensils, or by breastfeeding, coughing, sneezing, or close contact such as kissing and hugging.
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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.
What Are The Uses For Hepatitis B Vaccine
Hepatitis B vaccine is used to prevent hepatitis B, a serious infection that affects the liver.
Most children are given their first shot at birth, followed by a 2nd shot at 1-2 months of age, and a 3rd shot at 6-18 months of age. Also, anyone who is 18 years of age or younger and hasn’t received the vaccine should be vaccinated.
Additionally, all unvaccinated adults at risk for hepatitis B infection should be vaccinated. This includes:
- Partners or people infected with hepatitis B
- Men who have sex with men
- People who inject street drugs
- People with more than one sex partner
- People with chronic liver or kidney disease
- People under the age of 60 who have type 1 or 2 diabetes
- People with jobs that expose them to human blood or other body fluids
- People who live with a family member infected with hepatitis B
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Liver Anatomy And Function
Main Function of the Liver
The liver is an essential organ that has many functions in the body. The liver plays an important role in detoxifying the body by converting ammonia, a byproduct of metabolism in the body, into urea that is excreted in the urine by the kidneys. The liver also breaks down medications and drugs, including alcohol, and is responsible for breaking down insulin and other hormones in the body. The liver also stores vitamins and chemicals that the body requires as building blocks.
Many different disease processes can occur in the liver, including infections such as hepatitis, cirrhosis , cancers, and damage by medications or toxins.
Symptoms of liver disease can include:
- Jaundice
What Are The Side Effects Of The Hepatitis B Vaccine
Mild-to-moderate problems:
- Soreness, redness, or swelling where the shot was given
- Headache, tiredness, fever and loss of appetite
Severe problems :
- Dizziness
Over-the-counter pain relievers such as acetaminophen or ibuprofen can help ease pain and reduce fever.
It’s extremely rare for these vaccines to cause serious harm or death. If the person getting the vaccine has a serious reaction, call the doctor or seek immediate medical attention.
The hepatitis B vaccine is available at Walgreens Pharmacy. Ages vary by state.*
If you believe you have a medical emergency, please call 911.
Tell your doctor or a healthcare provider if the person getting the vaccine has any severe allergies.
Call the Centers for Disease Control and Prevention at 800-232-4636 or visit www.cdc.gov/vaccines for more vaccine information.
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Site Of Injection For Vaccination And Antibody Response
Hepatitis B vaccination should be given in the upper arm or the anterolateral aspect of the thigh and not in the buttock. There are over 100 reports of unexpectedly low antibody seroconversion rates after hepatitis B vaccination using injection into the buttock. In one center in the USA a low antibody response was noted in 54% of healthy adult health-care personnel. Many studies have since shown that the antibody response rate is significantly higher in centers using deltoid injection than centers using the buttock. On the basis of antibody tests after vaccination, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention in the USA recommended that the arm be used as the site for hepatitis B vaccination in adults, as has the Department of Health in the UK.
These observations have important public health implications, well illustrated by the estimate that about 20% of the 60 000 people immunized against HBV in the buttock in the USA by March 1985 had failed to attain a minimum level of antibody of 10 IU/l and were therefore not protected.
Hepatitis B surface antibody titers should be measured in all people who have been immunized against HBV by injection in the buttock, and when this is not possible a complete course of three injections of vaccine should be administered into the deltoid muscle or the anterolateral aspect of the thigh, the only acceptable sites for HBV immunization.
Dean A. Blumberg, in, 2012
How Are Hepatitis B And Hepatitis C Spread From Person To Person
Like HIV, the hepatitis B and hepatitis C viruses spread:
- From mother to child: Pregnant women can pass these infections to their infants. HIV-HCV coinfection increases the risk of passing on hepatitis C to the baby.
- Sexually: Both viruses can also be transmitted sexually, but HBV is much more likely than HCV to be transmitted sexually. Sexual transmission of HCV is most likely to happen among gay and bisexual men who are living with HIV.
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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.
History Of Vaccine Development
Since the 1990s, several vaccines against HAV have been commercially available, including both an inactivated and live attenuated vaccine. The first inactivated HAV vaccine was produced from a strain of the virus propagated in cell culture. This was then purified and inactivated using formalin and the purified HAV strain was then grown on human diploid MRC-5 cells . This vaccine was clear of any remaining infective capability in vitro. Marmoset monkeys injected with the vaccine did not show any changes in hematological or chemistry values, effectively demonstrating vaccine administration without the clinical effects of an acute HAV infection. Infectious HAV particles were detected neither in feces nor in the sera of the vaccinated primates by enzyme-linked immunosorbent assay. With regards to the immunogenicity of the vaccine, guinea pigs were injected with 0.8, 0.2, or 0.05 micrograms of HAV antigen. The antibody response was dose dependent, with one injection of 0.2 micrograms of the HAV antigen prompting sero-conversion in 100% of animals . Further increase of antibody titers was achieved after the second and third immunizations. These initial tests showed this methodology was safe and provided a great immunologic response in the animal models, which led to further testing in human subjects confirming the same results .
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Immunogenicity Efficacy And Effectiveness
Immunogenicity
Protective concentrations of antibody against HA develop in 95% to 100% of vaccine recipients after 1 dose of HA vaccine, and nearly 100% seroconvert after receiving 2 doses of vaccine.
Pre-exposure
HA vaccines are at least 90% to 97% effective in preventing clinical HA illness.
Post-exposure
The use of HA vaccine in susceptible populations interrupts HA outbreaks. The protective efficacy of HA vaccine when used within 1 week of exposure is approximately 80%.
What Else Should I Know About Hepatitis B Vaccine
What preparations of hepatitis b vaccine-injection are available?
- Suspension for injection in single does vials and syringes: Recombivax 0.5 ml , 1 ml Engerix-B 0.5 ml , 1 ml .
How should I keep hepatitis b vaccine-injection stored?
Hepatitis B vaccine should be stored in the refrigerator, between 2 C to 8 C .
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Hepatitis B Vaccination In Pregnancy
Hepatitis B infection in pregnant women may result in severe disease for the mother and chronic infection for the baby. This is why the hepatitis B vaccine is recommended for pregnant women who are in a high-risk category.
There’s no evidence of any risk from vaccinating pregnant or breastfeeding women against hepatitis B. And, as it’s an inactivated vaccine, the risk to the unborn baby is likely to be negligible .
Hiv And Hepatitis B And Hepatitis C Coinfection
Hepatitis B and hepatitis C are liver infections caused by a virus. Because these infections can be spread in the same ways as HIV, people with HIV in the United States are often also affected by chronic viral hepatitis.
Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Liver disease, much of which is related to HBV or HCV, is a major cause of non-AIDS-related deaths among people with HIV.
Given the risks of hepatitis B or hepatitis C coinfection to the health of people living with HIV, it is important to understand these risks, take steps to prevent infection, know your status, and, if necessary, get medical care from someone who is experienced in treating people who are coinfected with HIV and HBV, or HIV and HCV.
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How Can I Learn More
- Ask your healthcare provider. He or she can give you the vaccine package insert or suggest other sources of information.
- Contact the Centers for Disease Control and Prevention : Call or visit CDC’s website at .
Hepatitis B Vaccine Information Statement. U.S. Department of Health and Human Services/Centers for Disease Control and Prevention National Immunization Program. 10/12/2018.
Why It Is Used
Hepatitis B virus causes a liver infection that can lead to serious complications, including liver cancer. It is common in people throughout the world, particularly in Asia and sub-Saharan Africa.
The Canadian National Advisory Committee on Immunization recommends hepatitis B immunization for all children. Pregnant women and other adults who do not have immunity and who have a high chance of exposure should be vaccinated.
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