Who Should Be Immunised Against Hepatitis B
Hepatitis B immunisation is recommended and funded for the following groups:
- all children up to their 18th birthday
- babies born to mothers with hepatitis B infection
- people who live in close contact with someone infected with hepatitis B
- anyone undergoing renal dialysis
- people who have hepatitis C infection, or who are HIV positive, or who have had a needle stick injury.
- anyone who has received immunosuppression therapy of at least 28 days or has had solid organ or bone marrow transplant.
Hepatitis B immunisation is also recommended, but not funded, for:
- workers who are likely to come into contact with blood products, or who are at increased risk of needlestick injuries, assault, etc.
- people who change sex partners frequently such as sex workers
- people who regularly receive blood transfusions such as people with haemophilia
- prison inmates
- current or recent injecting drug users
- migrants and travellers from or to areas with intermediate or high rates of hepatitis B such as the Asia and Pacific region.
Burden Of Chronic Hepatitis B In Australia
Chronic infection and its sequelae, including cirrhosis and hepatocellular carcinoma, contribute to most of the hepatitis B disease burden in Australia. The burden from chronic disease has been increasing with the increasing number of immigrants from regions of high hepatitis B prevalence.62
First-generation immigrants from countries of high hepatitis B endemicity usually retain the prevalence of chronic hepatitis B virus infection of the country they are from. Migrants born in Asian, Pacific islands, North African, Middle Eastern and Mediterranean countries have a significantly higher prevalence of chronic hepatitis B virus infection than the Australian-born population.62
Other population groups with higher prevalence of hepatitis B virus infection include:63,64
- Aboriginal and Torres Strait Islander people
- people with HIV
- people who injected drugs between 1980 and 1990
- household contacts of someone diagnosed with hepatitis between 1980 and 1990
Notification of chronic hepatitis B virus infection depends on hepatitis B testing and reporting. Many people with chronic hepatitis B virus infection remain undiagnosed. Mathematical modelling suggests that, in Australia in 2015:64
- about 230,000 people were living with hepatitis B virus infection
- about 419 deaths were due to hepatitis B virus infection
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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Provincially Funded Vaccine For Adults
People of certain high risk categories are able to receive the provincially funded vaccine through our Health Unit. These categories include:
- People who have someone in their household or a sexual partner who currently has the hepatitis B infection.
- Drug users who share needles.
- People with multiple sexual partners.
- People diagnosed with hepatitis C.
- People who have had a needle stick injury outside of the health care setting.
If you fall into any of these high risk categories, please call our sexual health clinic to book an appointment.
Geographic Distribution Of Chronic Hepatitis B Infection Worldwide
Map provided by the CDC
If you have insurance, visit your primary care provider. The hepatitis B test and vaccine are covered by most insurance plans. Let your doctor know that you might be at risk for hepatitis B and need to be tested. Your doctor should order the following blood tests:
If you do nothave insurance, you can contact the following clinics to ask about free or low-cost screening:
- Pacific Free Clinic
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Persons With Chronic Diseases
Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional general information about vaccination of people with chronic diseases.
Chronic renal disease and patients on dialysis
People with chronic renal disease may respond sub-optimally to HB vaccine and experience more rapid decline of anti-HBs titres, and are therefore recommended immunization with a higher vaccine dose. Individuals undergoing chronic dialysis are also at increased risk for HB infection. In people with chronic renal disease anti-HBs titre should be evaluated annually and booster doses using a higher vaccine dose should be given as necessary.
People with conditions such as autism spectrum disorders or demyelinating disorders should receive all routinely recommended immunizations, including HB-containing vaccine.
Chronic liver disease
HB immunization is recommended for non-immune persons with chronic liver disease, including those infected with hepatitis C, because they are at risk of more severe disease if infection occurs. Vaccination should be completed early in the course of the disease, as the immune response to vaccine is suboptimal in advanced liver disease. Post-immunization serologic testing may be used to confirm vaccine response.
Non-malignant hematologic disorders
Persons with bleeding disorders and other people receiving repeated infusions of blood or blood products are considered to be at higher risk of contracting HB and should be offered HB vaccine.
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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Prevalence Of Chronic Hepatitis B
The prevalence of chronic hepatitis B virus infection varies between and within countries:58-61
- < 0.5% among Caucasians in the United States, northern Europe and Australia
- 15% in Mediterranean countries, parts of eastern Europe, Africa, and Central and South America
- > 10% in many sub-Saharan African, East and Southeast Asian, and Pacific island populations
Regions where 2% of the population is positive to hepatitis B surface antigen are considered to have moderate to high prevalence. In these regions, people mainly acquire the infection perinatally or in early childhood.55
Adults Recommended To Receive Hepb Vaccine:
- Persons at risk for infection by sexual exposure
- Sex partners of hepatitis B surface antigen positive persons
- Sexually active persons who are not in a long-term, mutually monogamous relationship
- Persons seeking evaluation or treatment for a sexually transmitted infection
- Men who have sex with men
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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.
Hepatitis B Vaccine And Surface Antibody Titer Faqs
PLEASE NOTE: This is program specific some programs require 3 Hepatitis B vaccines AND a positive Hepatitis B Surface Antibody titer while others will accept 3 vaccines OR a titer. Please read the information in your CastleBranch account carefully so that you know exactly what you need to meet your programs requirements. If you have any questions, please email and a team member will respond.
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Hepatitis B Vaccination In The Travel & Immunization Clinic For High Risk Populations
There are many ways that people can get hepatitis B. It is possible for people to have hepatitis B and not know it because they do not feel sick. That is why some people need to be tested for hepatitis B before they get the vaccine.
If you would like to get the hepatitis B vaccine , please complete the health risk assessment first and ask yourself the following questions:
If you answered yes to any of the questions, you should be testedfor hepatitis B beforegetting the vaccine.
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.
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Recommended Adult Dosing Volume Of Monovalent Hepatitis B Vaccine
- Age 19 years and younger: Use 0.5 mL per dose .
- Age 20 years and older: 1.0 mL per dose .
For a one-page sheet reviewing the hepatitis B dosing schedule for children and adults, consult IACs 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.
How Does The Hepatitis B Vaccine Series Work
The vaccine protects you from the hepatitis B virus by getting your body’s immune system to make antibodies. Those antibodies protect you by fighting off the virus if it ever gets into your body.
Usually, the vaccine is spaced out into three different shots called a hepatitis B vaccine schedule. One month after your first shot, you get the second shot. Six months after your first shot, you get the third shot. If you miss your second or third dose, get it as soon as you remember.
The hepatitis vaccine is super effective. Its worked really well to lower the number of people who get hepatitis B every year.
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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.
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.
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People At Occupational Risk
Hepatitis B vaccine is recommended for people who work in any occupation that involves any of:
- direct patient care
- handling human tissue, blood or body fluids
- handling used needles or syringes
These people should also routinely follow standard precautions against exposure to human tissue, blood or body fluids.19
The risk to people in certain occupations differs considerably between settings in different parts of Australia. Workers who have an increased risk of acquiring hepatitis B include:
- healthcare workers
- police, members of the armed forces, emergency services staff and staff of correctional facilities, if they are assigned to duties that may involve exposure to human tissue, blood or body fluids
- funeral workers, embalmers and other workers who have regular contact with human tissue, blood or body fluids, or used needles or syringes
- staff involved in both residential and non-residential care of people with developmental disabilities, because of the high prevalence of markers of past or current infection in people in this setting16-18
- workers who perform skin penetration procedures, such as tattooists and body-piercers
Early childhood educators and carers are normally at minimal risk of hepatitis B transmission. The local public health authority can provide advice about risk if needed.
Adult-formulation hepatitis B vaccine should be given in a 3-dose schedule. See Table. Monovalent hepatitis B vaccines for adolescents and adults in Vaccines, dosage and administration.
When To Delay Or Avoid Hepb Immunization
Doctors delay giving the vaccine to babies who weigh less than 4 pounds, 7 ounces at birth whose mothers do not have the virus in their blood. The baby will get the first dose at 1 month of age or when the baby is discharged from the hospital.
The vaccine is not recommended if your child:
- is currently sick, although simple colds or other minor illnesses should not prevent immunization
- had a serious allergic reaction after an earlier dose of the vaccine or is allergic to baker’s yeast
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Who Should Get The Hepatitis B Vaccine
Most babies now get the HBV vaccine from their doctor as a regular part of their checkups.
Hepatitis B is really contagious. You can easily get it through unprotected sex or contact with infected blood or urine. So if youve never had the vaccine, its a good idea to talk to your doctor about getting it.
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.
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Aboriginal And Torres Strait Islander People
Aboriginal and Torres Strait Islander people are recommended to:
- have their risks and vaccination status for hepatitis B reviewed
- receive testing for previous hepatitis B virus infection
- receive vaccination if non-immune
Aboriginal and Torres Strait Islander people have a higher risk of acquiring new hepatitis B virus infection than non-Indigenous Australians.2,3
Adult-formulation hepatitis B vaccine should be given in a 3-dose schedule.
Children with HIV are recommended to receive 3 doses of hepatitis B vaccine using an adult formulation. This is double the recommended dose for children. In a limited number of studies, children who were immunocompromised responded better when given higher doses in a 3-dose schedule.4,5
Adults with HIV are recommended to receive larger-than-usual doses of hepatitis B vaccine. They should receive 2 injections of the standard adult dose on each occasion at 0, 1, 2 and 6 months. Limited studies in adults with HIV have revealed an improved and accelerated serological response to a schedule that consists of 4 double doses.6,7
A 3-dose schedule at 6, 8 and 12 months after transplant is required using:
How Can I Learn More
- Ask your healthcare provider. He or she can give you the vaccine package insert or suggest other sources of information.
- Visit the website of the Food and Drug Administration for vaccine package inserts and additional information at .
- Contact the Centers for Disease Control and Prevention : Call or visit CDC’s website at .
Hepatitis B Vaccine Information Statement. U.S. Department of Health and Human Services/Centers for Disease Control and Prevention National Immunization Program. 10/15/2021.
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