Hepatitis vaccine: History, who should be injected and when
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What is Hepatitis?
Hepatitis is a term used to describe inflammation (swelling) of the liver. It can be caused due to viral infection or when the liver is exposed to harmful substances such as alcohol. Hepatitis may occur with limited or no symptoms but often leads to jaundice, anorexia (poor appetite), and malaise. Hepatitis is of 2 types: acute and chronic, according to the National Health Portal. India.
Acute hepatitis occurs when it lasts for less than six months and chronic if it persists for a longer duration.
A group of viruses known as the hepatitis viruses most commonly cause the disease, but hepatitis can also be caused by toxic substances (notably alcohol, certain medications, some industrial organic solvents, and plants), other infections, and autoimmune diseases.
Symptoms
Initial symptoms of hepatitis caused by infection are similar to the flu and include:
- Muscle and joint pain
- A high temperature (fever) of 38C (100.4F) or above
- Feeling unwell
- Headache
- Occasionally yellowing of the eyes and skin (jaundice), Symptoms of chronic hepatitis can include:
- Feeling tired all the time
- Depression
- Jaundice
- A general sense of feeling unwell
Hepatitis B Immunization
Hepatitis B vaccine has been available for several decades and is highly safe and effective in preventing HBV infection and the development of its serious consequences. By preventing HBV infection, the Hepatitis B vaccine also protects against HDV infection.
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Two types of hepatitis B vaccine are available, plasma-derived and recombinant. The plasma-derived vaccine is prepared from purified HBsAg from the plasma of persons with chronic HBV infection. Recombinant hepatitis B vaccine is made using HBsAg synthesized by genetic engineering techniques. There are no significant differences in safety, immunogenicity, or efficacy between the two types of hepatitis B vaccines. The manufacture of plasma-derived vaccine includes several inactivation processes, each of which is adequate to kill the HBV. The plasma-derived vaccine is therefore entirely safe. The choice between the two types of vaccines should be based on cost, availability, and other considerations and not efficacy.
History of the Vaccine
The hepatitis B virus was discovered in 1965 by Dr. Baruch Blumberg who won the Nobel Prize for his discovery. Originally, the virus was called the "Australia Antigen" because it was named for an Australian aborigine's blood sample that reacted with an antibody in the serum of an American hemophilia patient.
Working with Dr. Blumberg, microbiologist Irving Millman helped to develop a blood test for the hepatitis B virus. Blood banks began using the test in 1971 to screen blood donations and the risk of hepatitis B infections from a blood transfusion decreased by 25 percent. Four years after discovering the hepatitis B virus, Drs. Blumberg and Millman developed the first hepatitis B vaccine, which was initially a heat-treated form of the virus.
Hepatitis B Vaccination for Adults — Who Needs It and When?
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 (even if a year or more has elapsed), continue vaccinating from where your patient left off. The series does NOT need to be restarted, said Immunize.org.
Recommended adult dosing volume of monovalent hepatitis B vaccine
- Age 19 years and younger: Use 0.5 mL per dose (Engerix®-B pediatric, GlaxoSmithKline; Recombivax HB® pediatric, Merck).
- Age 20 years and older: 1.0 mL per dose (Engerix-B adult, GlaxoSmithKline; Recombivax HB adult, Merck). (For dialysis patients, a larger dose is needed. See the prescribing information.)
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Which groups of adults should be vaccinated against hepatitis B?
According to CDC recommendations, adults in the following groups are recommended to receive the Hepatitis B vaccine:
General
- All people age 18 years and younger. (CDC includes 18-year-olds in their child/teen immunization recommendations.)
- Anyone 19 years and older who wants to be protected from hepatitis B.
People at risk for infection by sexual exposure
- Sex partners of people who are hepatitis B surface antigen (HBsAg)-positive.
- Sexually active people who are not in long-term, mutually monogamous relationships.
- People seeking evaluation or treatment for a sexually transmitted disease.
- Men who have sex with men.
People at risk for infection by percutaneous or per mucosal exposure to blood or body fluids
- Current or recent illegal injection drug users.
- Household contacts of people who are HBsAg-positive.
- Residents and staff of facilities for developmentally challenged people.
- Healthcare and public safety workers with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids.
- People with end-stage renal disease, including predialysis, hemo-, peritoneal- and home-dialysis patients.
Others
- International travelers to regions with intermediate or high levels of endemic HBV infection.
- People with chronic liver disease.
- People with HIV infection.
- People with diabetes who are age 19 through 59 years. For those age 60 and older, clinicians should make a determination of the need for vaccination based on their patients' situation.
According to ACIP recommendations, patients do not need to identify (or admit to) a particular risk factor in order to be eligible for vaccination. Anyone who wishes to be protected from hepatitis B should be vaccinated.
Some patients (e.g., foreign-born persons from regions with medium or high levels of HBV infection) are recommended to have their blood tested for evidence of past or present hepatitis B virus infection at the same time that they receive the first dose of hepatitis B vaccine. Blood testing should be done at the same visit as administering the first dose of Hepatitis B vaccine. Blood should be drawn prior to Hepatitis B vaccine being administered.
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Routine Hepatitis B Vaccination Schedules For Infants, Children and Teens
For newborns
- Dose #1: Administer every newborn before hospital discharge.
- Dose #2: Administer at 1 to 2 months of age.
- Dose #3: Administer at 6 to 18 months of age, and no earlier than 24 weeks of age.
Note about using combination vaccines: When using Comvax® (Hib/HepB; Merck) or Pediarix®(DTaP/IPV/HepB; GSK), a total of four doses of hepatitis B vaccine, including the monovalent birth dose, is recommended. The four doses are covered by the Vaccines for Children program and private insurers.
For children and teens not vaccinated beginning at birth
- The dosing schedule is 0, 1 to 2 months, and 4 to 6 months.
- There is some flexibility in this schedule. Just keep in mind the minimum intervals between doses. For the Hepatitis B vaccine, there must be:
+ At least four (4) weeks between doses #1 and #2
+ At least eight (8) weeks between doses #2 and #3
+ At least 16 weeks between doses #1 and #3
Note: A two-dose series instead of three doses may be administered to adolescents ages 11 through 15 years if using Recombivax HB® adult dose (1.0 mL, Merck). Dose #2 is given four to six months after dose #1.
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