Who Need Hepatitis B Vaccine

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 :

What Are Dosages Of Hepatitis B Vaccine

Dosages of Hepatitis B Vaccine:

Dosage Considerations Should be Given as Follows:

• Engerix B: 1 mL intramuscularly at 0, 1, and 6 months
• Recombivax HB: 1 mL intramuscularly at 0, 1, and 6 months

• Adults receiving dialysis or other immunocompromising conditions
• Recombivax HB : 40 mcg intramuscularly at 0, 1, and 6 months, OR
• Engerix-B : 40 mcg intramuscularly at 0, 1, and 6 months

Routine vaccination

Catch-up vaccination

• Unvaccinated children should complete a 3-dose series
• Children aged 11-15 years: 2-dose series of adult formulation Recombivax HB is licensed for use in children aged 11 through 15 years

Dosing Considerations

• Administer intramuscularly in the deltoid muscle
• Do not give IV/intradermal

Pediatric:

• low blood pressure
• pain when urinating

Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System , 1-800-822-7967

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

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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

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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.

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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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.

Emergency Hepatitis B Vaccination

If you have been exposed to the hepatitis B virus and have not been vaccinated before, you should get immediate medical advice, as you may benefit from having the hepatitis B vaccine.

In some situations, you may also need to have an injection of antibodies, called specific hepatitis B immunoglobulin , along with the hepatitis B vaccine.

HBIG should ideally be given within 48 hours, but you can still have it up to a week after exposure.

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How Do Inactivated Viral Vaccines Work

Inactivated viralvaccines are sterile biologic products that provide immunity against viral infections. Inactivated viral vaccines work by stimulating the bodys immune system to produce antibodies against specific types of viruses, and protect a person from becoming infected when exposed to these viruses.

In the case of SARS-CoV-2 coronavirus that causes respiratory illness and has led to the COVID-19 pandemic, vaccines do not entirely prevent infection but protect vaccinated individuals from serious illness and hospitalization from the disease.

Inactivated viral vaccines contain particles of proteins or genetic material from viruses. Inactivated viral vaccines may also contain substances that preserve and stabilize the vaccine, and enhance immune response. Some viral vaccines are delivered in inactivated harmless viruses such as human adenovirus.

Inactivated viral vaccines may be made from:

• Surface proteins of the viruses enable the virus to hold on to a human cell, enter inside and replicate.
• Modified RNA particles from the virus can enter host cells and induce the production of viral antigen, which stimulates an immune response from the body.
• Recombined DNA material from multiple strains and subtypes of viruses, killed to eliminate disease-causing capability.

Currently, inactivated viral vaccines approved by the FDA protect against viral infectious diseases that include:

• Coronavirus disease , caused by SARS-Cov-2 virus

Adults

For Adults And Children

This vaccine schedule involves three doses within 2 months, followed by a booster dose at 1 year.

The initial accelerated doses provide immediate protection from HBV, and the booster dose helps provide long-term protection.

Below is the accelerated vaccination schedule approved for both adults and children:

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Facts About Hepatitis B

• Two billion people, or one in three, have been infected with hepatitis B worldwide. Of these, almost 300 million live with chronic hepatitis B. This means about 1 of every 26 people throughout the world are living with a chronic hepatitis B infection.
• Each year about 900,000 people die from hepatitis B worldwide, and about 2,000 of these deaths occur in the United States.
• Hepatitis B is transmitted through blood and is 100 times more infectious than HIV. An estimated one billion infectious viruses are in one-fifth of a teaspoon of blood of an infected person, so exposure to even a very small amount, such as on a shared toothbrush, can cause infection.
• Hepatitis B is sometimes referred to as the silent epidemic because most people who are infected do not experience any symptoms.
• Liver cancer accounted for about 5% of cancer deaths in the U.S. during 2020.
• Almost half of liver cancers are caused by chronic infection with hepatitis B.
• The World Health Organization recommends the inclusion of hepatitis B vaccine in immunization programs of all countries in 2019, more than 8 of 10 infants born throughout the world received three doses of hepatitis B vaccine.

People With Diabetes Have Twice The Chance Of Becoming Infected With This Liver Disease

by Michelle Crouch, AARP, Updated September 10, 2021

Getty Images

En español | Even though there’s an effective vaccine to prevent it, the Centers for Disease Control and Prevention estimates that about 862,000 Americans are living with chronic, long-term hepatitis B, with the infection causing thousands of of cases of liver failure, cirrhosis and liver cancer ever year.

The virus attacks the liver silently at first, so many people don’t realize they are infected until decades later, when the virus has already done extensive damage or caused liver cancer, says John Scott, M.D., an infectious disease specialist and associate medical director of the Hepatitis and Liver Clinic at Harborview Medical Center in Seattle. It’s a bad cancer, it can be very aggressive, Scott says.

• Underlying Conditions & Booster Shots

While children are routinely vaccinated against hepatitis B, which can be spread from mother to baby at birth, it’s only recommended for certain groups of adults including diabetics and only 16 percent of Americans age 50 or older have received the vaccine.

Because children are vaccinated, the virus is more commonly spread through sexual contact or by sharing needles, syringes or other drug-injection equipment. The opioid epidemic has caused a spike in the number of cases.

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Who Should Get The Hepatitis A Vaccine

The CDC recommends that all children between ages 12 months and 23 months get this vaccine as well as for any infant aged 6 to 11 months who is traveling internationally.

The following people are also at risk for the disease and should be vaccinated:

• Children and teens through age 18 who live in states or communities that have made this vaccination routine because of a high rate of disease
• Men who have sex with men
• Anyone who uses illegal drugs
• People with chronic liver disease
• Anyone treated with blood clotting drugs, such as people with hemophilia
• People who work with HAV-infected primates or in HAV research laboratories.
• Travelers to countries where hepatitis A is common. A good source to check is the CDCâs travelersâ health website, which you can search by the country youâre going to.
• People adopting or close to a child adopted from a country where hepatitis A is common

You should not get the vaccine if you’re allergic to any ingredients in it or if you had a severe allergic reaction to an earlier dose of it. Tell your doctor or pharmacist about any allergies you have.

If you’re pregnant, let your doctor know. The safety of this vaccine for pregnant women is unknown, although the risk is considered to be very low.

What Are Side Effects Of Inactivated Viral Vaccines

Side effects of inactivated viral vaccines may include the following:

• Injection site reactions include:

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

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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 .

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

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How Safe Is The Hepatitis B Vaccine

The hepatitis B vaccine is totally safe for most people. Most babies, kids, and adults have no problems at all when they get the vaccine. In fact, more than 100 million people in the U.S. have gotten the hepatitis B vaccine.

Like all medicines, the hepatitis B vaccine may have some mild side effects: soreness, change in skin color, swelling, or itching around where you get the shot, or a slight fever. But these things arent serious and usually go away pretty quickly. Theres an extremely small risk of having an allergic reaction to the vaccine.

If you get dizzy, feel your heart beating really fast, have a high fever, feel weak, break out in hives, or have trouble breathing, get medical help right away. But again, the risk of having an allergy is super small.

You CANT get hepatitis from the hepatitis vaccine.

Routine Administration Schedule For Hepatitis B Vaccine In Adults

• The dosing schedule is 0, 1 to 2 months, and 4 to 6 months.
• There is some flexibility in the schedule, but be sure to keep in mind the minimum intervals between doses:
• At least four weeks between doses #1 and #2
• At least eight weeks between doses #2 and #3
• At least 16 weeks between doses #1 and #3
• If your patient falls behind on the hepatitis B vaccination schedule , continue vaccinating from where your patient left off. The series does NOT need to be restarted.

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Natural History Of Hbv Infection

HBV infected adults showed no clinically evident liver disease or mild acute hepatitis that terminated without long-term sequelae with development of lasting immunity to re-infection. The other patients who do not succeed in clearing the virus progress to chronic infection with continuous HBV replication. Host immune response plays an essential role in HBV-related hepatocyte damage because the virus itself is not cytolytic. The balance between host immune response and HBV replication in hepatocytes and in extrahepatic host cells is dynamic. Fortunately, 70%-90% chronic HBV infected patients are asymptomatic without life-threatening effects on liver cells, while 10%-30% of patients develop liver cirrhosis with consequent hepatic insufficiency and portal hypertension that make liver cirrhosis one of the most frightening consequences of chronic HBV infection. Development of HCC is also a catastrophic result of chronic HBV infection with a lot of evidence supporting an association between HBV replication and the risk of development of HCC. The HBx protein is a potent transactivator that activates host genes, including oncogenes.

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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