hepatitis b vaccine

Vaccine types

The United States Advisory Committee on Immunization Practices (ACIP) recommends the use of the following vaccine formulations:

  • Recombinant hepatitis B vaccines (conventional)
    • Recombivax HB (10 mcg HBsAg/mL)
    • Engerix-B (20 mcg HBsAg/mL)
  • Recombinant hepatitis B vaccine (CpG-adjuvanted)
    • Heplisav-B (20 mcg HBsAg/0.5 mL)

Recombivax HB and Engerix-B use an aluminum adjuvant and typically require three doses over a six-month period to provide protection. These vaccines used to contain very small amounts of thimerosal, but those formulations were discontinued.

In November 2017, a new recombinant hepatitis B vaccine (designated HepB-CpG; sold as Heplisav-B) received approval for use in adults 18 years of age and older. This vaccine consists of recombinant HBsAg with a novel immunostimulatory adjuvan. The vaccine is administered as two intramuscular doses given one month apart. It is not clear when this vaccine will be available outside of the United States.

  • For most patients, use Engerix-B and Recombivax HB
  • Use Heplisav-B for patients unlikely to follow up with 3 dose vaccine and those needing rapid protection
  • Pregnant women: use the conventional vaccines (no teratogenic effect)

Population

Hepatitis B vaccine is recommended for patients:

  • no prior HBV infection
  • at high risk of acquiring infection
    • lives with HBV person
    • has sexual or needle contact with HBV person
  • high risk of sexual/drug use behaviors:
    • multiple sexual partners
    • seeking treatment/evaluation for STD
    • IVDU
    • Men who have sex with men
  • HBV prevalence higher
    • incarcerated
    • diabled persons facility staff/resident
  • Health care and public safety workers with exposure to blood or blood contaminated body fluid
  • Certain comorbidity:
    • HIV
    • ESRD
    • chronic liver disease (cirrhosis, fatty liver, autoimmune liver, elevated transaminase)
    • HCV infections
    • DM
  • Travelers to endemic areas

How to give

  • Give same type of vaccine
  • Can interchange Engerix-B and Recombivax HB
  • If using HepB-CpG, only use it for the 2 doses
  • 3 dose schedule: 4 weeks between 1 and 2, 8 weeks 2 and 3, 16 weeks 1 and 3
  • Doses given less than minimum interval should be repeated
  • If miss first dose, give second dose as soon as possible
  • If only third dose missed, give when convenient

Vaccination

Hepatitis B vaccination is recommended for any nonimmune adult who desires vaccination or who is considered to be at high risk for infection (Table 20). The typical hepatitis B vaccination series is a three-dose series, with doses administered at 0, 1, and 6 months. In adults aged 40 years or younger, 30% to 55% of patients will mount a protective antibody response after being administered one dose, 75% after the second dose, and more than 90% after the third dose. Older adults and patients undergoing hemodialysis have lower protective antibody response rates. A newer vaccine with a novel adjuvant, which was released in 2017 and endorsed by the ACIP in 2018, requires only two doses administered at least 4 weeks apart; it appears to be more immunogenic than previous vaccines. Safety data for the two-dose vaccine are not available for pregnant women.

Checking serum antibodies is not typically recommended after routine vaccination but is indicated in persons in whom subsequent clinical management is dependent upon knowledge of serologic response (chronic hemodialysis patients, persons with HIV, health care and public safety workers, and needle-sharing partners of persons with positive hepatitis B surface antigen).

Health care workers (HCWs) are at increased risk for acquiring and transmitting hepatitis B, influenza, measles, mumps, rubella, pertussis, and varicella viruses. All HCWs, regardless of patient contact, should receive the influenza vaccine annually. HCWs without immunity should be vaccinated against hepatitis B; measles, mumps, and rubella; and varicella. Additionally, all HCWs who have not previously received the Tdap vaccine should receive one dose, irrespective of when they last received the Td vaccine.

Patients with anatomic or functional asplenia are at increased risk for infection from encapsulated organisms, such as Haemophilus influenzae type B, meningococcus, and pneumococcus, and should be appropriately vaccinated.

Vaccination recommendations for international travelers vary depending on the destination. Trip-specific recommendations from the CDC can be accessed at https://wwwnc.cdc.gov/travel. For more information on vaccination in travelers, see MKSAP 18 Infectious Disease.