Hepatitis B vaccination

Hepatitis B vaccine

There are two classes of products available for immunisation against hepatitis B:

• a vaccine that confers active immunity and a specific immunoglobulin that provides passive and temporary immunity while awaiting response to vaccine

The hepatitis B vaccines

The Hepatitis B vaccine is given as a single or combined product:

• monovalent hepatitis B vaccine (HepB)
• bivalent combination vaccine: hepatitis A and B (HepA/HepB)
• hexavalent combination vaccine containing diphtheria/tetanus/acellular pertussis/ inactivated polio vaccine/Haemophilus influenzae type b/hepatitis B (DTaP/IPV/Hib/HepB)

The available vaccines are highly effective in preventing infection in children and most adults through the production of specific antibodies to HBsAg (anti-HBs)

• hepatitis B vaccine is also highly effective at preventing infection if given shortly after exposure - ideally, immunisation should commence within 24 hours of exposure, although it should still be considered up to a week after exposure

Hepatitis B immunoglobulin

• specific hepatitis B immunoglobulin (HBIG) is obtained from the plasma of immunised and screened human donors
  • donors are screened for HIV, hepatitis B and hepatitis C, and all plasma pools are tested for the presence of nucleic acid from these viruses
  • because of a theoretical risk of transmission of vCJD from plasma products, HBIG used in the UK is now prepared from plasma sourced from outside the UK, and supplies are scarce
  • HBIG provides passive immunity and can give immediate but temporary protection after accidental inoculation or contamination with hepatitis B-infected blood
    • given concurrently with hepatitis B vaccine and does not affect the development of active immunity

Routine childhood immunisation programme

• a total of three doses of vaccine at the appropriate intervals (8, 12 and 16 weeks of age) are considered to give satisfactory longterm protection - the appropriate intervals are determined by the need to also protect individuals against diphtheria, tetanus, pertussis, polio and Hib

Selective neonatal immunisation programme

• post-exposure immunisation is provided to infants born to hepatitis B infected mothers, identified through antenatal screening, to prevent mother to child transmission at or around the time of birth
  • immunisation of the infant should start as soon as possible after birth, and no later than 24 hours, and be followed by a dose four and eight weeks later and a further dose at one year of age.
    • from 2017, as hepatitis B is included in the routine childhood immunisation programme, the dose at eight weeks in the selective neonatal programme will be provided in DTaP/IPV/Hib/HepB as part of the routine programme, as will additional doses given at 12 and 16 weeks

Selective immunisation programme

• immediate post-exposure vaccination is used to prevent infection following exposure, for example needlestick injuries, followed by a dose one and two months later - note that pre-exposure vaccination is also used to protect individuals at high risk of exposure to the virus or of the complications of the disease

Pre-exposure immunisation Primary Immunisation

• used for individuals who are at increased risk of hepatitis B or complications of the disease because of their lifestyle, occupation, co-existing medical conditions or other factors
• Pre-exposure immunisation is recommended for the following groups:
  • People who inject drugs (PWID)
  • Individuals who change sexual partners frequently
  • Close family contacts of a case or individual with chronic hepatitis B infection
  • Families adopting children from countries with a high or intermediate prevalence of hepatitis B
  • Foster carers
  • Individuals receiving regular blood or blood products and their carers
  • Patients with chronic renal failure
  • Patients with chronic liver disease
  • Inmates of custodial institutions
  • Individuals in residential accommodation for those with learning difficulties
  • People travelling to or going to reside in areas of high or intermediate prevalence
  • Individuals at occupational risk
    • healthcare workers in the UK and overseas (including students and trainees)
    • laboratory staff
    • staff of residential and other accommodation for those with learning difficulties
    • other occupational risk groups: in some occupational groups, such as morticians and embalmers, there is an established risk of hepatitis B, and immunisation is recommended. Immunisation is also recommended for all prison service staff who are in regular contact with prisoners Hepatitis B vaccination may also be considered for other groups such as the police and fire and rescue services

Check the Summary of Product Characteristics (SPC) before prescribing/administering a Hepatitis B-containing vaccine.

Reference:

1. BNF 14.4
2. The Green Book. Chapter18 - Hepatitis B (April 2019)