What Is Hepatitis B
Hepatitis B is caused by a virus that infects the liver. It is one of the most common vaccine-preventable diseases affecting travellers and can cause either acute or chronic infection.
About 90 to 95 percent of adults with acute hepatitis B infection will clear the virus on their own within six months, and develop lifelong protection against it.
Some people are unable to clear the virus, and develop chronic hepatitis B. Untreated chronic hepatitis B can later develop into serious health problems. Children under four years old are at particular risk of chronic hepatitis B, because only up to 10% will clear the virus.
Newborn Babies At Risk
A newborn whose mother has hepatitis B is at an increased risk of contracting the disease. A programme ensures newborn babies receive the vaccination within the first three months after birth and the fourth dose at the age of one. This vaccination is incorporated into SFE for providers of the childhood immunisation additional services.
Why Might I Need A Hepatitis B Vaccine For Occupational Travel
The vaccine is the safest, most effective way to protect yourself. 9 in 10 adults develop protection against Hepatitis B as a result. It is especially important to get it if you work in occupations such as:
Care home or healthcare workers
Medical environment cleaners
Policing or prison staff
In the case of these particular professions, they increase your risk of coming into contact with bodily fluids.
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What Is Hepatitis B Infection
Hepatitis B is a virus that attacks the liver. It can cause serious disease including permanent liver damage . Hepatitis B is also one of the main causes of liver cancer, which can be fatal. Hepatitis B virus is spread from one infected person to another by contact with blood or body fluids. This includes an accidental or intentional poke with a used needle, being splashed in the mouth, nose, or eyes with infected blood, being bitten by an infected person, sharing items that may have blood on them such as a toothbrush, dental floss or razor, and by having unprotected sex with someone infected with the hepatitis B virus. Mothers who are infected with hepatitis B virus can pass the virus to their newborn babies during delivery.
After the virus enters your body, it usually takes 2 to 3 months to develop symptoms or signs of illness. Symptoms of hepatitis B may include fatigue, fever, nausea and vomiting, loss of appetite, abdominal pain, dark urine, pale stools and jaundice . Many people who get hepatitis B show no symptoms and may not know they have the disease. Whether there are signs of illness or not, you can pass the virus on to others.
Hepatitis A And B: Diseases Of The Liver
Hepatitis is an inflammation of the liver, most often caused by a viral infection. There are three common types of hepatitis caused by viruses: hepatitis A, hepatitis B, and hepatitis C. Vaccines have been developed that protect people from contracting hepatitis A and B. There is no vaccine for hepatitis C.
Over the last 20 years, there has been a 90% decrease in cases of hepatitis A and an 80% decrease in hepatitis B cases in the U.S. Health experts believe that immunization efforts have led to this drop in rates of infection.
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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.
Who Should Get The Vaccine
The hepatitis B vaccine is provided free to babies as part of their routine immunizations. It is usually combined with other childhood vaccines such as diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b. For more information see HealthLinkBC File #105 Diphtheria, Tetanus, Pertussis, Hepatitis B, Polio and Haemophilus influenzae type b Vaccine. Some babies may receive the hepatitis B vaccine separately, for more information see HealthLinkBC File #25c Hepatitis B Infant Vaccine.
People born in 1980 or later who have never received the hepatitis B vaccine or have not received the recommended number of doses for their age can also get the vaccine for free.
The vaccine is also provided free to children and adults at high risk of hepatitis B infection, including:
Anyone who is not eligible for a free hepatitis B vaccine can purchase it at most pharmacies and travel clinics.
It is important to keep a record of all immunizations received.
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What Are The Symptoms
- Symptoms can take 2 to 6 months to appear.
- Many people who are infected with hepatitis B have either no symptoms or only mild symptoms.
- Symptoms of acute hepatitis B can include fatigue, loss of appetite, joint pain, abdominal pain, nausea, vomiting, fever, and dark urine. A small number of people will develop jaundice .
- Some people develop chronic hepatitis B and most remain contagious for the rest of their lives. Chronic infection may lead to cirrhosis and/or liver cancer. Most people with chronic hepatitis B are unaware of their infection.
Who Should Not Get The Vaccine
Speak with your health care provider if you have had a life-threatening reaction to a previous dose of hepatitis B vaccine, or any component of the vaccine such as yeast, or to latex.
There is no need to delay getting immunized because of a cold or other mild illness. However, if you have concerns speak with your health care provider.
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Protecting Your Baby Against Hepatitis B Guide
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This publication is available at https://www.gov.uk/government/publications/protecting-your-baby-against-hepatitis-b-leaflet/protecting-your-baby-against-hepatitis-b-with-the-hepatitis-b-vaccine
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.
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When To Delay Or Avoid Hepb Immunization
Doctors delay giving the vaccine to babies who weigh less than 4 pounds, 7 ounces at birth whose mothers do not have the virus in their blood. The baby will get the first dose at 1 month of age or when the baby is discharged from the hospital.
The vaccine is not recommended if your child:
- is currently sick, although simple colds or other minor illnesses should not prevent immunization
- had a serious allergic reaction after an earlier dose of the vaccine or is allergic to baker’s yeast
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.
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Who Should Get Hepatitis Vaccinations
Since the vaccines were first developed, the hepatitis A and B vaccines have become part of the regular childhood immunization schedule. They are not considered a routine adult immunization.
“When we’re talking about adults, I would say yes, get the vaccine if they fit into one of these risk factors” says Poland. “If they don’t fit into the risk factors, their risk is so low that there’s no compelling reason to do it.”
People at risk for hepatitis A include:
- Anyone traveling to or working in areas where hepatitis A is more widespread.
- People whose work puts them in potential contact with hepatitis A, such as those who work with the hepatitis A virus in research labs
- People who are treated with clotting-factor concentrates
- People who have chronic liver disease
- People who use recreational drugs, injected or not
- Men who have sex with men
People at risk for hepatitis B include:
- Anyone traveling to or working in areas where hepatitis B is more widespread.
- Health care workers and other people whose job exposes them to human blood
- People with HIV infection, end-stage kidney disease, or chronic liver disease
- People who live with someone with hepatitis B
- People who inject street drugs
- Sexually active people who have had more than one partner
- Anyone who has had an STD
- Men who have sex with men
- Sex partners of people with hepatitis B
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.
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How Is It Transmitted
Hepatitis B is highly infectious, and is spread from one person to another through exposure to infected blood and body fluids . It can be spread through:
- blood transfusions or organ transplantation in countries where blood or blood products have not been properly screened for hepatitis B and other viruses transmitted through blood
- unprotected sex with an infected person
- sharing needles or equipment for injecting drugs
- unsterilized medical/dental equipment and shared/contaminated materials or equipment used for tattooing, body piercing or acupuncture
- sharing toothbrushes or razors
- household contact between family members
Hepatitis B Infection And The Risk To Your Baby
Each year in the UK, around 3,000 babies are born to women who have hepatitis B infection. This infection is caused by a virus that is spread through blood and attacks the liver.
During childbirth, your baby is in contact with your blood so there is a chance that the virus is passed on to your baby. If this happens, your baby could become infected, 9 out of 10 exposed babies will develop chronic infection.
This can lead to liver disease such as scarring of the liver and liver cancer, which stops the liver from working properly.
Hepatitis B infection can be prevented by vaccination.
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Which Adults Should Be Vaccinated Against Hepatitis B
According to CDC recommendations, adults in the following groups are recommended to receive hepatitis B vaccine:
- 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.
- 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 .
Who Should Get The Hepatitis B Vaccine
The Hepatitis B vaccine is provided free to:
- Babies at two, four and six months of age as part of the B.C. routine immunization schedule
- Those born in 1980 or later that have never received the vaccine or the recommended number of doses for their age
Get immunized against Hepatitis B by making an appointment with your doctor, pharmacist or Public Health.
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Where Is Hepatitis B Found
Ordinarily, Hepatitis B is not common in the UK. Any new cases tend to come from high-risk countries. These include:
Parts of South America
Southern parts of Central and Eastern Europe
The Pacific Islands
Southeast and East Africa
Regardless of where you are jetting off to, we recommend checking the NHS Fit for Travel site for the vaccines you need well in advance of your travels.
Adults Recommended To Receive Hepb Vaccine:
- Persons at risk for infection by sexual exposure
- Sex partners of hepatitis B surface antigen positive persons
- Sexually active persons who are not in a long-term, mutually monogamous relationship
- Persons seeking evaluation or treatment for a sexually transmitted infection
- Men who have sex with men
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How Hepatitis Is Spread
Hepatitis A: About 20,000 people in the U.S. contract hepatitis A each year. The hepatitis A virus is found in the stool of the infected person. It is spread through contaminated food or water or by certain types of sexual contact.
Children who get hepatitis A often don’t have symptoms, so they can have the virus and not know it. However, they can still spread it easily. Fortunately, children are now routinely vaccinated against hepatitis A.
Most people who get hepatitis A recover completely within two weeks to six months and don’t have any liver damage. In rare cases, hepatitis A can cause liver failure and even death in older adults or people with underlying liver disease.
Hepatitis B: Every year, about 40,000 people in the U.S. become infected with hepatitis B. Acute hepatitis lasts from a few weeks to several months. Many infected people are able to clear the virus and remain virus-free after the acute stage. However, for others, the virus remains in the body, and they develop chronic hepatitis B infection, which is a serious, lifelong condition. About 1.2 million people in the U.S. have chronic hepatitis B. Of these, 15% to 25% will develop more serious health problems, such as liver damage, cirrhosis, liver failure, and liver cancer, and some people die as a result of hepatitis B-related disease.