Panel: All Us Adults Under 60 Should Get Hepatitis B Shots
NEW YORK A government advisory committee on Wednesday recommended that all U.S. adults younger than 60 be vaccinated against hepatitis B, because progress against the liver-damaging disease has stalled.
The decision means that tens of millions of U.S. adults mostly between the ages of 30 and 59 would be advised to get shots. Hepatitis B vaccinations became standard for children in 1991, meaning most adults younger that 30 already are protected.
Were losing ground. We cannot eliminate hepatitis B in the U.S. without a new approach, said Dr. Mark Weng of the Centers for Disease Control and Prevention.
The Advisory Committee on Immunization Practices voted unanimously to approve the recommendation Wednesday. The CDCs director, Dr. Rochelle Walensky, must sign off on it before it becomes public policy, but its not clear when she will decide.
The virus is spread through contact with blood or other bodily fluids and many recent cases have been linked to the opioid epidemic.
An estimated 1.9 million Americans are living with hepatitis B infections, though many may not experience liver damage and accompanying symptoms for many years. The government has set a goal of eliminating viral hepatitis as a threat by 2030.
Health officials estimate about 20,000 new infections occur each year. The rate has been generally flat, though it has been rising in Americans in their 40s and 50s, officials said.
Under existing policy, people 60 and older can get the shots if they wish.
Hepatitis B: Should I Have The Vaccine
In most adults, an acute hepatitis B infection will usually clear up on its own, without treatment. If it becomes chronic, though, it can have serious consequences. There is a vaccine to prevent hepatitis B. It is recommended for all babies and toddlers, as well as for adults who have a high risk of becoming infected.
The hepatitis B virus is mainly spread through blood, but also through other body fluids. This usually happens during unprotected sex most commonly between men who have sex with other men. Having several sexual partners and recurring sexual STIs can increase the risk of getting hepatitis B too. Other routes of infection include using non-sterile syringes when injecting drugs or having a tattoo done with non-sterile needles.
If a pregnant woman has hepatitis B, she might pass it on to her baby while giving birth. In Germany and other countries, pregnant women are offered a hepatitis B test to see whether they are infected.
The likelihood of becoming infected is generally quite low in countries like Germany, where less than 1 out of 100 people have hepatitis B.
Complications Of Hepatitis B In Infants And Children
Mothers who are infected with hepatitis B can pass the virus to their children either through the womb or at the time of birth. Hepatitis B virus can also be spread through exposure of broken skin or mucous membranes to the blood or other body fluids of an infected person.
If newborn babies are quickly immunised with 2 vaccines, they can be protected from getting hepatitis B.
Many people who are infected with hepatitis B have no symptoms. Babies and children who are infected with hepatitis B are less likely than adults to have symptoms of infection, but are more likely to develop chronic hepatitis B.
A child who contracts chronic hepatitis B has an increased risk of developing liver disease and cancer later in life. A small proportion of adults who become infected with the hepatitis B virus develop a long-term hepatitis B infection.
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Facts About Hepatitis B
- Two billion people, or one in three, have been infected with hepatitis B worldwide. Of these, about 260 million live with chronic hepatitis B.
- 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 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 fourth leading cause of cancer deaths throughout the world, behind lung, colorectal and stomach cancers.
- 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 2017, about 8 of 10 infants born throughout the world received three doses of hepatitis B 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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Concerns About Immunisation Side Effects
If the side effect following immunisation is unexpected, persistent or severe, or if you are worried about yourself or your child’s condition after a vaccination, see your doctor or immunisation nurse as soon as possible or go directly to a hospital.
It is important to seek medical advice if you are unwell, as this may be due to other illness, rather than because of the vaccination.
Immunisation side effects may be reported to SAEFVIC, the Victorian vaccine safety and reporting service. Discuss with your immunisation provider how to report adverse events in other states or territories.
International 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.
The hepatitis B vaccine is an injection that is generally given in the arm and as a three-dose series. The World Health Organization recommends a 0, 1, and 6-month vaccine schedule, though schedules may vary based on a countrys national immunization program. 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. Please note that the vaccine brand name, manufacturer and associated schedules for adults, children and infants may be unique to different countries, though there is a list of WHO prequalified vaccines.
3-Dose Vaccine Series for Infants
The World Health Organization recommends all infants receive the first dose of the hepatitis B vaccine within 24 hours of birth and to complete the vaccine series with additional shots at 1 month and 6 months of age. Beginning the hepatitis B vaccine at birth will ensure protection against hepatitis B for life.
3-Dose Vaccine Series for Children and Adults
4-Dose Combination Vaccine Series for Infants
Additional Resource Links:
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Hepatitis B Immunisation Service
Hepatitis B vaccines are given as a needle, either on their own or as a combination vaccine. They can be provided by a variety of recognised immunisation providers. If you’re eligible, you can get the hepatitis B vaccine for free under the National Immunisation Program .
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Find information that will help you deliver your service to your patients
The National Vaccine Injury Compensation Program
The National Vaccine Injury Compensation Program is a federal program that was created to compensate people who may have been injured by certain vaccines. Claims regarding alleged injury or death due to vaccination have a time limit for filing, which may be as short as two years. Visit the VICP website at or call to learn about the program and about filing a claim.
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Talk With Your Health Care Provider
Tell your vaccination 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 until a future visit.
Pregnant or breastfeeding people should be vaccinated if they are at risk for getting hepatitis B. Pregnancy or breastfeeding are not reasons to avoid hepatitis B vaccination.
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.
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
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Haemophilus Influenzae Type B Vaccination
Special situations
- Anatomical or functional asplenia : 1 dose if previously did not receive Hib if elective splenectomy, 1 dose, preferably at least 14 days before splenectomy
- Hematopoietic stem cell transplant : 3-dose series 4 weeks apart starting 612 months after successful transplant, regardless of Hib vaccination history
Routine vaccination
- Not at risk but want protection from hepatitis A: 2-dose series HepA or 3-dose series HepA-HepB
Special situations
- At risk for hepatitis A virus infection: 2-dose series HepA or 3-dose series HepA-HepB as above
- Chronic liver disease
- HIV infection
Routine vaccination
- Not at risk but want protection from hepatitis B: 2- or 3-dose series or 3-dose series HepA-HepB
Special situations
- At risk for hepatitis B virus infection: 2-dose or 3-dose series or 3-dose series HepA-HepB as above
- Chronic liver disease
- HIV infection
- Sexual exposure risk
- Current or recent injection drug use
- Percutaneous or mucosal risk for exposure to blood
- Incarcerated persons
- Travel in countries with high or intermediate endemic hepatitis B
- Pregnancy if at risk for infection or severe outcome from infection during pregnancy. Heplisav-B not currently recommended due to lack of safety data in pregnant women
Who Should Not Get The Hepatitis B Vaccine
Generally seen as a safe vaccine, there are some circumstances in which doctors advise against receiving the HBV vaccine. You shouldnt have the hepatitis B vaccine if:
- youve had a serious allergic reaction to a previous dose of the hepatitis B vaccine
- you have a history of hypersensitivity to yeast or to any other vaccine components
- youre experiencing a moderate or severe acute illness
If youre currently experiencing an illness, you should postpone receiving the vaccine until your condition has improved.
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How Is The Hepatitis B Vaccine Given
Hepatitis B
The vaccination for hepatitis B is given as 3 injections over a 6-month period–an initial dose, followed by a second dose 1 month later, and a third dose 5 months after the second.
If you need hepatitis A vaccination in addition to hepatitis B, you can do these individually or as a combined vaccine that covers both. The combination vaccine is given as 3 injections over a 6-month period–an initial dose, followed by a second dose 1 month later, and a third dose 5 months after the second.
If you are not able to get the shots on time, it is not necessary to restart the series, but you should continue from the last dose given.
Babies born to mothers who have chronic hepatitis B should get the first shot within 12 hours after birth, followed by a second shot 1 month later, and the third shot 5 months after the second. Babies born to mothers who are not infected with the hepatitis B virus should get the first shot within 1 to 2 months after birth, the second shot a month later, and the third shot 5 months after the second.
You will NOT get hepatitis B from the vaccine.
You will be protected for about 13 years. If it has been many years since you received your hepatitis B vaccination, or if you do not know when you were vaccinated, ask your doctor to check to see if you have antibodies against hepatitis B.
Who Should Get The Hbv Vaccine
The Centers for Disease Control and Prevention recommends that children should get their first hepatitis B vaccine at birth and complete the doses by 6 to 18 months of age. However, the HBV vaccine is still recommended for all children if they havent already gotten it, from infanthood up to 19 years old. Most U.S. states require a hepatitis B vaccine for school admittance, however.
Its also recommended for adults at an increased risk of catching the HBV infection, or anyone who fears they have or will be exposed to it in the near future.
The HBV vaccine is even safe to administer to pregnant women.
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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 , 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 . Your health care provider will usually file this report, or you can do it yourself. Visit the VAERS website at or call . VAERS is only for reporting reactions, and VAERS staff members do not give medical advice.
Who Should Get The Hepatitis B Vaccine
The CDC recommends it for all babies, who should get their first dose as newborns.
Other people who need it include:
- People younger than age 19 who haven’t been vaccinated
- Anyone who has a sex partner with hepatitis B
- People who are sexually active but arenât in a long-term relationship in which both partners are monogamous
- Anyone being evaluated or treated for an STD
- Men who have sex with men
- People who share needles used to inject drugs
- Anyone who lives with someone who has hep B
- Anyone whose job routinely puts them at risk for coming in contact with blood or blood-contaminated body fluids
- People with end-stage kidney disease
- People who live and work in facilities for people who are developmentally disabled
- Travelers to regions with moderate to high rates of hepatitis B
- People with chronic liver disease
- People with HIV infections
You should not get the vaccine if you had a severe allergic reaction to an earlier dose or are allergic to yeast, because yeast is used to make the vaccine.
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Hepatitis A Vaccine: Canadian Immunization Guide
For health professionals
Last partial chapter update
: The immunoglobulin dosage for Hepatitis A pre-exposure and post-exposure prophylaxis was increased based on the Product Monograph update for GamaSTAN®, which is available on Health Canada’s Drug Product Database.
Last complete chapter revision: March 2018
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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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.
Hepatitis A and hepatitis B can be spread from person to person, although in different ways. They have similar symptoms, which include abdominal pain, fever, fatigue, joint pain, and jaundice .
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.