People whose lifestyle puts them at high risk for exposure include:. For certain people, such as those with impaired immune systems or who are at high risk of exposure to HBV, health professionals will want to perform a blood test to make sure the vaccine worked post-vaccination testing. The hepatitis B vaccine Hep B gives long-term possibly lifelong protection from hepatitis B infection. Most people who get the vaccine do not have any problems. But there may be soreness or tenderness where the shot was given or mild fever for a short time.
Even though serious allergic reactions are rare with these vaccines, call your doctor or local health unit right away if you or your child has trouble breathing, a high fever, or anything unusual after having the shot.
A child who has had a severe allergic reaction to a previous dose of hepatitis B vaccine should not get another dose of this vaccine. Tell your doctor or nurse if your child has had a severe reaction to any vaccine or has severe allergies. See Drug Reference for a full list of side effects. Drug Reference is not available in all systems. If you are exposed to HBV before you have received all three shots in the vaccination series, a dose of hepatitis B immune globulin HBIG usually will prevent infection until the vaccine takes effect.
If you have already had hepatitis B and have developed protective antibodies to the virus, you do not need the vaccine because you have lifetime protection immunity against the infection. If you are not sure whether you have had hepatitis B, you can be tested, or you can be vaccinated without testing.
The vaccine is not harmful for you if you are already immune. If you have chronic HBV infection, the vaccine will be ineffective, although it is not harmful. The vaccine is safe for women who are pregnant or breastfeeding. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.
Your use of this information means that you agree to the Terms of Use and Privacy Policy. Most healthy people do not need a booster dose, but a blood test can be performed to check your immunity and decide if a booster dose of vaccine is necessary.
Yes, there is a combination vaccine approved for adults that protects people from both hepatitis A and hepatitis B. The combined hepatitis A and B vaccine is usually given as three separate doses over a 6-month period. Getting two different vaccines at the same time is not harmful. Talk to your health-care provider or local health department about getting vaccinated. Some clinics offer free or low-cost hepatitis B vaccines. Most children younger than 5 and people with serious health problems like having compromised immune systems have no symptoms.
Up to half of all older children, adolescents, and adults experience symptoms of acute hepatitis B. If symptoms occur, they begin an average of 90 days or 3 months after exposure to the virus, but they can appear any time between 8 weeks and 5 months after exposure. They usually last several weeks, but some people can feel sick for as long as 6 months. Many people with hepatitis B have no symptoms, but they can still spread the virus to others.
Most people with chronic hepatitis B do not have any symptoms, do not feel ill, and remain symptom free for decades. When and if symptoms do appear, they are similar to the symptoms of acute infection , but can be a sign of advanced liver disease. Some people still do not have symptoms even after their liver becomes diseased, although certain blood tests for liver function might show some abnormalities.
Chronic hepatitis B can develop into a serious disease resulting in long-term health problems, including liver damage, liver failure, liver cancer, and even death. There were 1, deaths related to hepatitis B virus reported to CDC in , but this is an underestimate. Talk to your health-care provider if you have risk factors for or think you might have hepatitis B.
Since many people with hepatitis B do not have symptoms, blood tests are used to diagnose the infection. Several different hepatitis B tests are available. Depending on the test, they can determine whether you. Certain tests can even determine how likely it is that someone who is infected with hepatitis B will transmit it to others. Ask your health-care provider to explain what tests were ordered, when you can expect to get the results, and what those results mean.
If test results show that you are infected with the hepatitis B virus, you should consult a health-care provider that is experienced in caring for people with hepatitis B. This can be an internist or family medicine practitioner, or it may be someone who specializes in treating people with infectious, digestive, or liver diseases.
There is no medication available to treat acute hepatitis B. For people with mild symptoms, health-care providers usually recommend rest, adequate nutrition, and fluids. Those with more severe symptoms may need to be hospitalized. Several medications have been approved to treat people who have chronic hepatitis B, and new drugs are in development.
However, not every person with chronic hepatitis B needs medication, and the drugs may cause side effects in some patients. People who start hepatitis B treatment may need to take medication indefinitely because these medications do not lead to a cure. People with chronic hepatitis B should be under the care of a health-care provider that is knowledgeable about this illness like an internist or provider that specializes in treating people with infectious, digestive, or liver diseases and is able to regularly monitor their liver function.
People recently diagnosed with hepatitis B should. When a pregnant woman comes in for prenatal care, she is given a series of routine blood tests, including one that checks for hepatitis B virus infection. Almost all cases of hepatitis B can be prevented in babies born to infected mothers, but these newborns must receive the necessary shots at the recommended times. The combination of hepatitis B immune globulin known as HBIG and hepatitis B vaccine can be given to infants born to infected mothers within 12 hours of birth to protect them from infection.
Nearly all newborns who become infected with the hepatitis B virus develop lifelong hepatitis B. This can eventually lead to serious health problems, including liver damage, liver cancer, and even death. Hepatitis B vaccination is recommended for all babies to protect them from this serious but preventable disease. Skip directly to site content Skip directly to page options Skip directly to A-Z link.
Viral Hepatitis. Section Navigation. Facebook Twitter LinkedIn Syndicate. Hepatitis B Questions and Answers for the Public. Minus Related Pages. 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.
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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.
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 inflammation of the liver , cirrhosis severe liver disease , or cancer of the liver hepatocellular carcinoma. Every year in the United States about 22, new hepatitis B infections occur and about 2, people die from their infections.
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 sharing of washcloths, toothbrushes, or razors 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.
Because the disease can be transmitted by casual contact, and because about three-quarters of a million to 2 million people are chronically infected with hepatitis B virus many of whom don't know that they have it , it has been hard to control hepatitis B virus infections in the United States.
The original strategy started in the early s was to vaccinate only those at highest risk for example, healthcare workers, patients on dialysis, and intravenous drug users. But because the disease can be transmitted to those who are not in high-risk groups, this vaccine strategy didn't work. The incidence of hepatitis B virus disease in the United States was unchanged 10 years after the vaccine was first used!
For this reason, the vaccine strategy changed. Now all infants and young children are recommended to receive the hepatitis B vaccine and the incidence of hepatitis B virus infections in the United States is starting to decline. Indeed, the new vaccine strategy has virtually eliminated the disease in children less than 19 years of age.
If we stick with this strategy, we have a chance to finally eliminate this devastating disease within one or two generations. Large quantities of hepatitis B virus are present in the blood of people with hepatitis B; in fact, as many as one billion infectious viruses can be found in a milliliter one-fifth of a teaspoon of blood from an infected individual. Therefore, hepatitis B virus is transmitted in the blood of infected individuals during activities that could result in exposure to blood, such as intravenous drug use, tattooing, or sex with people who are infected.
However, it is also possible to catch hepatitis B virus through more casual contact, such as sharing washcloths, toothbrushes or razors. In each of these cases, unseen amounts of blood can contain enough viral particles to cause infection. In addition, because many people who are infected don't know that they are infected, it is very hard to avoid the chance of getting infected with hepatitis B virus.
People are protected against hepatitis B virus infection by making an immune response to a protein that sits on the surface of the virus.
When hepatitis B virus grows in the liver, an excess amount of this surface protein is made.
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