Hepatitis B Vaccine On The Nhs
A hepatitis B-containing vaccine is provided for all babies born in the UK on or after 1 August 2017. This is given as part of the 6-in-1 vaccine.
Hospitals, GP surgeries and sexual health or GUM clinics usually provide the hepatitis B vaccination free of charge for anyone at risk of infection.
GPs are not obliged to provide the hepatitis B vaccine on the NHS if you’re not thought to be at risk.
GPs may charge for the hepatitis B vaccine if you want it as a travel vaccine, or they may refer you to a travel clinic for a private vaccination. The current cost of the vaccine is around £50 a dose.
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.
Who Should Get Immunised Against Hepatitis B
Anyone who wants to protect themselves against hepatitis B can talk to their doctor about getting immunised.
Hepatitis B immunisation is recommended for:
People under 20 years old, refugees and other humanitarian entrants of any age, can get hepatitis B vaccines for free under the NIP. This is if they did not receive the vaccines in childhood. This is called catch-up vaccination.
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Treatment Options For Antiviral Resistant Pathogens
If a virus is not fully wiped out during a regimen of antivirals, treatment creates a bottleneck in the viral population that selects for resistance, and there is a chance that a resistant strain may repopulate the host. Viral treatment mechanisms must therefore account for the selection of resistant viruses.
The most commonly used method for treating resistant viruses is combination therapy, which uses multiple antivirals in one treatment regimen. This is thought to decrease the likelihood that one mutation could cause antiviral resistance, as the antivirals in the cocktail target different stages of the viral life cycle. This is frequently used in retroviruses like HIV, but a number of studies have demonstrated its effectiveness against influenza A, as well. Viruses can also be screened for resistance to drugs before treatment is started. This minimizes exposure to unnecessary antivirals and ensures that an effective medication is being used. This may improve patient outcomes and could help detect new resistance mutations during routine scanning for known mutants. However, this has not been consistently implemented in treatment facilities at this time.
Despite their successes, in the United States there exists plenty of stigma surrounding vaccines that cause people to be incompletely vaccinated. These “gaps” in vaccination result in unnecessary infection, death, and costs. There are two major reasons for incomplete vaccination:
Which Adults Should Be Vaccinated Against Hepatitis B
According to CDC recommendations, adults in the following groups are recommended to receive hepatitis B vaccine:
General
- All people age 18 years and younger.
- Anyone 19 years and older who wants to be protected from hepatitis B.
People at risk for infection by sexual exposure
- Sex partners of people who are hepatitis B surface antigen -positive.
- Sexually active people who are not in long-term, mutually monogamous relationships.
- People seeking evaluation or treatment for a sexually transmitted disease.
- Men who have sex with men.
People at risk for infection by percutaneous or permucosal exposure to blood or body fluids
- Current or recent illegal injection drug users.
- Household contacts of people who are HBsAg-positive.
- Residents and staff of facilities for developmentally challenged people.
- Healthcare and public safety workers with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids.
- People with end-stage renal disease, including predialysis, hemo-, peritoneal- and home-dialysis patients.
Others
- International travelers to regions with intermediate or high levels of endemic HBV infection.
- People with chronic liver disease.
- People with HIV infection.
- People with diabetes who are age 19 through 59 years. For those age 60 and older, clinicians should make a determination of need for
- vaccination based on their patients’ situation.
In a future issue, we will review the various hepatitis B serologic tests, who needs testing, and when they need it .
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What Is Hepatitis B Vaccine
Hepatitis B vaccine gives protection against infection from the hepatitis B virus. The vaccine works by causing the body to produce antibodies against the virus responsible for hepatitis B infection and in this way protects against the disease. Hepatitis B is a virus that is easily spread through contact with the blood or bodily fluids of an infected person. For example, it can be passed on through unprotected sex, by sharing injection gear, through a needle stick injury or from mother to child during childbirth. Hepatitis B infection can cause serious problems including liver failure, cirrhosis, and liver cancer. Preventing infection can prevent these problems. Read more about hepatitis B.
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.
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What Are The Possible Side Effects Of Hepatitis A Immunisation
All medicines and vaccines can have side effects. Sometimes they are serious, most of the time theyre not.
For most people, the chance of having a serious side effect from a vaccine is much lower than the chance of serious harm if you caught the disease.
Talk to your doctor about possible side effects of hepatitis A vaccines, or if you or your child have possible side effects that worry you.
Common side effects of hepatitis A vaccines include:
- headache
- tiredness
- pain where the needle went in.
How Does Hepatitis B Spread
The hepatitis B virus spread through bodily fluids like blood or semen. Some common vectors include: sex, contaminated needles, and direct contact with blood or open wounds.
Sexual transmission accounts for nearly two-thirds of acute hepatitis B cases. It is 50 to 100 times more infectious than HIV.
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Where Is It Found
Hepatitis B prevalence is highest among some sub-Saharan African, East and Southeast Asian, and Pacific island populations but can also be found in high numbers in the Mediterranean countries, parts of Eastern Europe, Africa, and Central and South America. It is important to note that although there is a higher risk in certain countries or regions, hepatitis B occurs in all countries.
Some people may have a higher risk of contracting hepatitis B through their occupation, i.e. healthcare workers, police and other emergency services workers, funeral company employees, staff of residential care facilities, tattooists, acupuncturists, people who perform body piercings and sex workers.
Why Is The Hepb Vaccine Recommended
People who dont know they’re infected can spread the hepatitis B virus. So it cant be avoided just by being careful. That’s why health experts recommend that all babies get the vaccine right from birth.
The HepB injection usually creates long-term immunity. Most infants who get the HepB series are protected from hepatitis B infection beyond childhood, into their adult years.
Eliminating the risk of infection also decreases risk for cirrhosis of the liver, chronic liver disease, and liver cancer.
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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.
Recommended Adult Dosing Volume Of Monovalent Hepatitis B Vaccine
- Age 19 years and younger: Use 0.5 mL per dose .
- Age 20 years and older: 1.0 mL per dose .
For a one-page sheet reviewing the hepatitis B dosing schedule for children and adults, consult IACs Hepatitis A and B Vaccines: Be Sure Your Patients Get the Correct Dose. For complete dosing information, consult the ACIP hepatitis B vaccine recommendations for adults.
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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.
Concurrent Administration Of Vaccines
HB-containing vaccines may be administered concomitantly with other vaccines or with HBIg. Different injection sites and separate needles and syringes must be used for concurrent parenteral injections.
Refer to Timing of Vaccine Administration in Part 1 for additional information about concurrent administration of vaccines.
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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
Safety Checks Before Immunization
For Children being immunized at the public health office:
Your nurse will talk to you about your childs health history before giving your child any vaccines. This will include questions about any medicines your child is taking, health conditions your child has or is experiencing, as well as any allergies your child may have. Your nurse will guide you on what is safe for your child, based on your childs health history.
When your nurse talks to you about your childs health history, it is important that you inform your nurse if your child:
- is sick or has a fever greater than 38.5 C
- has allergies to any part of the vaccine
- is allergic to any foods, drugs, bee stings, etc.
- has a weakened immune system
- has had an allergic reaction or other severe or unusual reaction to this or other vaccines in the past
Your nurse will guide you on what is safe for your child, based on your childs health history.
For Children being immunized at school:
If you have additional questions about the in-school immunization, you can dial for Health Link, or contact the Public Health Nurse who provides immunizations in your school at the number included in the information package.
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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.
Where Can I Get Vaccinated
The best place to go for vaccinations is your family medical clinic. They have your medical records and can check to see if youve already had a particular vaccination. Either your doctor or a nurse can give the vaccination.If you dont have a family doctor, you can go to one of the after-hour medical clinics. Ring them first to make sure they can help you with the vaccination you need.You can find a clinic near you on the Healthpoint website. Put in your address and region, and under Select a service, click on GPs/Accident & Urgent Medical Care.Vaccines on the National Immunisation Schedule are free. Other vaccines are funded only for people at particular risk of disease. You can choose to pay for vaccines that you are not eligible to receive for free.
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To Whom Is The Hepatitis B Vaccine Administered
A free vaccine is offered as part of the national programme to
- haemophiliacs receiving regular treatment
- persons close to intravenous drug users, including family members, housemates and sexual partners
- men who have sex with men
In case of persons belonging to one of these groups, also check their protection against hepatitis A. If the person has not received either vaccine previously, you can administer a free hepatitis A and B combination vaccine.
Due to increased infection risk, a free hepatitis B vaccine is also offered to
- newborn children and sexual partners of, and those living in the same household with, persons with a hepatitis B infection and asymptomatic HBsAg positive persons
- sex workers
- students exposed to infection risk during internships
- persons at risk of hepatitis B infection resulting from a needlestick injury or other blood exposure and who have been exposed in environments other than the workplace
- children aged under 5 years at a day care centre when a child in the group is known to be HBsAg positive
- newborn infants when at least one of the parents comes from a country where hepatitis B is common
- newborn infants of mothers with a hepatitis C infection.
Which Vaccine Is Used And What Does It Contain
The product used in the national programme is called Engerix-B. There are different vaccine products for children and adults:
Engerix-B vaccine in a 0,5 ml single-dose syringe is intended for children aged from 0 to 15 years.
Engerix-B vaccine in a 1 ml single-dose syringe is intended for adolescents over 16 years of age and adults.
Vaccine composition:
- The vaccines do not contain live pathogens.
- The active substance is surface structures from hepatitis B viruses.
- The adjuvant is an aluminium compound.
- The excipients are salts and purified water.
- The vaccines contain no preservatives.
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If I Already Have Hepatitis B Can The Vaccine Treat It
No. The hepatitis vaccine prevents hepatitis, but doesnt cure it if you already have it. If you have hepatitis B, there are other treatment options.
However, if you recently got exposed to the hepatitis B virus and you havent had the vaccine yet, tell your doctor right away. The vaccine and possibly other treatment can reduce your chances of getting hepatitis B if you get it within 2 weeks after you came into contact with the virus. The sooner you seek care after being exposed to hepatitis B, the better, so try to get there right away.
How And When Do Doctors Give Vaccines
For the hepatitis A vaccine:
You should get two doses, given as shots, 6 months apart for complete protection. The virus in the vaccine is killed .
Children should get the first dose between 12 and 23 months of age. Children older than age 2 can get the first dose at their next doctorâs visit.
If you need the vaccine because of upcoming travel, get it at least 1 month before you go.
For the hepatitis B vaccine:
For long-lasting immunity, you need three to four doses, depending on which type of vaccine is used. You get them as shots.
Children should get their first dose at birth and complete the series by age 6 months. Usually, the baby would get a second dose at 1 month old and the third dose at 6 months.
Babies born to women who have hepatitis B need a shot of hep B antibodies, as well as their first hep B vaccine shot, when theyâre born. They will also need follow-up blood tests to make sure theyâre OK.
Catch-up vaccinations are recommended for children and teens who were never vaccinated or who did not get all three shots.
If you’re an adult who wants to be vaccinated, you should talk about it with your doctor or pharmacist. If you are considering both vaccines, ask your doctor about vaccines that combine hep A and B.
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