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.
Other Reported Adverse Events And Conditions
While serious events and chronic illnesses such as chronic fatigue syndrome, multiple sclerosis, Guillain-Barré syndrome, rheumatoid arthritis and sudden infant death syndrome have been alleged or reported following HB vaccination, no evidence of a causal association has been demonstrated in a number of studies.
How Is The Hepatitis B Vaccine Made
People are protected against hepatitis B virus infection by making an immune response to a protein that sits on the surface of the virus. When hepatitis B virus grows in the liver, an excess amount of this surface protein is made. The hepatitis B vaccine is made by taking the part of the virus that makes surface protein and putting it into yeast cells. The yeast cells then produce many copies of the protein that are subsequently used to make the vaccine. When the surface protein is given to children in the vaccine, their immune systems make an immune response that provides protection against infection with the hepatitis B virus.
The first hepatitis B vaccine was made in the 1980s by taking blood from people infected with hepatitis B virus and separating or purifying the surface protein from the infectious virus. Because blood was used, there was a risk of contaminating the vaccine with other viruses that might be found in blood, such as HIV. Although contamination with HIV was a theoretical risk of the early, blood-derived hepatitis B vaccine, no one ever got HIV from the hepatitis B vaccine. That is because the blood used to make vaccine was submitted to a series of chemical treatments that inactivated any possible contaminating viruses. Today, there is no risk of contaminating the vaccine with other viruses because the surface protein is manufactured in the laboratory.
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Babies And Children Can Develop Chronic Hbv
You may be wondering why the recommendations for the HBV vaccine start on the first day of life.
Adults who contract HBV will likely not experience long-term complications from hepatitis B. But the same is not the case for babies. As many as of babies who contract an HBV infection at birth from their mothers become chronically infected with HBV.
Children between the ages of 1 and 5 who get an HBV infection have a 25 percent of people who become chronically infected during childhood will develop liver cancer or cirrhosis. Thats why pediatricians want children to have immunity from HBV from the earliest possible age. Many babies and children exposed to HBV receive post-exposure prophylaxis, which decreases chance of infection.
If youre pregnant, youll most likely have a blood test to see if youre positive for hepatitis B. This allows doctors to find out if theres a chance that you could pass on the virus. These tests are highly sensitive and have a good accuracy rate, but they arent perfect. Additionally, a pregnant person may become infected between the time of the test and giving birth. The first dose of the vaccine given at birth lowers the risk of a newborn baby contracting hepatitis B.
Recommended Doses Of Hepatitis B Vaccine
Recommended doses of hepatitis B by vaccine type, age, formulation, dosage and schedule.
Download PDF version formatted for print: Recommended Doses of Hepatitis B Vaccine
Infants: birth, 1-4, 6-18 monthsOROlder children: 0, 1-2, 4-6 months
20 years & older
Infants: birth, 1-4, 6-18 monthsOROlder children: 0, 1-2, 4-6 months
0, 1, 4-6 months
* The schedule for hepatitis B is flexible, but minimal intervals and minimum ages need to be observed:
- There should be at least 4 weeks between doses 1 and 2, and at least 8 weeks between doses 2 and 3.
- The minimum interval for the overall series from dose 1 to final dose is 4 months .
- Infants, should receive the final dose of hepatitis B vaccine on or after 6 months of age, otherwise long term immunity may be impacted.
- Adults who are immunocompromised or on dialysis require a larger dose of hepatitis B vaccine.
- The Engerix-B dose required is 40mcg/2.0mL on a scheduled of 0, 1, 2, and 6 months.
- For Recombivax HB, a special formulation is available. The dose is 40mcg/1.0mL given on a schedule of 0, 1, and 6 months
6 weeks thru 6 years
Hep B as Engerix-B 10 mcg, DTaP as Infanrix, Polio
Give single antigen hep B dose at birth followed by Pediarix at: 2, 4, 6 months
Hep A as Havrix 720 El.U, Hep B as Engerix-B 20 mcg
0, day 7, day 21-30, 12 months
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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.
A Note About Sex And Gender
Sex and gender exist on spectrums. This article will use the terms male, female, or both to refer to sex assigned at birth. .
It is important that infants who are born to females with hepatitis B receive accurate doses of the hepatitis B vaccine. They may also be required to receive hepatitis B immunoglobulin if it is available.
The WHO also recommends using antiviral prophylaxis to help prevent hepatitis B transmission.
The table below outlines the two recommended hepatitis B vaccine schedules for infants born to those who have hepatitis B:
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Immunisation Against Hepatitis B
The current Australian immunisation program provides free hepatitis B vaccine to protect all children against the hepatitis B virus.
A full course of hepatitis B injections must be given for a child to be protected. It is recommended that this course begins within 24 hours of birth with a vaccine against hepatitis B alone. Further doses are routinely given at 2 months , 4 months and 6 months of age, as a combination vaccine.
Vaccination is the best protection against hepatitis B infection. In Victoria a free hepatitis B vaccine is available for a number of groups at high risk, including but not limited to Aboriginal and Torres Strait Islander peoples, men who have sex with men, and people living with HIV.
The adult course involves 3 doses of the vaccine over 6 months and gives protection to about 95 per cent of people. Once you have had the 3 doses, you can have a blood test to see if you are protected.
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What Are The Side Effects
The most common of the hepatitis B vaccine are mild and include:
- Sore arm from the shot.
Prepare for your child’s vaccine visit and learn about how you can:
- Research vaccines and ready your child before the visit
- Comfort your child during the appointment
- Care for your child after the shot
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What To Do If You Miss A Scheduled Dose
The recommended schedule for the HBV vaccine follows a three-dose pattern, with all doses complete within 6 months. The good news is that if you miss a dose, you dont need to start the series of shots all over.
If you missed getting the second dose 1 month after the first, make an appointment as soon as possible. If you miss the third dose, you should also try to get it as quickly as possible. Keep in mind that the second and third doses
Annual Updates To The Immunization Schedule 1995 To 2010
As more vaccines became available, an annual update to the schedule was important because of changes that providers needed to know, such as detailed information about who should receive each vaccine, age of receipt, number of doses, time between doses, or use of combination vaccines. New vaccines were also added.
Important changes to the schedule between 1995 and 2010 included:
- New vaccines: Varicella , rotavirus hepatitis A pneumococcal vaccine
- Additional recommendations for existing vaccines: influenza hepatitis A
- New versions of existing vaccines: acellular pertussis vaccine intranasal influenza
- Discontinuation of vaccine: Oral polio vaccine
2000 | Recommended Vaccines
* Given in combination as DTaP** Given in combination as MMR
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Who Should Receive The Hepatitis B Vaccine
For most people, the hepatitis B vaccine is safe and effective. About 90% of people who receive three vaccine doses are protected against hepatitis B for over 30 years.
The CDC’s Advisory Committee on Immunization Practices recommends the hepatitis B vaccine for the following groups:
- All babies, starting just after birth
- Children and adolescents under 19 years old
- Adults ages 1959 who have not previously completed vaccination
- Adults ages 60 and over with a high risk of contracting HBV
Adults ages 60 and over who do not have any hepatitis B risk factors can receive the hepatitis B vaccine, but it is optional.
Hepatitis B spreads when the bodily fluids of an infected person enter another person’s body. Sexual contact is one way it can be spread. A person with HBV can spread it to their baby during childbirth. Other ways in which HBV may be transmitted include:
- Sharing medical equipment, whether at home or in a hospital setting, with a person who has an HBV infection
- Sharing syringes with a person who has hepatitis B, such as during injection drug use or at-home piercing or tattooing
- Sharing personal items, such as razors or toothbrushes, with someone who has hepatitis B
- Coming into contact with the sores or blood of a person who has hepatitis B
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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Hepatitis B Vaccine: Canadian Immunization Guide
For health professionals
Last partial content update : May 2022
The footnotes in and the accompanying text description for the figure have been revised to align with the corresponding figure in Protocole dimmunisation du Québec, 5e édition from which it was adapted.
Last complete chapter revision :
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.
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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.
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Hepatitis B Vaccine Schedule For Adults
Hepatitis B is a vaccine-preventable viral disease that involves inflammation of the liver.
The hepatitis B virus usually leads to a short-term infection known as acute hepatitis B. If their infection is left untreated, some people develop chronic hepatitis B. Chronic hepatitis B is a serious, permanent condition that can cause organ damage, cirrhosis , liver cancer, liver failure, and even death.
According to the Centers for Disease Control and Prevention , all people should be vaccinated against hepatitis B starting at birth. Adults who are at risk of developing hepatitis B should also receive the vaccine, which is highly effective in preventing infection.
Read on to learn more about the hepatitis B vaccine for adults, including who should receive it, the details of the dosage schedule, side effects, and more.
Prasit photo / Getty Images
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Who Should Get The Hepatitis B Vaccine
Any child up to 18 years of age who did not get the vaccine or all of the needed doses should get the vaccine.
- Your adolescent should get the vaccine if:
- He or she gets a stick from an infected needle, including for illegal drugs and for procedures such as tattooing
- He or she has unprotected sex with an infected person, sex with more than one partner, or is a male who has sex with males
- She is pregnant or breastfeeding and is at risk for hepatitis B
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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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 .
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 and COVID-19 viruses, 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.
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