I Am A Healthcare Worker Who Did Not Develop Hepatitis B Antibodies After Immunization What Should I Do
Not everyone responds to the hepatitis B vaccine. In fact, in a group of adults younger than 40 years of age who have received two doses of the vaccine only 75 of 100 will be protected. Following the third dose, this number will increase to 90 of 100. However, people older than 40 years of age will be less likely to respond to the vaccine with increasing age.
Even if people do not respond to three doses, it does not mean that they are at high risk for hepatitis B. Because hepatitis B is transmitted primarily through blood and body fluids, using safety precautions while working will help decrease the chance of exposure to the disease. It is also possible that the immune response was not great enough to be measured by the laboratory test, but would still provide some level of protection upon exposure to hepatitis B. The CDC recommends getting the three-dose series again if an immune response is not generated following the first series.
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 the series of three doses again. About 5 of 100 people will still not respond after six doses. If these people 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.
Side Effects Of Hepatitis B Vaccines
Immunisations containing components to protect against hepatitis B are effective and safe, although all medication can have unwanted side effects.
Side effects from the vaccine are uncommon and usually mild, but may include:
- Localised pain, redness and swelling at the injection site.
- Low-grade temperature .
- In children being unsettled, irritable, tearful, generally unhappy, drowsy and tired.
- Occasionally, an injection-site lump that may last many weeks, but for which treatment is not needed.
Should I Be Screened For Hepatitis B
Screening is testing for a disease in people who have no symptoms. Doctors use blood tests to screen for hepatitis B. Many people who have hepatitis B dont have symptoms and dont know they are infected with hepatitis B. Screening tests can help doctors diagnose and treat hepatitis B, which can lower your chances of developing serious health problems.
Your doctor may recommend screening for hepatitis B if you9,14
- are pregnant
- were born in an area of the world where 2 percent or more of the population has hepatitis B infection, which includes Africa, Asia, and parts of the Middle East, Eastern Europe, and South America
- didnt receive the hepatitis B vaccine as an infant and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection, which includes sub-Saharan Africa and parts of Asia
- are HIV-positive
- are a man who has sex with men
- have lived with or had sex with a person who has hepatitis B
- have an increased chance of infection due to other factors
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Is It An Emergency
If you or someone in your care has chest pains, difficulty breathing, or severe bleeding, it could be a life-threatening emergency. Call 9-1-1 or the local emergency number immediately.
If you are concerned about a possible poisoning or exposure to a toxic substance, call Poison Control now at 1-800-567-8911.
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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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Hepatitis B In The United States
In the United States, about 862,000 people have chronic hepatitis B.6 Asian Americans and African Americans have higher rates of chronic hepatitis B than other U.S. racial and ethnic groups.10 Researchers estimate that about half of the people living with chronic hepatitis B in the United States are Asian Americans and Pacific Islanders.11 Chronic hepatitis B is also more common among people born in other countries than among those born in the United States.7
The hepatitis B vaccine has been available since the 1980s and, in 1991, doctors began recommending that children in the United States receive the hepatitis B vaccine. The annual rate of acute hepatitis B infections went down 88.5 percent between 1982 and 2015.12 In 2017, the annual number of hepatitis B infections rose in some states.13 Experts think the rise was related to increases in injection drug use. Injection drug use increases the risk of hepatitis B infection.
Is It Okay To Get An Extra Dose Of Hepatitis B Vaccine
Yes. Although extra doses of vaccine are not recommended, you can think of the extra dose as another chance for the immune system to see the hepatitis B virus. A vaccine is not the only time the immune system will see the virus or bacteria contained in it. People may be exposed to the virus or bacteria at school or the store or when visiting family or friends. An extra dose of vaccine is like one more exposure, except the difference is that the virus or bacteria in any vaccine has been made safe, so it wont make you ill.
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More Information On Side Effects
Reactions listed under âpossible side effectsâ or âadverse eventsâ on vaccine product information sheets may not all be directly linked to the vaccine. See Vaccine side effects and adverse reactions for more information on why this is the case.
If you are concerned about any reactions that occur after vaccination, consult your doctor. In the UK you can report suspected vaccine side effects to the Medicines and Healthcare products Regulatory Agency through the Yellow Card Scheme
What Causes Hepatitis B
The hepatitis B virus causes hepatitis B. The hepatitis B virus spreads through contact with an infected persons blood, semen, or other body fluids. Contact can occur by
- being born to a mother with hepatitis B
- having unprotected sex with an infected person
- sharing drug needles or other drug materials with an infected person
- getting an accidental stick with a needle that was used on an infected person
- being tattooed or pierced with tools that were used on an infected person and werent properly sterilized, or cleaned in a way that destroys all viruses and other microbes
- having contact with the blood or open sores of an infected person
- using an infected persons razor, toothbrush, or nail clippers
You cant get hepatitis B from
- being coughed on or sneezed on by an infected person
- drinking unclean water or untreated water that has not been boiled
- eating food that is unclean or has not been properly cooked
- hugging an infected person
- shaking hands or holding hands with an infected person
- sharing spoons, forks, and other eating utensils
- sitting next to an infected person
Mothers who have hepatitis B can safely breastfeed their babies. If a baby receives hepatitis B immune globulin and starts receiving the hepatitis B vaccine to prevent hepatitis B infection shortly after birth, hepatitis B is unlikely to spread from mother to child through breastfeeding.15
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Immunisation Against Hepatitis B For Children
Immunisation is the best protection against hepatitis B infection and is recommended for all infants and young children, adolescents and those in high-risk groups. Immunisation can be with a vaccine against hepatitis B alone or with a combination vaccine.
Protection against hepatitis B is available free of charge under the National Immunisation Program Schedule.
In Victoria, immunisation against hepatitis B is free for all babies and children including:
- Babies at birth immunisation against hepatitis B alone as soon as possible after birth.
- Babies at 2, 4 and 6 months immunisation in the form of a diphtheria, tetanus, whooping cough, hepatitis B, polio and Haemophilus influenzae type b vaccine .
- Premature babies at 12 months premature babies born under 32 weeks gestation or under 2,000g birth weight receive a single booster dose.
- Children up to and including 9 years of age.
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 , cirrhosis , or cancer of the liver . Every year in the United States about 22,000 new hepatitis B infections occur and about 2,000 people die from their infections.
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Immunisation Against Hepatitis B
The current Australia-wide immunisation program is necessary to protect all children from hepatitis B infection.
A full course of hepatitis B injections must be given for a child to be protected. It is recommended that this course begins within 24 hours of birth with a vaccine against hepatitis B alone. Further doses are routinely given at 2 months, 4 months and 6 months, as a combination vaccine.
Immunisation is the best protection against hepatitis B infection. In Victoria a free hepatitis B vaccine is available for a number of groups at high risk, including men who have sex with men, and people living with HIV.
The adult course involves 3 doses of the vaccine over 6 months and gives protection to about 95 per cent of people. Once you have had the 3 doses, you can have a blood test to see if you are protected.
Why Should I Vaccinate My Newborn Child If I Know That I Am Not Infected With Hepatitis B Virus
Before the hepatitis B vaccine, every year in the United States about 18,000 children were infected with hepatitis B virus by the time they were 10 years old. This statistic is especially important because people are much more likely to develop liver cancer or cirrhosis if they are infected early in life, rather than later in life .
About 9,000 of the 18,000 children infected in the first 10 years of life caught the virus from their mother during birth. However, many young children didn’t catch the disease from their mother. They caught it from either another family member or someone else who came in contact with the child. Because hepatitis B can be transmitted by relatively casual contact with items contaminated with blood of an infected person, and because many people who are infected with hepatitis B virus don’t know that they have it, it is virtually impossible to be “careful enough” to avoid this infection.
For these reasons, all young children are recommended to receive the hepatitis B vaccine. The best time to receive the first dose is right after birth. This will ensure that the child will be protected as early as possible from catching hepatitis B from people who dont know that they are infected with the virus.
Listen to Dr. Offit explain why newborns get the hepatitis B vaccine by watching this short video, part of the series Talking About Vaccines with Dr. Paul Offit.
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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.
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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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.
Does The Hepatitis B Vaccine Have Side Effects
Some children will develop pain or soreness in the local area of the shot, and low-grade fever.
There is one extremely rare, but serious, side effect. About 1 out of every 600,000 doses of the hepatitis B vaccine will cause a severe allergic reaction, called anaphylaxis, with symptoms including swelling of the mouth, difficulty breathing, low blood pressure or shock. Anaphylaxis usually occurs within 15 minutes of receiving the vaccine. Although anaphylaxis can be treated, it is quite frightening. People should remain at the doctors office for about 15 minutes after getting the vaccine.
Although the hepatitis B vaccine is made in yeast cells, no one has ever been shown to be allergic to the yeast proteins contained in the hepatitis B vaccine .
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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 .
How Is This Vaccine Given
This vaccine is given as an injection into a muscle. You will receive this injection in a doctor’s office or other clinic setting.
The hepatitis A and B vaccine is given in a series of 3 shots. The booster shots are given 1 month and 6 months after the first shot.
If you have a high risk of hepatitis infection, you may be given 3 shots within 30 days, and a fourth shot 12 months after the first.
Your individual booster schedule may be different from these guidelines. Follow your doctor’s instructions or the schedule recommended by the health department of the state you live in.
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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.
What Are The Benefits Of The Hepatitis B Vaccine
Young children, in particular, may become life-long virus carriers if they contract the infection. This is why vaccinating newborn infants and young children at risk of an infection is particularly useful. By vaccinating them, the consequences of a chronic hepatitis B infection can also be prevented, including liver cirrhosis and cancer.
Vaccinating persons close to a hepatitis B carrier is important to prevent infections in daily life.
Vaccinating a person in an at-risk group protects the vaccine recipient and persons close to them as well as prevents the spread of the virus in the population.
After a situation involving a blood-to-blood infection risk, a potential infection can usually be prevented by administering the vaccine and HB immunoglobulin.
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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 virus, 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.