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Hepatitis B Vaccine
Aka: Hepatitis B Vaccine, Hep B Vaccine
- Indications
- All Newborns (at birth, age 2 months, and age 6 months)
- All health care personnel
- Hemodialysis patients
- Patients requiring frequent Blood Transfusion
- Staff and residents at developmentally disabled home
- Male homosexuals and their sexual contacts
- Intravenous Drug Abuse
- Sexual contacts of chronic HBsAg carriers
- Consider for areas of high prevelance
- Asia
- Sub-Saharan Africa
- Diabetes Mellitus under age 60 years
- Diabetes patients are twice as likely to contract Hepatitis B and more prone to liver disease and to develop chronic hepatitis
- Consider for older age 60 years with additional risks (but lower efficacy in this group)
- (2012) Presc Lett 19(2): 8-9
- Contraindications
- Anaphylactic reaction to baker's yeast
- Efficacy
- Starting series after age 3 months may improve immunity
- Immunity appears to be lifelong after series
- Perinatal and childhood exposure once accounted for one quarter of Chronic Hepatitis B
- Since 2004, >92% of U.S. children have complete Hepatitis B immunity
- References
- Kim (1997) Pediatrics 99:534-6 [PubMed]
- Kane (2000) Lancet 355:561 [PubMed]
- Available Preparations
- Recombivax HB
- Infants, Children and Adolescents: 5 ug/dose
- Adults: 10 ug/dose
- Immunosuppressed Adult: 20 ug/dose
- Energix-B (SKB)
- Infants and Children: 10 ug/dose
- Twinrix (Combined Hepatitis A and Hepatitis B Vaccine)
- Adults: 720 EU/20 ug (1.0 ml)
- Not approved for use in Children
- Requires 3 doses as in Hepatitis B Vaccine schedule
- Dosage: Protocols for Standard Schedule (Harmonized Schedule)
- Dose 1: Birth to age 2 months (first dose at age >1 month if birth weight <2000 grams)
- Dose 2: Age 1 to 4 months (>1 month after dose 1)
- Dose 3: Age 6 to 18 months (>2 months after dose 2)
- Alternative Protocols
- Rapid Vaccination (3 weeks) French Study
- French Protocol
- Regular: Days 0, 28, and 56
- Rapid: Days 0, 10, and 21
- Efficacy compared with regular French schedule
- Day 28: Higher seroprotection than reg schedule
- Day 56: Lower seroprotection than regular
- Day 365: Same seroprotection as regular schedule
- References
- Marchou (1995) J Infect Dis 172:258-60 [PubMed]
- Moderately Rapid Vaccination schedule
- Rapid Schedule: months 0, 1, and 2
- Efficacy
- Month 3: Greater seroprotective effect
- Month 7: Equivalent seroprotection (100%)
- Higher Antibody titer for standard group
- Suggests possible longer term protection
- References
- Marsano (1996) Am J Gastroenterol 91:111-5 [PubMed]
- Management: Infant with HBsAg Positive Mother
- Administer HBig and Hepatitis B Vaccine
- Hepatitis B Immunoglobulin (HBIG)
- Dose: 0.5 ml within 12 hours of birth
- Hepatitis B Vaccine starting with dose in hospital
- Dose 1: Within 12 hours of birth
- Dose 2: Age 1 months
- Dose 3: Age 6 months
- Additional Dose: Age 2 months if birth weight <2000 grams
- Labs at 9 and 15 months of age
- Hepatitis B Surface Antigen (HBsAg)
- Hepatitis B Surface Antibody (HBsAb)
- Precautions
- Safe in HIV
- See Immunization in HIV
- Safe in Pregnancy
- See Immunization in Pregnancy
- Adverse Effects
- Anaphylaxis (in those with yeast allergy)
- One serious reaction per 600,000 doses
- References
- (1996) MMWR Morb Mortal Wkly Rep 45(No. RR-12):1-35 [PubMed]
- References
- (2001) Med Lett Drugs Ther 43(1110):67-8 [PubMed]
- Ackerman (2015) Am Fam Physician 92(6): 460-8 [PubMed]