When Was The Hepatitis B Vaccine Developed

Measles Mumps And Rubella

Measles, Mumps, and Rubella are viral infections that have each caused widespread, deadly disease outbreaks. Throughout the 1960s, individual vaccines were developed for each of them, but a decade later, they were combined into one.

Measles was the first of the three to receive its own vaccine in 1963, followed by mumps in 1967, and rubella in 1969. Two years later, in 1971, Maurice Hilleman of the Merck Institute of Therapeutic Research developed a combined vaccination that would provide immunity for all three viruses.

Hilleman was credited with creating the first measles and mumps vaccine, and began researching ways to incorporate a system of immunity for each virus. Using his previous research and a rubella vaccine developed by Stanley Plotkin in 1969, he created the first successful MMR vaccine in just two years.

According to the CDC, “One dose of MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella.”

“Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps.”

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.

Vaccine Development In The 1980s Hepatitis B And Haemophilus Influenzae Type B

The vaccine for Haemophilus influenzae type b was licensed in 1985 and placed on the recommended schedule in 1989. When the schedule was published again in 1994, the hepatitis B vaccine had been added.

The hepatitis B vaccine was not new, as it had been licensed in 1981 and recommended for high-risk groups such as infants whose mothers were hepatitis B surface antigen positive, healthcare workers, intravenous drug users, homosexual men and people with multiple sexual partners. However, immunization of these groups didn’t effectively stop transmission of hepatitis B virus. Thats because about one-third of patients with acute disease were not in identifiable risk groups. The change of recommendation to immunize all infants in 1991 was the result of these failed attempts to control hepatitis B by only immunizing high-risk groups. Following this recommendation, hepatitis B disease was virtually eliminated in children less than 18 years of age in the United States.

1985 – 1994 | Recommended Vaccines

* Given in combination as DTP** Given in combination as MMR

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How To Get Vaccinated Against Hepatitis B

All babies in the UK born on or after 1 August 2017 are given 3 doses of hepatitis B-containing vaccine as part of the NHS routine vaccination schedule.

These doses are given at 8, 12 and 16 weeks of age.

Babies at high risk of developing hepatitis B infection from infected mothers are given extra doses of the hepatitis B vaccine at birth, 4 weeks and 1 year of age.

If you think you’re at risk and need the hepatitis B vaccine, ask your GP to vaccinate you, or visit any sexual health or genitourinary medicine clinic.

If your job places you at risk of hepatitis B infection, it’s your employer’s responsibility to arrange vaccination for you, rather than your GP. Contact your occupational health department.

Symptoms And Causative Agent

Hepatitis is a general term for inflammation of the liver, which may result from infectious or non-infectious causes. Viruses responsible for many cases of infectious hepatitis include hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E. Hepatitis A and B are the only hepatitis viruses for which vaccines are currently available in the United States .

The hepatitis B virus is a partly double-stranded DNA virus in the hepadnavirus family. The hepatitis A virus is a single-stranded RNA virus in the picornavirus family. Both viruses, though they are structurally unrelated to one another, infect and replicate primarily in liver cells.

The symptoms of acute hepatitis A infection are identical to those of hepatitis B infection. Early symptoms are headache, nausea, vomiting, abdominal pain, fever, rash, body aches and pains, and dark colored urine. Following this phase, jaundice , light stools, and liver pain may appear.

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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.

Historic Dates And Events Related To Vaccines And Immunization

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Vaccines For Adolescents: A New Generation Of Vaccines

Adolescents, like adults, were recommended to get tetanus boosters every 10 years most requiring their first booster dose around age 11. Other than this, however, most adolescents did not require additional vaccines unless they missed one in childhood. By 2005, vaccines specifically recommended for adolescents were only recommended for sub-groups based on where they lived or medical conditions that they had. However, a new group of vaccines became available in the latter part of the decade.

• New vaccines: Tdap, 2005, meningococcal conjugate , HPV , meningococcal serogroup B vaccine
• Additional recommendations for existing vaccines: HPV , intranasal influenza vaccine
• New versions of existing vaccines: HPV
• Discontinuation of vaccine: intranasal influenza vaccine

2000

Pneumococcus

Indications For Hepatitis B Vaccine

HepB vaccine also is indicated for adults who have not been previously vaccinated when any of the following is present:

• A desire for protection from hepatitis B in people who have not been previously vaccinated

• 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 disease

• 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

• HIV infection

• 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 disease 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

• Pregnant women if at risk of infection or severe outcome resulting from infection during pregnancy

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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Hbv Vaccination Doses And Formulations

Given differences in the manufacturing processes and populations vaccinated, the quantity of HBsAg protein per dose that will induce a protective immune response differs in various vaccine products. Currently, hepatitis B vaccines are formulated to contain 540 g of recombinant HBsAg protein and an aluminum phosphate or aluminum hydroxide adjuvant . In general, based on immunogenicity data with different vaccine dosages in different age groups, the vaccine dosages to provide protection for infants, children, and adolescents are 50% lower than that required for adults . Marketed hepatitis B vaccines are to be administered by intramuscular injection on the anterolateral site of the thigh or into the deltoid muscle . The WHO has developed recommendations to ensure the quality, safety, and efficacy of recombinant hepatitis B vaccines and keeps a list of current hepatitis B vaccines prequalified by the WHO .

Hepatitis B vaccines are available as monovalent formulations for birth doses or for vaccination of adult persons at risk, and as combination vaccines . Major progress in the global response to viral hepatitis has been achieved through the introduction of routine hepatitis B vaccination via the WHOs Expanded Programme on Immunization, which was facilitated by the introduction of combination vaccines . Hepatitis B vaccines are generally stable for 3 to 4 years from the date of manufacture if stored between 2°C and 8°C.

The Vaccine Everyone Was Waiting For Polio Vaccine

Parents were scared of the polio epidemics that occurred each summer they kept their children away from swimming pools, sent them to stay with relatives in the country, and clamored for an understanding of the spread of polio. They waited for a vaccine, closely following vaccine trials and sending dimes to the White House to help the cause. When the polio vaccine was licensed in 1955, the country celebrated, and Jonas Salk, its inventor, became an overnight hero.

Late 1950s | Recommended Vaccines

* Given in combination as DTP

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The Impact Of Worldwide Hepatitis B Vaccination Programs: Model Of Success

A, Immunization coverage with third dose of hepatitis B in infants in 2019. B, Global immunization 19892019 HepB3 coverage in infants. Global coverage was 84% in 2019. Abbreviations: AFR,African region AMR,Americas region EMR,Eastern Mediterranean region EUR,European region SEAR,South-East Asia region WPR,Western Pacific region. Source: United Nations Children’s Fund /World Health Organization.

The success of HBV vaccination programs has been clearly demonstrated over the recent years in several regions around the world. Countries that have adopted the recommendation had a marked reduction in carrier rates as well as complications from HBV, including HCC. The low prevalence of chronic HBV infection in children younger than 5 years, reducing from 4.7% in the prevaccine era to less than 1% in 2019, can be attributed to the widespread use of hepatitis B vaccine. Due to the implementation of routinely birth-dose vaccination the greatest decrease appears to be in the Western Pacific region, from 8.3% HBsAg prevalence in the prevaccine era to 0.93% in 20022015 . Among health care workers, hepatitis B vaccination is highly effective for the prevention of healthcare associated HBV infection and chronic infection. Using mathematical models, it was estimated that since their implementation, HBV vaccination programs have averted 210 million new HBV infections globally .

For Adults At High Risk Of Exposure

Adults who have not received the hepatitis B vaccine series should be immunized when they have an increased risk of exposure. Job, travel, health condition, or lifestyle all may increase a person’s risk of contracting hepatitis B.

People who live or work where there is risk of exposure include:

• Health care and public safety workers who are likely to be exposed to blood or blood products.
• Clients and staff of institutions or residential settings with known or potential HBV carriers.
• People planning extended travel to China, Southeast Asia, Africa, and other areas where hepatitis B infection is high.

People who have health conditions that put them at high risk for exposure or a severe infection include:

• People who have a severe kidney disease that requires them to have their blood filtered through a machine .
• People who have chronic liver disease.
• People who have hemophilia and other conditions in which they need to have blood products on an ongoing basis.
• People who had a stem cell transplant.

People whose lifestyle puts them at high risk for exposure include:

• People who inject illegal drugs.
• Men who have sex with men.
• People who have had more than one sex partner in the past 6 months or who have a history of sexually transmitted infection.
• Household contacts and sex partners of hepatitis B carriers.
• Prison inmates.

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What Are The Potential Adverse Effects Of The Hepatitis B Vaccine

The most common adverse effects are local symptoms at the injection site, including pain, redness and swelling.

Transient generalised symptoms are also common, including

• fever
• tiredness.

Skin symptoms or actual hypersensitivity reactions are rare.

Local and generalised symptoms usually begin within a few days of the vaccination and go on for some days. They may be treated with fever and pain medications.

Local and generalised symptoms are not a contraindication for further vaccinations.

Hepatitis B Prevention Strategies

HepB vaccination is the mainstay of hepatitis B prevention efforts. A comprehensive strategy to eliminate HBV transmission includes universal vaccination of infants beginning at birth, routine vaccination of previously unvaccinated children less than age 19 years, and vaccination of adults at risk for HBV infection, including those requesting protection from HBV without acknowledgement of a specific risk factor. It also includes universal testing of pregnant women for HBsAg to identify newborns who require immunoprophylaxis for prevention of perinatal infection and to pregnant women who can benefit from antiviral therapy to reduce perinatal transmission.

• HepB

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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.

Transmission Symptoms And Treatment

How is HBV transmitted?

HBV is transmitted through activities that involve percutaneous or mucosal contact with infectious blood or body fluids , including

• sex with an infected partner
• injection-drug use that involves sharing needles, syringes, or drug-preparation equipment
• birth to an infected mother
• contact with blood from or open sores on an infected person
• exposures to needle sticks or sharp instruments and
• sharing certain items with an infected person that can break the skin or mucous membranes , potentially resulting in exposure to blood.

How long does HBV survive outside the body?

HBV can survive outside the body and remains infectious for at least 7 days .

What should be used to clean environmental surfaces potentially contaminated with HBV?

Any blood spills should be disinfected using a 1:10 dilution of one part household bleach to 10 parts of water. Gloves should be worn when cleaning up any blood spills.

Who is at risk for HBV infection?

The following populations are at increased risk for becoming infected with HBV:

• Infants born to infected mothers
• Sex partners of infected people
• Men who have sex with men
• People who inject drugs
• Household contacts or sexual partners of known people with chronic HBV infection
• Health-care and public-safety workers at risk for occupational exposure to blood or blood-contaminated body fluids
• Hemodialysis patients

Who should be screened for HBV?

CDC recommends that the following people be screened for HBV :

• fever,

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Implementing Strategies For Hepatitis B Vaccination

When hepatitis B vaccines became available, strategies for HBV control were initially focused on vaccination of high-risk groups . However, high-risk individuals are mostly difficult to reach and are often infected before vaccination . Consequently, coverage of 3 doses of hepatitis B vaccine remained low in most high-risk groups due to low compliance and logistic reasons . In addition, as many as 30% or more people with acute hepatitis B infection do not have identifiable risk factors and are therefore missed by only a high-risk group approach .

Hence it was clear that an additional global strategy was required as the high-risk strategy made little impact and the global burden of hepatitis B diseases became more and more obvious. Decision makers and health professionals worldwide started to discuss a strategy of universal hepatitis B immunization for a certain age cohort, even in low-endemicity countries. In 1991, the WHOs Global Advisory Group of the Expanded Programme on Immunization recommended that hepatitis B vaccine be integrated into national immunization programs in all countries by 1997 . This 1991 recommendation was endorsed by the World Health Assembly in 1992 . Progressively, it has become more widely used and recommendations for HBV vaccination have been extended in an attempt to achieve maximum protection .