The Hepatitis B Vaccine And Immunosuppressants
If you are taking or about to start taking a medication that suppresses your immune response, let your healthcare provider know. Immunosuppressants may make certain vaccines less effective. Your healthcare provider may recommend that you get the hepatitis B vaccine at a particular time during your course of medication.
Hepatitis B Adult Vaccine Dosing Information
Usual Adult Dose for Hepatitis B Prophylaxis:
Primary Vaccination:Engerix-B:19 years and younger: Three doses intramuscularly on a 0, 1, and 6 month schedule20 years and older: Three doses intramuscularly on a 0, 1, and 6 month scheduleHeplisav-B: Two doses intramuscularly one month apartRecombivax-HB: 19 years and younger: Three doses intramuscularly on a 0, 1, and 6 month schedule 20 years and older: Three doses intramuscularly on a 0, 1, and 6 month schedule Known or Presumed Hepatitis B Exposure:Engerix-B : Use recommended doses of on a 0, 1, and 6 month schedule OR a 0, 1, 2, and 12 month schedule.Recombivax-HB: Refer to recommendations of the Advisory Committee on Immunization Practices
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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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A Look At Each Vaccine: Hepatitis B Vaccine
View larger image The hepatitis B vaccine is given to prevent the severe liver disease that can develop when children or adults are infected with hepatitis B virus. The hepatitis B vaccine is given as a series of three shots. The first dose is given within 24 hours of birth. The second dose is given one to two months after the first dose, and the third dose is given between 6 months and 18 months of age. The vaccine is also recommended for those up to 60 years of age who have not previously received it and those 60 years and older who are at increased risk or who simply want the protection afforded by vaccination.
Why Should My Baby Get The Hepatitis B Shot
- Protects your child from against hepatitis B, a potentially serious disease.
- Protects other people from the disease because children with hepatitis B usually dont have symptoms, but they may pass the disease to others without anyone knowing they were infected.
- Prevents your child from developing liver disease and cancer from hepatitis B.
- Keeps your child from missing school or child care and you from missing work.
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The Bodys Natural Response
A pathogen is a bacterium, virus, parasite or fungus that can cause disease within the body. Each pathogen is made up of several subparts, usually unique to that specific pathogen and the disease it causes. The subpart of a pathogen that causes theformation of antibodies is called an antigen. The antibodies produced in response to the pathogens antigen are an important part of the immune system. You can consider antibodies as the soldiers in your bodys defense system. Eachantibody, or soldier, in our system is trained to recognize one specific antigen. We have thousands of different antibodies in our bodies. When the human body is exposed to an antigen for the first time, it takes time for the immune system torespond and produce antibodies specific to that antigen.
In the meantime, the person is susceptible to becoming ill.
This means that if the person is exposed to the dangerous pathogen in the future, their immune system will be able to respond immediately, protecting against disease.
Accelerated Us Children And Adult 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.
In some instances, it may be necessary to vaccinate within a short period of time to ensure protection before travel. There are accelerated schedules to provide the highest level of protection over a short period of time. Individuals who need an accelerated schedule must have a booster dose at 1 year to ensure long-term protection. Note that the 2-dose Heplisav-B vaccine will also ensure maximum protection over a 1-month period without the need for a booster dose at 1 year.
4-Dose Vaccine Series for Children and Adults
Engerix-B is a 3-dose vaccine that can be given on an accelerated, four-dose schedule, with 3 shots administered within 2 months, and a booster dose at 1 year to provide maximum long-term protection.
4-Dose Combination Hepatitis A and B Vaccine Series
Twinrix is a 4-dose vaccine that can be given on an accelerated schedule to provide protection against hepatitis A and B. Three doses are administered within 1 month, followed by a booster shot at 1 year. This is a common choice of vaccine for those travelling on short-notice outside the U.S. It is important to complete the booster dose at 1 year, to ensure long-term protection.
2-Dose Vaccine Series
Additional Resource Links:
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Hepatitis B Vaccine Is Also Recommended For The Following People:
- People whose sex partners have hepatitis B
- Sexually active persons who are not in a long-term monogamous relationship
- People seeking evaluation or treatment for a sexually transmitted disease
- Victims of sexual assault or abuse
- Men who have sexual contact with other men
- People who share needles, syringes, or other drug injection equipment
- People who have household contact with someone infected with the hepatitis B virus
- Healthcare and public safety workers at risk for exposure to blood or body fluids
- Residents and staff of facilities for developmentally disabled persons
- People living in jail or prison
- Travelers to regions with increased rates of hepatitis B
- People with chronic liver disease, kidney disease on dialysis, HIV infection, infection with hepatitis C, or diabetes
Hepatitis B vaccine may be given as a stand-alone vaccine, or as part of a combination vaccine .
Hepatitis B vaccine may be given at the same time as other vaccines.
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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Us Children And Adult 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 Children and Adults
The hepatitis B vaccine is an injection that is generally given in the arm as a three-dose series on a 0, 1, and 6-month schedule. Alternative schedules may be considered, noting that a third dose at 6 months, meeting minimum intervals between doses, is needed for maximum, long-term protection. Completing the hepatitis B vaccine series, preferably beginning at birth, will ensure protection against hepatitis B, hepatitis delta and lower the lifetime risk of liver cancer. Greater than 90% of babies and up to 50% of young children who are not vaccinated and are infected with hepatitis B will have lifelong infection, which makes the birth dose essential to their protection.
There are four, 3-dose vaccine brands approved in the U.S.
- PreHevbrio PreHevbrio is only approved for adults age 18 and over.
2-Dose Vaccine Series
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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Babies And Hepatitis B Vaccination
Pregnant women have a routine blood test for hepatitis B as part of their antenatal care.
Babies born to mothers infected with hepatitis B need to be given a dose of the hepatitis B vaccine within 24 hours of their birth, followed by further doses at 4, 8, 12 and 16 weeks of age, plus a final dose when they’re 1 year old.
Babies of mothers identified by the blood test as particularly infectious might also be given an injection of HBIG at birth on top of the hepatitis B vaccination to give them rapid protection against infection.
All babies born to mothers infected with hepatitis B should be tested at 1 year of age to check if they have become infected with the virus.
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 a partner who has HBV infection
- injection drug use that involves sharing needles, syringes, or drug-preparation equipment
- birth to a person who has HBV infection
- contact with blood from or open sores on a person who has HBV infection
- exposures to needle sticks or sharp instruments and
- sharing certain items with a person who has HBV infection 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 9 parts 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 people with HBV infection
- Sex partners of people with HBV infection
- 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
- Patients on hemodialysis
Who should be screened for HBV?
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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 d’immunisation du Québec, 5e édition from which it was adapted.
Last complete chapter revision :
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.
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Hepatitis B Booster Vaccine
Hepatitis B is a highly infectious virus that can be passed on if you come into contact with the blood or other bodily fluids of an infected person.
If you’ve already had a course of three hepatitis B vaccines and need a booster, or require a vaccine to complete your course, use this service to order a hepatitis B booster vaccine.
- A single injection, usually in the upper arm
- Occupational health hep B booster, suitable for at-risk workers
- Use this service if you need a booster or to complete a course started elsewhere
What Is Hepatitis B
Hepatitis B is a serious, potentially fatal liver disease, but there is a vaccine that can prevent it in most people.
Hepatitis B is caused by the Hepatitis B virus . The virus can live outside of the body for 7 days at most, so most people get it directly from touching blood and fluids from people who have the virus. Common ways for the virus to spread include:
- Accidental needle sticks
- Direct contact with blood or open sores of an infected person
- Having sex with an infected person
- Sharing drug equipment
- Sharing razors or toothbrushes with an infected person
Newborn babies are at risk of getting Hepatitis B if their mothers have the virus. Hepatitis B is not spread through food, water, breastfeeding, hugging, coughing or sneezing.
Some people are at a higher risk of getting hepatitis B because of their job, a health condition or where they live. People who have a higher risk should get the vaccine if they have not done so already. Examples of people who have a higher risk of getting hepatitis B are:
- Health care workers
- Infants born to infected mothers
- Recreational injection drug users
- Men who have sex with men
- People on dialysis
- Public safety workers
- Sex partners of people who have the virus
- Travelers to countries with high rates of Hepatitis B virus infection
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Hepatitis B Vaccine Side Effects
Most people only experience mild, short-term side effects from the hepatitis B vaccine. Common side effects include:
- Pain, redness, or swelling at the site of injection
Severe allergic reactions to the hepatitis B vaccine are very rare. If you have symptoms of an allergic reaction shortly after getting the HepB vaccinesuch as difficulty breathing, facial swelling, or hivesseek medical help immediately.
The hepatitis B vaccine is safe and effective for most people. However, there are certain people who should not get the HepB vaccine, including:
- People who are moderately or severely ill at the time of vaccination
- People who have had a severe allergic reaction to yeast
- People who have had a severe allergic reaction to a hepatitis B vaccine in the past
What Is The Recommended Dosage
For all persons aged 12 years and above, SAGE recommends two doses , 4-8 weeks apart given intramuscularly into the deltoid muscle.
For children aged 5 to 11 years SAGE recommends two doses given intramuscularly into the deltoid muscle and provided 4-8 weeks apart, preferentially 8 weeks.
For infants and children aged 6 months to 4 years, the recommended schedule is three doses : a schedule of two doses 3 weeks apart followed by a third dose at least 8 weeks after the second dose are recommended according to the label. However, countries could consider extending the interval between the first and second dose up to 8 weeks.
Compliance with the full schedule is recommended and the same product can be used for both doses.
SAGE recommends that severe and moderately immunocompromised persons, including children, should be offered an additional dose of vaccine, as part of the primary series. This is due to the fact that this group is less likely to respond adequately to vaccination following a standard primary vaccination series and are at higher risk of severe COVID-19 disease.
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Managing Fever After Immunisation
Common side effects following immunisation are usually mild and temporary . Specific treatment is not usually required.
There are a number of treatment options that can reduce the side effects of the vaccine such as giving extra fluids to drink and not overdressing if there is a fever.
Although routine use of paracetamol after vaccination is not recommended, if fever is present, paracetamol can be given check the label for the correct dose or speak with your pharmacist, especially when giving paracetamol to children.
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