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Hepatitis B and Hepatitis B Vaccine

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Title: Hepatitis B and Hepatitis B Vaccine


1
  • Hepatitis B and Hepatitis B Vaccine

Epidemiology and Prevention of Vaccine-Preventable
Diseases National Immunization Program Centers
for Disease Control and Prevention
Revised January 2007
2
NOTICEContent and order of the slides in this
file may differ from those presented on the
broadcast and webcast
3
Hepatitis B Virus
  • Small DNA virus
  • Humans are only known host
  • Several subtypes that do not affect virulence or
    infectivity
  • May retain infectivity for more than 7 days at
    room temperature

4
Hepatitis B Virus
HBsAg
HBcAg
HBeAg
5
Hepatitis B Virus Infection
  • More than 350 million chronically infected
    worldwide
  • Established cause of chronic hepatitis and
    cirrhosis
  • Cause of up to 80 of hepatocellular carcinomas
  • 600,000 deaths worldwide in 2002

6
Hepatitis B Clinical Features
  • Incubation period 60-150 days (average 90 days)
  • Nonspecific prodrome of malaise, fever, headache,
    myalgia
  • Illness not specific for hepatitis B
  • At least 50 of infections asymptomatic

7
Hepatitis B Complications
  • Fulminant hepatitis
  • Hospitalization
  • Cirrhosis
  • Hepatocellular carcinoma
  • Death

8
  • Risk of Chronic HBV Carriage by Age of Infection

9
Hepatitis B Epidemiology
  • Reservoir Human
  • Transmission Bloodborne
    Asymptomatic cases transmit
  • Communicability 1-2 months before and after
    onset of symptoms

10
  • Hepatitis BUnited States, 1978-2006

Year
2006 provisional total
11
HepatitisUnited States, 2005
  • Highest incidence among adults 25 to 45 years of
    age
  • 79 associated with high risk sexual activity or
    injection drug use
  • 5 associated with other known exposures (e.g.,
    household and occupational exposures)
  • 16 deny a specific risk factor for infection

12
Hepatitis B Vaccine
  • Composition Recombinant HBsAg
  • Efficacy 95 (Range, 80-100)
  • Duration ofImmunity gt15 years
  • Schedule 3 Doses

13
Hepatitis B Vaccine Formulations
  • Recombivax HB (Merck) - 5 mcg/0.5 mL
    (pediatric) - 10 mcg/1 mL (adult) - 40 mcg/1 mL
    (dialysis)
  • Engerix-B (GSK) - 10 mcg/0.5 mL (pediatric) -
    20 mcg/1 mL (adult)

14
  • Recommended Dose of Hepatitis B Vaccine

Recombivax HB Dose (mcg) 0.5 mL (5) 0.5 mL
(5) 1.0 mL (10)
Engerix-B Dose (mcg) 0.5 mL (10) 0.5 mL
(10) 1.0 mL (20)
Infants and children lt11 years of
age Adolescents 11-19 years Adults gt20 years
15
Hepatitis B VaccineLong-term Efficacy
  • Immunologic memory established following
    vaccination
  • Exposure to HBV results in anamnestic anti-HBs
    response
  • Chronic infection rarely documented among vaccine
    responders

16
  • Hepatitis B Vaccine

Routine booster doses are NOT routinely
recommended for any group
17
Hepatitis B Vaccine Indications
  • Infants beginning at birth
  • Adolescents through 18 years of age
  • Adults at increased risk of HBV infection

18
Hepatitis B Vaccine Routine Infant Schedule
  • Dose
  • Primary 1
  • Primary 2
  • Primary 3

Usual Age Birth 1- 2 months 6-18
months
Minimum Interval - - - 4 weeks 8 weeks
infants who mothers are HBsAg or whose HBsAg
status is unknown should receive the third
dose at 6 months of age at least 16 weeks
after the first dose an additional dose at 4
months is acceptable if the clinician prefers to
use a combination vaccine that contains hepatitis
B vaccine
19
Third Dose of Hepatitis B Vaccine
  • Minimum of 8 weeks after second dose, and
  • At least 16 weeks after first dose, and
  • For infants, at least 24 weeks of age

20
Preterm Infants
  • Preterm infants lt2,000 grams have a decreased
    response to vaccine administered before 1 month
    of age
  • Delay first dose until chronologic age 1 month if
    mother documented to be HBsAg negative
  • Postexposure management must be started
    immediately if the mother is HBsAg positive, or
    if the mothers HBsAg status is not known

21
COMVAX
  • Hepatitis B-Hib combination
  • Use when either antigen is indicated
  • Cannot administer to infants younger than 6 weeks
    of age
  • May be used in infants whose mothers are HBsAg
    positive or status is unknown

22
Pediarix
  • DTaP IPV Hep B combination
  • Approved for 3 doses at 2, 4 and 6 months
  • Minimum age for first dose is 6 weeks
  • May be used in infants whose mothers are HBsAg
    positive or status is unknown

23
Pediarix
  • May be used interchangeably with other
    pertussis-containing vaccines if necessary
  • Can be given at 2, 4, and 6 months to infants who
    received a birth dose of hepatitis B vaccine
    (total of 4 doses)
  • May be used in infants whose mothers are HBsAg
    positive or status unknown

24
Twinrix
  • Combination hepatitis B (adult dose) and
    hepatitis A vaccine (pediatric dose)
  • 3-dose series at 0, 1, 6-12 months
  • Approved for persons 18 years of age and older
  • Can be used interchangeably with monovalent
    hepatitis B and hepatitis A vaccine

25
Hepatitis B Vaccine Adolescent and Adult Schedule
Minimum Interval - - - 4 weeks 8 weeks
Usual Interval --- 1 month 5 months
  • Dose
  • Primary 1
  • Primary 2
  • Primary 3

third dose must be separated from first dose by
at least 16 weeks
26
Alternative Adolescent Vaccination Schedule
  • Two 1.0 mL (10 mcg) doses of Recombivax HB
    separated by 4-6 months
  • Approved only for adolescents 11 through 15
    years of age
  • Only applies to Merck hepatitis B vaccine

27
Postvaccination Serologic Testing
  • Not routinely recommended following vaccination
    of infants, children, adolescents, or most adults
  • Recommended for
  • hemodialysis patients
  • immunocompromised persons
  • Sex partners of persons with chronic HBV
    infection
  • certain healthcare personnel

28
Postvaccination Serologic Testing
  • Healthcare personnel who have contact with
    patients or blood and are at ongoing risk for
    injuries with sharp instruments or needles should
    be tested for antibody after vaccination

29
Management of Nonresponse to Hepatitis B Vaccine
  • Complete a second series of three doses
  • Should be given on the usual schedule of 0, 1 and
    6 months
  • Retest 1-2 months after completing the second
    series

30
Hepatitis B VaccineAdverse Reactions
Infants and Children 3-9 0-20 0.4-6 rare
Adults 13-29 11-17 1 rare
  • Pain at injection site
  • Mild systemic complaints(fatigue, headache)
  • Temperature 99.9F (37.7C)
  • Severe systemic reactions

31
Hepatitis B VaccineContraindications and
Precautions
  • Severe allergic reaction to a vaccine component
    or following a prior dose
  • Moderate or severe acute illness

32
Prevention of Perinatal Hepatitis B Virus
Infection
  • Begin treatment within 12 hours of birth
  • Hepatitis B vaccine (first dose) and HBIG at
    different sites
  • Complete vaccination series at 6 months of age
  • Test for anti-HBs and HBsAg at 9 to 18 months of
    age

33
National Immunization ProgramContact Information
  • Telephone 800.CDC.INFO
  • Email nipinfo_at_cdc.gov
  • Website www.cdc.gov/nip
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