What Is Hep B 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.

More About Hepatitis B Vaccines

The first available hepatitis B vaccines were plasma-derived, produced by harvesting hepatitis B surface antigen from the plasma of persons with chronic HBV infection. The particles are highly purified, and any residual infectious particles are inactivated by various combinations of urea, pepsin, formaldehyde and heat. Although concerns about transmission of bloodborne pathogens, including HIV, from plasma-derived vaccines have proven to be unfounded, public concerns over the safety of the plasma-derived vaccine hampered its acceptance in many populations. Therefore increased research efforts were made to develop a recombinant vaccine.

In 1986, a hepatitis B vaccine produced by recombinant technology was licensed, and a second followed in 1989. The recombinant technology expressed HBsAg in other microorganisms and offered the potential to produce unlimited supplies of vaccine.

Although both the plasma-derived and recombinant hepatitis B vaccines are safe and highly effective in protecting against acute hepatitis disease as well as chronic disease, including cirrhosis and liver cancer, competition among the various hepatitis B vaccine producers drove down the price . When the price of both the plasma-derived and recombinant hepatitis B vaccines was relatively similar, the recombinant gradually replaced the plasma-derived hepatitis B vaccine.

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 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.

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Persons With Inadequate Immunization Records

Evidence of long term protection against HB has only been demonstrated in individuals who have been vaccinated according to a recommended immunization schedule. Independent of their anti-HBs titres, children and adults lacking adequate documentation of immunization should be considered susceptible and started on an immunization schedule appropriate for their age and risk factors. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information.

Hepatitis A And Hepatitis B Vaccine Dosing Information

Usual Adult Dose for Hepatitis B Prophylaxis:

Primary immunization: 1 mL IM in the deltoid area at 0, 1 and 6 months.Alternatively, a 4 dose schedule given on days 0, 7, and 21 to 30 followed by a booster at month 12 may be used.

Usual Adult Dose for Hepatitis A Prophylaxis:

Primary immunization: 1 mL IM in the deltoid area at 0, 1 and 6 months.Alternatively, a 4 dose schedule given on days 0, 7, and 21 to 30 followed by a booster at month 12 may be used.

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How Is A Hepatitis B Vaccine Given

A health care provider gives the hepatitis B vaccine. The vaccine is given as a shot injected into a muscle, usually in the arm for adults and children older than 1 year and in the thigh for infants and children younger than 1 year. Vaccination with a hepatitis B vaccine is usually given as a series of injections over a period of time, depending on the specific brand of the vaccine. Read any printed information that your health care provider gives you about the hepatitis B vaccine.

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A Look At Each Vaccine: Hepatitis B Vaccine

The hepatitis B vaccine is given to prevent the severe liver disease that can develop when children or adults are infected with hepatitis B virus. The hepatitis B vaccine is given as a series of three shots. The first dose is given within 24 hours of birth. The second dose is given one to two months after the first dose, and the third dose is given between 6 months and 18 months of age.

Persons New To Canada

Health care providers who see persons newly arrived in Canada should review the immunization status and update immunization for these individuals, as necessary. In many countries outside of Canada, HB vaccine is in limited use.

All persons from a country that is endemic for HB should be assessed and vaccinated against HB if not immune and not infected. Individuals born in developing countries are more likely to be carriers of HB, necessitating vaccination of their sexual and household contacts based on review of their serologic test results. HB vaccine is recommended for all household contacts whose families have immigrated to Canada from areas in which there is a high prevalence of HB and who may be exposed to HB carriers through their extended families or when visiting their country of origin.

Children adopted from countries in which there is a high prevalence of HB infection should be screened for HBsAg and, if positive, household or close contacts in the adopting family should be immunized before adoption or as soon as possible thereafter. Adults going to pick-up children from these countries should be vaccinated before departure. Refer to Immunization of Persons New to Canada in Part 3 for additional information.

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Liver Anatomy And Function

Main Function of the Liver

The liver is an essential organ that has many functions in the body. The liver plays an important role in detoxifying the body by converting ammonia, a byproduct of metabolism in the body, into urea that is excreted in the urine by the kidneys. The liver also breaks down medications and drugs, including alcohol, and is responsible for breaking down insulin and other hormones in the body. The liver also stores vitamins and chemicals that the body requires as building blocks.

Many different disease processes can occur in the liver, including infections such as hepatitis, cirrhosis , cancers, and damage by medications or toxins.

Symptoms of liver disease can include:

• Jaundice

The Hepatitis B Vaccine

The hepatitis B vaccine sometimes known by the trade name Recombivax HB is used to prevent this infection. The vaccine is provided in three doses.

The first dose can be taken on a date you choose. The second dose must be taken one month later. The third and final dose must be taken six months after the first dose.

Adolescents 11 to 15 years old may follow a two-dose regimen.

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Indications For Hepatitis B Vaccine

HepB vaccine also is indicated for adults who have not been previously vaccinated when any of the following is present:

• A desire for protection from hepatitis B in people who have not been previously vaccinated

• A sexually active lifestyle in people who are not in a long-term, mutually monogamous relationship

• Need for evaluation or treatment of a sexually transmitted disease

• Current or recent use of illicit injection drugs

• Sex between men

• Employment in which workers may be exposed to blood or other potentially infectious body fluids

• Diabetes in people < 60 years and sometimes in those 60 years

• End-stage renal disease

• HIV infection

• A chronic liver disorder

• Household contact and/or sexual contact with people who are positive for hepatitis B surface antigen

• Travel to endemic areas

• Time spent in correctional facilities or in facilities that provide sexually transmitted disease treatment, HIV testing and treatment, drug abuse treatment and prevention services, services to injection-drug users or men who have sex with men, or care for patients with developmental disabilities or with end-stage renal disease

• Pregnant women if at risk of infection or severe outcome resulting from infection during pregnancy

The combination HepA and HepB vaccine can be used in people 18 years who have indications for either hepatitis A or hepatitis B vaccine and who have not been previously vaccinated with one of the vaccine components.

Hepatitis B Vaccine Side Effects

As with any medication, the hepatitis B vaccine may cause some side effects. Most people dont experience any unwanted effects. The most common symptom is a sore arm from the injection site.

When receiving the vaccination, youll likely receive information or a pamphlet regarding the side effects that you might expect, and others that warrant medical attention.

Mild side effects usually last only . Mild side effects of the vaccine include:

• redness, swelling, or itching at the injection site
• a purple spot or lump at the injection site

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How Is This Vaccine Given

This vaccine is given as an injection into a muscle. A healthcare provider will give you this injection.

The hepatitis B vaccine is given in a series of 2 to 4 shots. The booster shots are sometimes given 1 month and 6 months after the first shot. If you have a high risk of hepatitis B infection, you may be given an additional booster 1 to 2 months after the third shot.

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.

History And Development Of The First Anticancer Vaccine

The first hepatitis B vaccines, commercially available since 1982, were plasma-derived vaccines. The American microbiologist Maurice Hilleman produced these vaccines by harvesting subvirion particles of HBsAg from the plasma of asymptomatic chronic HBV-infected donors . The particles in the pooled plasma were highly purified and any residual infectious particles were inactivated by various combinations of urea, pepsin, formaldehyde, and heat . Plasma-derived vaccines have been investigated with success in several hundred million individuals, leading to the first licensed hepatitis B vaccines. This first HBV vaccines were manufactured under the name Heptavax B and Hevac B and targeted a number of high-risk groups, the main focus of the immunization program at that time. Although concerns about the safety of these vaccines regarding transmission of bloodborne pathogens, including human immunodeficiency virus , have proven to be unfounded, public anxieties over the safety of the plasma-derived vaccine persisted and hampered its acceptance in many populations . Other barriers for high coverage included high vaccine costs and the lack of global vaccine policies .

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What Is The Transmission Route Of Hbv

Today, we know that HBVs are highly infectious and are spread by exposure of mucosal membranes or nonintact skin to infected blood or other body fluids . In high endemic areas, HBV is most commonly transmitted from mother to child at birth and during early childhood from infected to uninfected children . Most HBV infections in areas of low endemicity occur in adults in relatively well-defined risk groups, such as those at risk through sexual exposure, household members of an infected person, hemodialysis patients, incarcerated persons, injection-drug users, persons at risk for occupational exposure, developmentally disabled persons in long-term care facilities, and travelers to regions with moderate or high HBV endemicity. Today, only humans are a known reservoir for human HBV genotypes, but closely related HBV genotypes exist in higher primates . Hence, a comprehensive control strategy could eventually lead to the eradication of HBV.

The Duration Of Protection And The Need For Booster Doses

In vaccine efficacy studies, immunocompetent children and adults who developed anti-HBs concentrations of 10 mIU/mL or higher after vaccination had complete protection against both acute disease and chronic infection for decades , even if subsequently, over time, anti-HBs concentrations declined to less than 10 mIU/mL . Indeed, the protective efficacy of hepatitis B vaccination is related to the induction of anti-HBs antibodies, but it also involves the induction of memory B and T cells. Ongoing surveillance of vaccinees is required to clarify whether hepatitis B vaccination can confer longer, or even lifelong, protection . Based on currently available scientific evidence, different advisory groups do not recommend routine booster doses of hepatitis B vaccine in immunologically competent persons who have received a full primary course, because the majority of previously vaccinated people with an anti-HBs antibody concentration of 10 mIU/mL or less mount an anamnestic response when they receive a booster dose or are exposed to HBV, indicating that they remained protected by memory B and T cells .

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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.

Hepatitis B cannot be spread by contaminated water, food, cooking, or eating utensils, or by breastfeeding, coughing, sneezing, or close contact such as kissing and hugging.

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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For Adults At High Risk Of Exposure

Adults who have not received the hepatitis B vaccine series should be immunized when they have an increased risk of exposure. Job, travel, health condition, or lifestyle all may increase a person’s risk of contracting hepatitis B.

People who live or work where there is risk of exposure include:

• Health care and public safety workers who are likely to be exposed to blood or blood products.
• Clients and staff of institutions or residential settings with known or potential HBV carriers.
• People planning extended travel to China, Southeast Asia, Africa, and other areas where hepatitis B infection is high.

People who have health conditions that put them at high risk for exposure or a severe infection include:

• People who have a severe kidney disease that requires them to have their blood filtered through a machine .
• People who have chronic liver disease.
• People who have hemophilia and other conditions in which they need to have blood products on an ongoing basis.
• People who had a stem cell transplant.

People whose lifestyle puts them at high risk for exposure include:

• People who inject illegal drugs.
• Men who have sex with men.
• People who have had more than one sex partner in the past 6 months or who have a history of sexually transmitted infection.
• Household contacts and sex partners of hepatitis B carriers.
• Prison inmates.