What Types Of Hepatitis Have Vaccines

What Is The Outlook For Hepatitis

Hepatitis A and E usually only cause short-term infections that your body can overcome. The others can also cause acute infections, but might also cause chronic infections. The chronic forms are more dangerous. Hepatitis non-E is usually acute, but can become chronic.

Most people recover fully from hepatitis even though it might take several months for the liver to heal. To help improve your health and to help speed up your recovery:

• Practice good nutrition.
• If you feel sick, rest.
• Talk to your healthcare provider about your medicines, even over-the-counter drugs or vitamins and supplements, to know which ones you should take and which to avoid until you are recovered.

With hepatitis, your healthcare provider will also be looking for long-term damage to the liver in the forms of cirrhosis or liver failure. You may be asked to take other types of tests, such as liver function tests, imaging tests or possibly a liver biopsy.

If you have questions, new symptoms, or worsening of any existing symptoms, you should call the office of your healthcare provider.

In the U.S., A, B and C are the most common viral forms of hepatitis. It doesnt matter how you were infectedwhat matters is taking care of yourself once you have been diagnosed and taking care not to spread the infection to anyone else.

Last reviewed by a Cleveland Clinic medical professional on 01/06/2020.

References

Dose And Administration Of Hepatitis A Vaccine

The HepA vaccine dose is 0.5 mL IM up to age 18 years or 1 mL IM for adults .

Children are given a 2-dose series typically at age 12 to 23 months and 6 to 18 months after the first dose.

Depending on the manufacturer, adults are given the vaccine in a 2-dose series at 0 and 6 to 12 months or 0 and 6 to 18 months .

Or adults may be given the combination HepA and HepB vaccine on a 3-dose schedule: at 0, 1, and 6 months. The first and second doses should be separated by 4 weeks, and the second and third doses should be separated by 5 months. Alternatively, the vaccine may be given on an accelerated 4-dose schedule: on days 0, 7, and 21 to 30, followed by a booster 12 months after the first dose.

As soon as an adoption of a child from an endemic area is planned, close contacts should be given the first dose of the 2-dose HepA vaccine series, ideally 2 weeks before the adopted child arrives.

How Can I Protect Myself Against Viral Hepatitis

There are many ways you can reduce your chances of getting hepatitis:

• Get the vaccines for hepatitis A and hepatitis B.
• Use a condom during sex.
• Don’t share needles to take drugs.
• Practice good personal hygiene such as thorough hand-washing with soap and water.
• Don’t use an infected person’s personal items.
• Take precautions when getting any tattoos or body piercings.
• Take precaution when traveling to areas of the world with poor sanitation.
• Drink bottled water when traveling.

It is very important that you take these preventive measures if you participate in risky behaviors. Take preventive steps, too, if you work in places like a nursing homes, dormitories, daycare centers, or restaurants where there you have extended contact with other people and a risk of coming into contact with the disease.

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Who Should Receive Hepatitis B Vaccination

• All newborns before hospital discharge. Infants born to hepatitis B-positive women need hepatitis B vaccine and HBIG within 12 hours of birth.
• All children and adolescents not previously vaccinated.
• Children born in the U.S. to individuals born in a country with high hepatitis B endemicity.
• All individuals at risk of hepatitis B infection:
• Sex partners of hepatitis B-positive persons
• Sexually active persons who are not in a long-term, mutually monogamous relationship
• Persons seeking evaluation or treatment for a sexually-transmitted disease
• Men who have sex with men
• Persons who inject drugs
• Household contacts of hepatitis B-positive persons
• Persons born in countries where hepatitis B infection is endemic should be tested and vaccinated if susceptible
• International travelers to regions with high or intermediate rates of endemic hepatitis B infection
• Health care and public safety workers that may be exposed to blood or blood-contaminated body fluids
• Residents and staff of facilities for developmentally disabled persons, corrections facilities, and other facilities that serve adults at risk for hepatitis B infection
• Persons with end-stage renal disease, including pre-dialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
• Persons with chronic liver disease
• Persons to age 60 years with diabetes
• Persons with HIV infection

• All other persons seeking protection from hepatitis B infection.

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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Impact Of The Vaccine On Disease Burden

Despite the development of safe and effective HBV vaccines over three decades ago, HBV remains a major public health problem worldwide, the leading cause of liver cancer, and an important contributor to cirrhosis as well as end-stage liver disease requiring liver transplantation. A recent systematic review estimated the HBsAg prevalence globally for the years 1990 and 2005 . The total number of HBsAg positive subjects in 2005 was estimated at 240 million, higher than the 223 million estimated for 1990. The global prevalence in 2005 was 3.7% vs. 4.2% for 1990. As shown in Figure 2, the areas of highest prevalence in the world are Asia and Africa. Locarnini et al. have argued that effective and enforced public health policies are needed in order to actualize a universal HBV vaccine and to see the marked reduction in morbidity and mortality that would be possible if this vision were to become a reality. As of 2008, 177 of 193 WHO member states had integrated HBV vaccination into their national infant vaccination schedules .

Global prevalence of HBV . Figure is used with permission from the publisher.

Reported acute hepatitis B incidence, United States, 1980-2013 . Figure is used with permission from the publisher.

Hepatitis A B And C: What Is The Difference

A, B, C D and E.

Aside from the letters associated with it, how much do you know about hepatitis? Whats the difference between the types? And if you get a vaccination for hepatitis, which are you protected from?

We spoke with Moises Ilan Nevah, MD, a transplant hepatologist/gastroenterologist and medical director of the Liver Transplant Program at Banner University Medical Center Phoenix, to help better understand the similarities and differences between the various types of hepatitis, who is at risk and when to get vaccinated.

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How Is Hepatitis Contracted

There are various ways of contracting hepatitis, depending on the type. Contracting a viral form of hepatitis depends on the mode of transmission, which the table above shows.

A person may sometimes contract hepatitis nonvirally. In autoimmune hepatitis, the immune system attacks the liver cells. Ingesting substances that contain toxins, such as alcohol, can also induce some types of hepatitis.

A doctor may use a blood test to diagnose viral hepatitis.

A healthcare professional will check a persons blood for:

• HAV-specific immunoglobulin G antibodies to diagnose HAV
• the surface antigen HBsAg to diagnose HBV
• anti-HCV antibodies to diagnose HCV
• high immunoglobulin G and anti-HDV immunoglobulin M levels to diagnose HDV
• virusspecific IgM antibodies to identify HEV

To autoimmune hepatitis, a doctor may consider:

I Am A Healthcare Worker Who Did Not Develop Hepatitis B Antibodies After Immunization What Should I Do

Two versions of hepatitis B vaccine are available. One, called Heplisav-B, contains a novel adjuvant that was not present in previous versions used by adults . Some people did not respond to the older version hepatitis B vaccine. In fact, in a group of adults younger than 40 years of age who received two doses of the older version vaccine 75 of 100 were protected. Following the third dose, this number increased to 90 of 100. However, people older than 40 years of age were less likely to respond to the vaccine with increasing age. On the other hand, 90 to 100 of 100 adults 18 years of age and older respond to Heplisav-B, which was approved for use in 2018.

About 5-10 of every 100 children and adults younger than 40 years of age do not respond to the third dose of the hepatitis B vaccine. Some of these people will be recommended to get vaccinated again. About 5 of 100 people will still not respond after getting all recommended doses of both series. Note that children younger than 18 years of age cannot get Heplisav-B.

If the people who do not respond to vaccination are determined not to have chronic hepatitis B, they will be reliant on taking precautions to reduce the chance of exposure and relying on those around them for protection. In other words, these people will be reliant on herd immunity.

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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.

Is There A Vaccine For Hepatitis

There are vaccines for hepatitis A and hepatitis B that are available in the U.S. There is no vaccine for hepatitis C. Since you can only get hepatitis D if you have hepatitis B, getting the vaccine against B should protect you against hepatitis D. There is no FDA approved vaccine against hepatitis E, but vaccines against hepatitis E exist overseas .

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How Is Hepatitis A Infection Prevented

Vaccination

• The hepatitis A vaccine offers excellent protection against HAV. The vaccine is safe and highly effective. Vaccination consists of 2 doses of vaccine spaced 6-12 months apart. Protection starts 1-2 weeks after the first dose of vaccine, and lasts for 20 years to life after 2 doses.
• The American Academy of Pediatrics recommends that all children should receive hepatitis A vaccine starting at 1 year of age .
• The CDC recommends hepatitis A vaccine for all persons traveling to countries where HAV is common . For infants that will be traveling internationally, an early dose of Hepatitis A vaccine can be given at age 6-11 months.

Natural Immunity

• People who have hepatitis A infection become immune to HAV for the rest of their lives once they recover. They cannot get hepatitis A twice.
• The blood test for immunity to hepatitis A is called the Hepatitis A Total Antibody test. People who have had hepatitis A and those who have received hepatitis A vaccine show positive antibodies to hepatitis A on this test for the rest of their life.

Healthy Habits

• Good personal hygiene and proper sanitation help prevent the spread of the HAV virus. Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing, serving, or eating food.
• Alcohol-based hand sanitizers do not kill the hepatitis A virus

After Exposure to HAV

Indications For Hepatitis A Vaccine

HepA vaccine also is indicated when any of the following is present:

• A desire for protection from hepatitis A in people not previously vaccinated

• Travel to or work in endemic areas

• Occupational exposure

• Sex between men

• Use of illicit drugs , such as methamphetamine

• HIV infection in all people 1 year of age

• A chronic liver disorder

• Anticipated close personal contact with an adopted child during the first 60 days after the child’s arrival in the US from an endemic area

• Healthy adults 40 years who have recently been exposed to hepatitis A virus and adults > 40 if hepatitis A immunoglobulin cannot be obtained

• Pregnant women who are identified to be at risk of HAV infection during pregnancy or who are at risk of having a severe outcome resulting from HAV infection

During hepatitis A outbreaks, people 1 year of age who are at risk of HAV infection should be vaccinated.

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.

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Check If You Have Hepatitis A

Symptoms of hepatitis A infection include:

• a high temperature
• flu-like symptoms, such as tiredness, headache, and muscle pains
• feeling sick or being sick
• pain in your upper tummy
• diarrhoea or constipation
• pale yellow or pale grey poo
• itchy skin you may also have a raised rash
• yellowing of the skin and the whites of the eyes

Most children, and some adults, may have mild symptoms or no symptoms.

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:

If your child is undergoing hemodialysis, your healthcare provider may recommend that they receive additional doses of the HBV vaccine.

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The A B Cs Of Hepatitis

Hepatitis A

The hepatitis A virus causes acute inflammation of the liver that almost always gets better on its own, although it can be more serious if you get it when you are older or if you already have liver disease. It is easily spread from person to person, in food and water, and can infect many people at once. For example, if a food handler at a restaurant is infected with hepatitis A, those who eat food prepared by that handler may be infected. Hepatitis A can be prevented by getting vaccinated.

Hepatitis B

The hepatitis B virus can be both acute and chronic and is spread through blood or other body fluids in various ways. Hepatitis B is very common in Asia and Africa and those who were born or lived in these areas should be checked for hepatitis B. Like hepatitis A, a vaccine is available to prevent HBV infection as long as you have not been previously exposed. Although chronic HBV cannot be cured, there are oral medications available to treat and control the virus.

Hepatitis C

The hepatitis C virus is almost always chronic and spreads mostly by direct blood to blood contact. Although hepatitis A and B can be prevented by vaccination, hepatitis C cannot. However, there are currently oral medications available that are able to cure Hepatitis C in 95% of all cases regardless of prior treatment history.

Are Hepatitis B Virus Infections Easily Avoided

Large quantities of hepatitis B virus are present in the blood of people with hepatitis B in fact, as many as one billion infectious viruses can be found in a milliliter of blood from an infected individual. Therefore, hepatitis B virus is transmitted in the blood of infected individuals during activities that could result in exposure to blood, such as intravenous drug use, tattooing, or sex with people who are infected. However, it is also possible to catch hepatitis B virus through more casual contact, such as sharing washcloths, toothbrushes or razors. In each of these cases, unseen amounts of blood can contain enough viral particles to cause infection. In addition, because many people who are infected don’t know that they are infected, it is very hard to avoid the chance of getting infected with hepatitis B virus.

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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:

General Information About Vaccination Outside The Us

In developing countries, the pentavalent vaccine, a combination 5-in-one vaccine that protects against five diseases, diphtheria, pertussis, tetanus, Hib and hepatitis B, may be given to babies more than 6 weeks of age, and can be given up to 1 year of age. The first dose is given at 6 weeks, and the second and third doses are given at 10 and 14 weeks of age. The pentavalent vaccine may be made available free of charge with the support of GAVI, the vaccine alliance. Check the GAVI country hub to see the resources and immunizations that may be available:

For babies born to mothers with hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from vertical or horizontal transmission of hepatitis B. Babies born to a mother with hepatitis B have a greater than 90% chance of developing chronic hepatitis B if they are not properly treated at birth.

WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Plan ahead and inquire about the availability and cost of the monovalent , birth dose of the vaccine, as it is not a GAVI provided immunization. This is particularly important to women who are positive for hepatitis B.

If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B!

*WHO does not recommend a birth dose of HBIG, which may not be available in all countries. Talk to your doctor if you have questions.

Page updated September 2022.

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