What kind of vaccine is hep b

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.

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. View this video with a transcript. The hepatitis B vaccine should be given to all teenagers and adults who have not yet received the hepatitis B vaccine or been infected with hepatitis B virus. People may be exposed to the virus or bacteria at school or the store or when visiting family or friends. 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 will be protected. Following the third dose, this number will increase to 90 of 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 of every 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 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. Every year in the United States about 2, people die following an overwhelming hepatitis B virus infection. In addition, every year about 22, 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.

Hepatitis B Vaccines in Vaccines , 7th Edition. Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy. You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health.

Detailed guidance on vaccination of hemodialysis patients and other immunocompromised people is available from the Advisory Committee on Immunization Practices recommendations on adult hepatitis B vaccination pdf icon [40 pages]. After a person has been exposed to HBV, appropriate prophylaxis, given as soon as possible but preferably within 24 hours, can effectively prevent infection.

The mainstay of postexposure immunoprophylaxis is hepatitis B vaccine, but, in certain circumstances, the addition of HBIG provides increased protection 20 , See Who should be screened for HBV? The first vaccine dose should be administered immediately after collection of the blood sample for serologic testing. Vaccinating people who are immune to HBV infection because of current or previous infection or vaccination is not harmful and does not increase the risk for adverse events.

For people determined to be HBsAg negative, no further action is required. People with positive HBsAg should be referred to a specialist in the management of hepatitis B infection and receive further serologic evaluation, prevention counseling, and evaluation for antiviral treatment see Management of HBsAg-Positive Persons. People who have already been infected with HBV will receive no benefit from vaccination.

Vaccinating someone who is already infected poses no risk to the patient. Testing for immunity is advised only for people whose subsequent clinical management depends on knowledge of their immune status, including. Testing should not be performed before age 9 months in order to avoid detection of anti-HBs from hepatitis B immune globulin HBIG administered during infancy and to avoid detection of HBsAg from vaccine HBsAg can be transiently positive for 1—18 days after vaccination.

Testing at 9 months or later also maximizes detection of late HBV infection. Following vaccination, anti-HBs levels decline over time. Booster doses are not recommended for people with normal immune status who have been vaccinated 16 , Only certain people should receive a booster dose in specific situations.

For other immunocompromised people including those with HIV, hematopoietic stem-cell transplant recipients, and people receiving chemotherapy , the need for booster doses has not been determined. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Viral Hepatitis. Section Navigation. Facebook Twitter LinkedIn Syndicate. Minus Related Pages. Overview and Statistics.

What are the case definitions for reportable HBV infections? How many deaths can be attributed to chronic HBV infection? Transmission, Symptoms, and Treatment. How is HBV transmitted? How long does HBV survive outside the body? What should be used to clean environmental surfaces potentially contaminated with HBV?

Who is at risk for HBV infection? Who should be screened for HBV? Are international travelers at risk for HBV infection? What are the signs and symptoms of HBV infection? What is the incubation period for hepatitis B? When symptoms of acute hepatitis B occur, how long do they usually last? How serious is acute HBV infection? How serious is chronic HBV infection? How likely is HBV infection to become chronic? What tests are used to identify patients with hepatitis B? Where can I learn more about HBV serology?

How is HBV infection treated? What is HBV reactivation? Who is at greatest risk for HBV reactivation? Hepatitis B Vaccination. Who should be vaccinated against hepatitis B? Is hepatitis B vaccination recommended in certain settings? What are the hepatitis B vaccines licensed for use in the United States? What are the recommended schedules for hepatitis B vaccination? What are the recommended dosages of hepatitis B vaccines?

Who should not receive hepatitis B vaccine? Can a patient receive the first dose of hepatitis B vaccine from one manufacturer and subsequent doses from another manufacturer? If there is an interruption between doses of hepatitis B vaccine, does the vaccine series need to be restarted?

Is it harmful to administer an extra dose s of hepatitis B vaccine or repeat the entire vaccine series if documentation of vaccination history is unavailable? Can hepatitis B vaccine be administered concurrently with other vaccines? How long does protection from hepatitis B vaccine last?

Why should an infant receive hepatitis B vaccine at birth before hospital discharge, even if the mother is negative for hepatitis B surface antigen HBsAg? Should pregnant women be tested for HBV? Vaccination using only Recombivax HB dialysis formulation is a 3-dose schedule doses at 0, 1, and 6 months. Vaccination of a hemodialysis patient also may be completed with Heplisav-B using the standard 0. Is this practice advisable?

When using Engerix-B or Recombivax HB brands of HepB to vaccinate hemodialysis or other immunocompromised people, a higher dose is recommended, so to the extent these patients are immunocompromised, this is within ACIP recommendations note that "immunocompromised" is not defined in the recommendations.

Regardless, this practice is appropriate for several reasons, including that these patients may be starting hemodialysis soon, and because use of the higher dose is not harmful. When using Heplisav-B, the standard 0.

Can a dialysis or pre-dialysis patient receive Heplisav-B vaccine? Use the standard dose and dosing interval 1 month. I would like more information about Twinrix, the combination hepatitis A and B vaccine. The vaccine contains EL. In the United States, Twinrix is licensed for use in people who are age 18 years or older.

It can be administered to people who are at risk for both hepatitis A and hepatitis B, such as certain international travelers, people with chronic liver disease, men who have sex with men, illegal drug users, or to people who want to be immune to both diseases. A standard Twinrix series consists of 3 doses given intramuscularly on a 0, 1, and 6 month schedule. It consists of 3 doses given within 3 weeks, followed by a booster dose at 12 months 0, 7 days, 21 to 30 days, and 12 months.

The 4-dose schedule could benefit individuals needing rapid protection from hepatitis A and hepatitis B, such as some people traveling imminently. Twinrix cannot be used for post-exposure prophylaxis. I have seen adults who have had 1 or 2 doses of Twinrix, but we only carry single-antigen vaccine in our practice.

How should we complete their vaccination series with single-antigen vaccines? Twinrix is licensed as a 3-dose series for people age 18 years and older. So a dose of Twinrix can be substituted for any dose of the HepB series but not for any dose of the HepA series.

What are the minimum intervals for giving the 3-dose series of Twinrix? Minimum intervals for Twinrix are 4 weeks between dose 1 and dose 2, and 5 months between dose 2 and dose 3.

For Healthcare Personnel Back to top Which people who work in healthcare settings need hepatitis B vaccine? This requirement does not include personnel who would not be expected to have occupational risk for example, general office workers.

Employers must ensure that workers who decline HepB vaccination sign a declination form. For a fact sheet about this OSHA requirement, go to: www. For adults, administer HepB intramuscularly IM in the deltoid muscle. The gluteus muscle should not be used as a sit for administering HepB. For optimal protection, it is crucial that the vaccine be administered IM, not subcutaneously. Can Heplisav-B be used for vaccinating healthcare professionals? Heplisav-B is approved as a 2-dose schedule for persons age 18 years and older, including healthcare professionals.

The doses should be separated by at least 4 weeks. However, data are limited on the safety and immunogenicity effects when Heplisav-B is interchanged with HepB from other manufacturers. The 2-dose HepB series only applies when both doses in the series consist of Heplisav-B. However, any series containing 2 doses of Heplisav-B administered at least 4 weeks apart is valid, even if the patient received a single earlier dose from another manufacturer.

I work in occupational health and have some patients who are off schedule for their 3-dose hepatitis B vaccine series. They came back for dose 2 in 4 to 6 months rather than getting it 1 month later. In this situation, what is the correct timing for dose 3? And how long must the interval be between doses before I am required to restart the series? The minimal intervals for the 3-dose HepB vaccines are at least 4 weeks between doses 1 and 2, at least 8 weeks between doses 2 and 3, and at least 16 weeks between doses 1 and 3.

Since in your cases 16 weeks or more have elapsed since dose 1, you should schedule dose 3 to be given 8 weeks after dose 2. It is not necessary to restart the series because of an extended interval between doses, no matter how long. Is it safe for a healthcare professional to be vaccinated during pregnancy? Many years of experience with HepB vaccines indicate no apparent risk for adverse events to a developing fetus.

If not vaccinated, a pregnant woman may contract an HBV infection during pregnancy, which might result in severe disease for the newborn. Women who breastfeed their babies and are healthcare professionals can and should be vaccinated against hepatitis B if they haven't been previously vaccinated. Receipt of the vaccine is not a reason to discontinue breastfeeding. There are no clinical studies of Heplisav-B in pregnant women.

Available human data on Heplisav-B administered to pregnant women are insufficient to assess vaccine-associated risks in pregnancy. Until safety data are available for Heplisav-B, providers should continue to vaccinate pregnant women needing HepB vaccination with a vaccine from a different manufacturer.

Which HCP need serologic testing after receiving a hepatitis B vaccine series? All HCP, including trainees, who have a high risk of occupational percutaneous or mucosal exposure to blood or body fluids for example, HCP with direct patient contact, HCP at risk of needlestick or sharps injury, laboratory workers who draw, test or handle blood specimens should have postvaccination testing for antibody to hepatitis B surface antigen anti-HBs.

Postvaccination testing for persons at low risk for mucosal or percutaneous exposure to blood or body fluids for example, public safety workers and HCP without direct patient contact likely is not cost-effective; however, those who do not undergo postvaccination testing should be counseled to seek immediate testing if exposed. There are two options for healthcare personnel who test negative after completing their first HepB series. The first option is to give one dose of HepB, then retest for anti-HBs.

If the result is positive, the person should be considered immune. If negative, the person should receive the remaining doses in the series, and then retest for anti-HBs. Those found to be HBsAg negative but total anti-HBc positive were infected in the past and require no vaccination or treatment.

If the HBsAg and total anti-HBc tests are positive, the person should receive appropriate counseling for preventing transmission to others as well as referral for ongoing care to a specialist experienced in the medical management of chronic HBV infection.

They should not be excluded from work. Heplisav-B may be used for revaccination following an initial HepB series that consisted of doses of Heplisav-B or doses from a different manufacturer.

If the test is still negative after a second vaccine series, the person should be tested for HBsAg and total anti-HBc to determine their HBV infection status. The choice of option 1 and option 2 should be based on epidemiologic considerations and likelihood that the patient is HBsAg positive, since there is a delay in option 1 in determining HBsAg status. How often should I test HCP after they've received the hepatitis B vaccine series to make sure they're protected?

For immunocompetent HCP, periodic testing or periodic boosting is not needed. This information should be made available to the employee and recorded in the employee's health record. Immunocompetent people known to have responded to HepB vaccination in the past do not require additional passive or active immunization.

In this scenario, the initial postvaccination testing showed that the healthcare professional was protected. Only immunocompromised people for example, dialysis patients, some people living with HIV need to have anti-HBs testing performed periodically. HBIG dosage is 0. In general, no, but the type of testing pre-exposure or post-exposure depends on the healthcare worker's profession and work setting.

The risk might be low enough in certain settings that assessment of hepatitis B surface antibody anti-HBs status and appropriate follow-up can be done at the time of exposure to potentially infectious blood or body fluids. This approach relies on HCP recognizing and reporting blood and body fluid exposures and might be applied on the basis of documented low risk, implementation, and cost considerations.

Trainees, some occupations such as those with frequent exposure to sharp instruments and blood , and HCP practicing in certain populations are at greater risk of exposure to blood or body fluid exposure from an HBsAg-positive patient. We have a new employee with documentation of having received a series of hepatitis B vaccine as an adolescent. He now tests negative for hepatitis B surface antibody anti-HBs. How should we manage him? Those who test positive following the "booster" dose are immune and require no further vaccination or testing.

The "booster" dose counts as the first dose in this series. For more information see www. If an employee receives both HBIG and hepatitis B vaccine after a needlestick from a patient who is HBsAg positive, how long should one wait to check the employee's response to the vaccine? At our facility we do routine pre-employment anti-HBs testing regardless of whether the employee has documentation of a hepatitis B vaccination series and consider those who are anti-HBs positive to be immune.

Is this the recommended strategy? Persons who cannot provide written documentation of a complete HepB vaccination series should complete the series, then be tested for anti-HBs 1 to 2 months after the final dose. Is there a recommendation for a routine booster dose of hepatitis B vaccine? Immunocompetent persons have long-term protection against HBV and do not need further testing or vaccine doses.

Some immunodeficient persons including those on hemodialysis may need periodic booster doses of hepatitis B vaccine. Does CDC recommend restarting the hepatitis B vaccine series in the event the series is interrupted? The series should not be restarted. Continue the series from where you left off. Several physicians in our group have no documentation showing they received hepatitis B vaccine. They are relatively sure, however, that they received the doses many years ago.

What do we do now? There is no harm in receiving extra doses of vaccine. Postvaccination anti-HBs testing results should also be documented, including the date testing was performed. All healthcare settings should develop policies or guidelines to assure valid hepatitis B immunization. An employee thinks she had 3 doses of hepatitis B vaccine in the past but has no documentation of receiving those doses.

With this lab result, can't we assume she is immune? A positive anti-HBs indicates that the vaccinated person is immune at the time the person was tested but does not assure that the person has long-term immunity. An adequate anti-HBs result from a documented vaccine series would assure not only seroprotection, but long-term protection. What should I do now?

Do nothing. Data show that vaccine-induced anti-HBs levels might decline over time; however, immune memory anamnestic anti-HBs response remains intact following immunization. Does the employer have a responsibility in this area beyond providing vaccine? There are no regulations that require removal from job situations where exposure to bloodborne pathogens could occur; this is an individual policy decision within the organization. OSHA regulations require that employees in jobs where there is a reasonable risk of exposure to blood be offered hepatitis B vaccine.

In addition, the regulation states that adequate personal protective equipment be provided and that standard precautions be followed. Check your state OSHA regulations regarding additional requirements. Adequate documentation should be placed in the employee record regarding non-response to vaccination. If the HBsAg and total anti-HBc tests are positive, HCP should receive appropriate counseling for preventing transmission to others as well as referral for ongoing care to a specialist experienced in the medical management of chronic HBV infection.

Persons who are HBsAg-positive and who perform exposure-prone procedures should seek counsel from a review panel comprised of experts with a balanced perspective for example, infectious disease specialists and their personal physician[s] regarding the procedures that they can perform safely. Can a person with chronic HBV infection work in a healthcare setting?

HCP should not be discriminated against because of their hepatitis B status. This document is available at www.

Vaccine Safety Back to top Is hepatitis B vaccine safe? Hepatitis B vaccines have been demonstrated to be safe when administered to infants, children, adolescents, and adults.

Since , more than million people, including infants, children, and adults living in the United States have received at least one dose of hepatitis B vaccine; more than a billion doses of hepatitis B vaccine have been given worldwide.

Vaccination causes a sore arm occasionally, but serious reactions are very rare. Is it safe to give hepatitis B vaccine to a pregnant woman? Many years of experience with HepB vaccines indicates no apparent risk for adverse events to a developing fetus. Current vaccines contain noninfectious HBsAg and pose no risk to the fetus. If the mother is being vaccinated because she is at risk for HBV infection for example, a healthcare worker, a person with a sexually transmitted disease, an injection drug user, a person with multiple sex partners, or a person with diabetes who is 19 through 59 years of age , vaccination should be initiated as soon as her risk factor is identified during the pregnancy.

HBV infection affecting a pregnant woman might result in severe disease for the mother and chronic infection for the newborn. Until safety data are available for Heplisav-B, providers should continue to vaccinate pregnant women needing hepatitis B vaccination with a vaccine from a different manufacturer.

Does a birth dose of vaccine increase the risk of elevated temperature and subsequent microbiologic evaluations? Administration of HepB soon after birth has not been associated with an increased rate of elevated temperatures or subsequent evaluations for possible sepsis in the first 21 days of life.

Contraindications and Precautions Back to top Who should not receive hepatitis B vaccine? A serious allergic reaction to a prior dose of hepatitis B vaccine or a vaccine component is a contraindication to further doses of HepB vaccine.

The recombinant vaccines that are licensed for use in the United States are synthesized in yeast cells into which a plasmid containing the gene for HBsAg has been inserted. Purified HBsAg is obtained by lysing the yeast cells and separating HBsAg from the yeast components by biochemical and biophysical techniques.

People with a severe allergic to yeast should not be vaccinated with vaccines produced in yeast cells. As with other vaccines, vaccination of people with moderate or severe acute illness, with or without fever, should be deferred until the illness improves. Vaccine Storage and Handling How should hepatitis B vaccine be stored? The vaccines must not be frozen. Any vaccine exposed to freezing temperature should not be used. Do not use these or any other vaccines after the expiration date shown on the packaging.

Any vaccine administered after its expiration date should be repeated. Back to top This page was updated on August 30, This page was reviewed on September 13, Immunization Action Coalition. Sign up for email newsletter. ACIP Recommendations. Package Inserts. Additional Immunization Resources. Adult Vaccination. Screening Checklists. Ask the Experts. Shop IAC. CDC Schedules. Standing Orders for Vaccination. Clinic Tools.

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Meningococcal ACWY. Meningococcal B. Travel Vaccines. Disease Issues. For Adults. Tests and Interpretation. For Healthcare Personnel. Pregnancy, Perinatal, and Infants. For Children and Teens. Vaccine Storage and Handling. What are the signs and symptoms of hepatitis B? Back to top. What are the various serologic tests for hepatitis B? Table 1: Hepatitis B laboratory nomenclature.

Hepatitis B surface antigen is a marker of infectivity.