- Hepatitis B Vaccine – What You Need to Know
- Hepatitis B Vaccine
- A Look at Each Vaccine: Hepatitis B Vaccine
- Routine administration schedule for hepatitis B vaccine in adults
- Recommended adult dosing volume of monovalent hepatitis B vaccine
- Which adults should be vaccinated against hepatitis B?
- Resources from IAC
- Resources from CDC
- Hepatitis B Adult Vaccine
Hepatitis B Vaccine – What You Need to Know
1. Why get vaccinated?
Hepatitis B vaccine can prevent hepatitis B. Hepatitis B is a liver disease that can cause mild illness lasting a few weeks, or it can lead to a serious, lifelong illness.
- Acute hepatitis B infection is a short-term illness that can lead to fever, fatigue, loss of appetite, nausea, vomiting, jaundice (yellow skin or eyes, dark urine, clay-colored bowel movements), and pain in the muscles, joints, and stomach.
- Chronic hepatitis B infection is a long-term illness that occurs when the hepatitis B virus remains in a person’s body. Most people who go on to develop chronic hepatitis B do not have symptoms, but it is still very serious and can lead to liver damage (cirrhosis), liver cancer, and death. Chronically-infected people can spread hepatitis B virus to others, even if they do not feel or look sick themselves.
Hepatitis B is spread when blood, semen, or other body fluid infected with the hepatitis B virus enters the body of a person who is not infected. People can become infected through:
- Birth (if a mother has hepatitis B, her baby can become infected)
- Sharing items such as razors or toothbrushes with an infected person
- Contact with the blood or open sores of an infected person
- Sex with an infected partner
- Sharing needles, syringes, or other drug-injection equipment
- Exposure to blood from needlesticks or other sharp instruments
Most people who are vaccinated with hepatitis B vaccine are immune for life.
2. Hepatitis B vaccine.
Hepatitis B vaccine is usually given as 2, 3, or 4 shots.
Infants should get their first dose of hepatitis B vaccine at birth and will usually complete the series at 6 months of age (sometimes it will take longer than 6 months to complete the series).
Children and adolescents younger than 19 years of age who have not yet gotten the vaccine should also be vaccinated.
- Hepatitis B vaccine is also recommended for certain unvaccinated adults:
- People whose sex partners have hepatitis B
- Sexually active persons who are not in a long-term monogamous relationship
- Persons seeking evaluation or treatment for a sexually transmitted disease
- 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
- Health care and public safety workers at risk for exposure to blood or body fluids
- Residents and staff of facilities for developmentally disabled persons
- Persons in correctional facilities
- Victims of sexual assault or abuse
- Travelers to regions with increased rates of hepatitis B
- People with chronic liver disease, kidney disease, HIV infection, infection with hepatitis C, or diabetes
- Anyone who wants to be protected from hepatitis B
Hepatitis B vaccine may be given at the same time as other vaccines.
3. Talk with your health care provider.
Tell your vaccine provider if the person getting the vaccine:
- Has had an allergic reaction after a previous dose of hepatitis B vaccine, or has any severe, life-threatening allergies.
In some cases, your health care provider may decide to postpone hepatitis B vaccination to a future visit.
People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting hepatitis B vaccine.
Your health care provider can give you more information.
4. Risks of a vaccine reaction.
- Soreness where the shot is given or fever can happen after hepatitis B vaccine.
People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears.
As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death.
5. What if there is a serious problem?
An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness), call 9-1-1 and get the person to the nearest hospital.
For other signs that concern you, call your health care provider.
Adverse reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your health care provider will usually file this report, or you can do it yourself. Visit the VAERS website at www.vaers.hhs.gov or call 1-800-822-7967. VAERS is only for reporting reactions, and VAERS staff do not give medical advice.
6. The National Vaccine Injury Compensation Program.
The National Vaccine Injury Compensation Program (VICP) is a federal program that was created to compensate people who may have been injured by certain vaccines. Visit the VICP website at www.hrsa.gov/vaccinecompensation or call 1-800-338-2382 to learn about the program and about filing a claim. There is a time limit to file a claim for compensation.
7. How can I learn more?
- Ask your health care provider.
- Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC):
- Call 1-800-232-4636 (1-800-CDC-INFO) or
- Visit CDC’s website at www.cdc.gov/vaccines
Hepatitis B Vaccine
This vaccine gives protection against the hepatitis B virus, which is a major cause of serious liver disease, including liver cancer and cirrhosis (scarring of the liver which prevents the liver from working properly).
The individual hepatitis B vaccine can be given at the same time as other vaccines such as the PCV, hepatitis A, MMR, pre-school booster and other travel vaccines. The vaccines should be given at a separate site, preferably in a different arm or leg.
The vaccine does not contain any live viruses, and cannot cause hepatitis B disease.
Since the disease is so serious, the World Health Organization has said that all babies in the world should be protected by hepatitis B vaccination. In the UK all babies are now offered the combination 6-in-1 vaccine which contains hepatitis B vaccine as well as vaccines against five other serious diseases.
Who should have the vaccine?
The individual (monovalent) hepatitis B vaccine continues to be given to those in the UK at high risk of hepatitis B disease. This includes:
- Babies born to mothers who have been infected with hepatitis B. These babies are exposed to the virus during birth, and should be given the individual hepatitis B vaccine within 24 hours of birth. They should be given another dose of the individual vaccine at 4 weeks, and then follow the routine UK schedule (three doses of the 6-in-1 vaccine at 2 months, 3 months and 4 months of age). They should have another dose of the individual hepatitis B vaccine at 12 months of age. They will also be tested for hepatitis B infection at this time. Babies born to women who are thought to be particularly infectious may also be given hepatitis B immunoglobulin at birth. This provides immediate, temporary protection while the baby develops their own immunity through vaccination.
- People with chronic (long-term) liver disease or kidney conditions
- People with blood disorders such as haemophilia, who receive blood products
- Close family contacts of someone with chronic hepatitis B infection
- Foster carers and people adopting children from countries where there is a high risk of hepatitis B infection
- People who inject drugs
- People who change sexual partners frequently
- People with learning disabilities who live in residential accommodation
- Healthcare workers and other staff in healthcare settings who may come into direct contact with blood or blood products
- Workers in other settings who may be at risk of injury from needles, or at risk of being deliberately injured or bitten by patients.
The hepatitis B vaccine may also be recommended as a travel vaccine for travel to some parts of the world.
A Look at Each Vaccine: Hepatitis B Vaccine
What is hepatitis B virus?
Hepatitis B virus attacks the liver. Hepatitis B virus infections are known as the “silent epidemic” because many infected people don’t experience symptoms until decades later when they develop hepatitis (inflammation of the liver), cirrhosis (severe liver disease), or cancer of the liver (hepatocellular carcinoma). Every year in the United States about 2,000 people die from hepatitis soon after they are infected, and another 12,000 go on to develop long-term hepatitis, putting them at high-risk for cirrhosis and liver cancer.
How do you catch hepatitis B virus?
Blood from a person infected with hepatitis B virus is heavily contaminated with the virus. As a result, contact with blood is the most likely way to catch hepatitis B. Even casual contact with the blood of someone who is infected (sharing of washcloths, toothbrushes, or razors) can cause infection.
Healthcare workers are at high risk of catching the disease, as are intravenous drug users and newborns of mothers infected with the virus. Sexual contact can also expose people to infection. The virus is also present in low levels in saliva.
Because the disease can be transmitted by casual contact, and because about 1 million people are infected with hepatitis B virus (many of whom don’t know that they have it), it has been hard to control hepatitis B virus infections in the United States. The original strategy (started in the early 1980s) was to vaccinate only those at highest risk (for example, healthcare workers, patients on dialysis, and intravenous drug users). But because the disease can be transmitted to those who are not in high-risk groups, this vaccine strategy didn’t work. The incidence of hepatitis B virus disease in the United States was unchanged 10 years after the vaccine was first used! For this reason, the vaccine strategy changed. Now all infants and young children are recommended to receive the hepatitis B vaccine and the incidence of hepatitis B virus infections in the United States is starting to decline. Indeed, the new vaccine strategy has virtually eliminated the disease in children less than 19 years of age. If we stick with this strategy, we have a chance to finally eliminate this devastating disease within one or two generations.
Are hepatitis B virus infections easily avoided?
Large quantities of hepatitis B virus are present in the blood of people with hepatitis B; in fact, as many as one billion infectious viruses can be found in a milliliter (one-fifth of a teaspoon) of blood from an infected individual. Therefore, hepatitis B virus is transmitted in the blood of infected individuals during activities that could result in exposure to blood, such as intravenous drug use, tattooing, or sex with people who are infected. However, it is also possible to catch hepatitis B virus through more casual contact, such as sharing washcloths, toothbrushes or razors. In each of these cases, unseen amounts of blood can contain enough viral particles to cause infection. In addition, because many people who are infected don’t know that they are infected, it is very hard to avoid the chance of getting infected with hepatitis B virus.
Facts about hepatitis B
- Two billion people, or one in three, have been infected with hepatitis B worldwide. Of these, more than 240 million live with chronic hepatitis B.
- Each year about 680,000 people die from hepatitis B worldwide, and 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 minute 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 is the second leading cause of cancer deaths throughout the world, and half of these are caused by hepatitis B.
- The World Health Organization (WHO) recommends the inclusion of hepatitis B vaccine in immunization programs of all countries; in 2014, 184 member states (of 193) had infant immunization programs.
It takes only a few shots to protect yourself and your loved ones against hepatitis B for a lifetime.
The hepatitis B vaccine is a safe and effective vaccine that is recommended for all infants at birth and for children up to 18 years. The hepatitis B vaccine is also recommended for adults living with diabetes and those at high risk for infection due to their jobs, lifestyle, living situations, or country of birth. Since everyone is at some risk, all adults should seriously consider getting the hepatitis B vaccine for a lifetime protection against a preventable chronic liver disease.
The hepatitis B vaccine is also known as the first “anti-cancer” vaccine because it prevents hepatitis B, the leading cause of liver cancer worldwide.
You cannot get hepatitis B from the vaccine. All hepatitis B vaccines that have been used since 1986 are made synthetically – meaning the hepatitis B vaccines do not contain any blood products. Learn more.
If you have a current HBV infection (HBsAg positive) or have recovered from a past HBV infection, the hepatitis B vaccine series will not benefit you or clear the virus. However, the vaccine will provide a lifetime of protection for loved ones. Testing is the only way to know if you or your loved ones have a current infection or have recovered from a past infection.
Hepatitis B Vaccine Recommendations
The hepatitis B vaccine is recommended for all infants and children up to age 18 years by the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). The CDC also recommends that adults in high-risk groups be vaccinated (see below).
Every person may be at some risk for a hepatitis B infection during their lifetime, so getting the hepatitis B vaccine should be considered by all people. There are, however, groups that the CDC recommends should definitely receive the hepatitis B vaccine, which are listed below:
- All infants, beginning at birth
- All children aged <19 years who have not been vaccinated previously
- Susceptible sexual partners of hepatitis B-positive persons
- Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., >1 sex partner during the previous 6 months)
- Persons seeking evaluation or treatment for a sexually transmitted disease
- Men who have sex with men
- Injection drug users
- Susceptible household contacts of hepatitis B-positive persons
- Healthcare and public safety workers at risk for exposure to blood
- Persons with end-stage renal disease, including pre-dialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
- Residents and staff of facilities for developmentally disabled persons
- Travelers to and families adopting from countries where hepatitis B is common (e.g. Asia, Africa, South America, Pacific Islands, Eastern Europe, and the Middle East)
- Persons with chronic liver disease, other than hepatitis B (e.g. cirrhosis, fatty liver disease, etc.)
- Persons with hepatitis C infection
- Persons with HIV infection
- Adults with diabetes aged 19 through 59 years (clinicians can decide whether or not to vaccinate their diabetic patients ≥60 years)
- All other persons seeking protection from HBV infection — acknowledgment of a specific risk factor is not a requirement for vaccination
Three-Dose Hepatitis B Vaccine Schedule
The hepatitis B vaccine is available at your doctor’s office and local health department or clinic. Three doses are generally required to complete the hepatitis B vaccine series, although there is an accelerated two-dose series for adolescents age 11 through 15 years. It is important to remember that babies born to infected mothers must receive the first dose of hepatitis B vaccine in the delivery room or within the first 12 hours of life (learn more about hepatitis B and pregnancy).
- 1st Shot – At any given time, but newborns should receive this dose in the delivery room
- 2nd Shot – At least one month (or 28 days) after the 1st shot
- 3rd Shot – At least 4 months (16 weeks) after the 1st shot (and at least 2 months after the 2nd shot). Infants should be a minimum of 24 weeks old at the time of the 3rd shot.
You do not need to restart the hepatitis B vaccine series if you miss any of the shots. For example, if you start the vaccine series and stop, then get the 2nd shot when you can and make sure to get the 3rd shot at least two months later. Or, if you get the first two doses of vaccine and miss the third dose, then just schedule the last shot when you can.
To be certain that you are protected against hepatitis B, ask for a simple blood test to check your “antibody titers” that will confirm whether the vaccination was successful.
Two-Dose Hepatitis B Vaccine Schedule for Adults
In November 2017, a vaccine was approved by the FDA for use in the U.S. Heplisav-B (Dynavax) is a two-dose vaccine approved for use in adults aged 18 and older. The vaccine is administered as two doses given one-month apart.
Ask your doctor about the 2-dose vaccine. You can now find Heplisav-B at more than 1,700 Albertsons Companies’ store pharmacies across the US. For assistance accessing this vaccine, you can contact Heplisav-B’s Access Navigator at 1-844-375-4728.
Hepatitis B Vaccine Safety and Side Effects
More than 1 billion doses of the hepatitis B vaccine have been given worldwide and it is considered one of the safest and most effective vaccines ever made. Numerous studies looking at the vaccine’s safety have been conducted by the World Health Organization, U.S. Centers for Disease Control and Prevention, and many different medical societies.
No evidence has been found that the hepatitis B vaccine causes sudden infant deaths (SIDs), autism, multiple sclerosis, or other neurological disorders.
Common side effects from the hepatitis B vaccine may include soreness, swelling and redness at the injection site. The vaccine may not be recommended for those with documented yeast allergies or a history of an adverse reaction to the vaccine.
Hepatitis B vaccination recommendations vary by a person’s age and risk factors. In the Technically Speaking column in August, we discussed routine hepatitis B vaccination of infants, children and teens. This month, let’s review hepatitis B vaccination of adults, including vaccination guidance for high-risk groups. In an upcoming column, we will review the issues surrounding hepatitis B serologic tests and vaccination, including who needs testing and when.
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 (even if a year or more has elapsed), continue vaccinating from where your patient left off. The series does NOT need to be restarted.
Recommended adult dosing volume of monovalent hepatitis B vaccine
- Age 19 years and younger: Use 0.5 mL per dose (Engerix®-B pediatric, GlaxoSmithKline; Recombivax HB® pediatric, Merck).
- Age 20 years and older: 1.0 mL per dose (Engerix-B adult, GlaxoSmithKline; Recombivax HB adult, Merck). (For dialysis patients, a larger dose is needed. See the prescribing information.)
For a one-page sheet reviewing the hepatitis B dosing schedule for children and adults, consult IAC’s 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.
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. (CDC includes 18-year-olds in their child/teen immunization recommendations.)
- 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 (HBsAg)-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.
According to ACIP recommendations, patients do not need to identify (or admit to) a particular risk factor in order to be eligible for vaccination. Anyone who wishes to be protected from hepatitis B should be vaccinated.
Some patients (e.g., foreign-born persons from regions with medium or high levels of HBV infection) are recommended to have their blood tested for evidence of past or present hepatitis B virus infection at the same time that they receive the first dose of hepatitis B vaccine. Blood testing should be done at the same visit as administering the first dose of hepatitis B vaccine. Blood should be drawn prior to hepatitis B vaccine being administered.
In a future issue, we will review the various hepatitis B serologic tests, who needs testing, and when they need it (pre- or post-vaccination).
Resources from IAC
- Hepatitis A and Hepatitis B Vaccines: Be Sure Your Patients Get the Correct Dose
- Should You Be Vaccinated Against Hepatitis B?
- Do I Need Any Vaccinations Today?
- Standing Orders for Administering Hepatitis B Vaccine to Adults
Resources from CDC
- A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of Adults
- Use of Hepatitis B Vaccination for Adults with Diabetes Mellitus: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Hepatitis B Adult Vaccine
Hepatitis is a serious disease caused by a virus. Hepatitis causes inflammation of the liver, vomiting, and jaundice (yellowing of the skin or eyes). Hepatitis can lead to liver cancer, cirrhosis, or death.
Hepatitis B is a disease of the liver that is spread through blood or bodily fluids, sexual contact or sharing IV drug needles with an infected person, or during childbirth when the mother is infected.
The hepatitis B adult vaccine is used to help prevent this disease in adults.
This vaccine works by exposing you to a small amount of the virus, which causes the body to develop immunity to the disease. This vaccine will not treat an active infection that has already developed in the body.
Vaccination with hepatitis B adult vaccine is recommended for all adults who are at risk of getting hepatitis B. Risk factors include: having more than one sex partner; being a homosexual male; having sexual contact with infected people; having chronic liver disease; having diabetes and being under age 60; having HIV or AIDS; using intravenous (IV) drugs; being on dialysis or receiving blood transfusions; working in an institution for developmentally disabled patients; working in healthcare or public safety and being exposed to human blood; being in the military or traveling to high-risk areas; and living with a person who has hepatitis B.
Like any vaccine, the hepatitis B vaccine may not provide protection from disease in every person.
You should not receive hepatitis B vaccine if you are allergic to baker’s yeast.
This vaccine will not protect against hepatitis B if you are already infected with the virus, even if you do not yet show symptoms.
Hepatitis B vaccine will not protect against infection with hepatitis A, C, and E, or other viruses that affect the liver. It may also not protect against hepatitis B if you are already infected with the virus, even if you do not yet show symptoms.
You should not receive this vaccine if you have ever had a life-threatening allergic reaction to any vaccine containing hepatitis B, or if you are allergic to baker’s yeast.
If you have any of these other conditions, your vaccine may need to be postponed or not given at all:
- multiple sclerosis;
- kidney disease (or if you are on dialysis);
- a bleeding or blood clotting disorder such as hemophilia or easy bruising;
- an allergy to latex rubber; or
- a neurologic disorder or disease affecting the brain (or if this was a reaction to a previous vaccine).
You can still receive a vaccine if you have a minor cold. In the case of a more severe illness with a fever or any type of infection, wait until you get better before receiving this vaccine.
It is not known whether this vaccine will harm an unborn baby. However, if you are at a high risk for infection with hepatitis B during pregnancy, your doctor should determine whether you need this vaccine.
It may not be safe to breast-feed while receiving this medicine. Ask your doctor about any risk.