Active immunisation against hepatitis B
Hepatitis B Vaccine is indicated for active immunization against infection caused by all known subtypes of Hepatitis B virus. As Hepatitis D (caused by the delta virus) does not occur in the absence of Hepatitis B infection, it can be expected that Hepatitis D will also be prevented by Hepatitis B vaccination.
Immunization is recommended in persons of all ages, especially those who are, or will be, at increased risk of exposure to Hepatitis B virus, for example:
A baby whose mother is infected can be infected at birth.
Children, adolescents, and adults can become infected by:
- Contact with blood and body fluids through breaks in the skin such as bites, cuts, or sores
- Contact with objects that have blood or body fluids on them such as toothbrushes, razors or monitoring and treatment devices for diabetes
- Having unprotected sex with an infected person
- Sharing needles when injecting drugs
- Being stuck with a used needle
- Household contacts of people infected with Hepatitis B
- Residents and staff in institutions for the developmental^ disabled
- Kidney dialysis patients
- People who travel to countries where Hepatitis B is common
- People with HIV infection
- Persons with hemophilia, thalassemia, sickle cell anemia, cirrhosis
Military personnel identified as being at increased risk.
Morticians and Embalmers.
Prisoners.
Users of illicit injectable drugs.
Others: Police, fire department personnel, who render first aid or medical assistance, and any others who, through their work or personal life-style, may be exposed to the Hepatitis B virus.
Neonates, infants and children upto 19 years of age: The recommended dose of Hepatitis B vaccine (rDNA) is >10 mcg of antigen protein in 0.5 ml.
Adults 19 years of age and older: The recommended dose of Hepatitis B vaccine (rDNA) is >20 mcg of antigen in 1 ml.
Primary immunization schedule for all ages:
The usual immunization schedule consists of 3 doses of vaccine-
- First dose: at elected date
- Second dose: 1 month after first dose
- Third dose: 6 months after first dose
or accelerated schedule consists of 4 doses of vaccine-
- First dose: at elected date
- Second dose: 1 month after first dose
- Third dose: 2 months after first dose
- Fourth dose: 12 months after first dose
Accelerated schedule confer protection more quickly and is expected to provide better patient compliance.
Neonate born to hepatitis B surface antigen-positive mother, 4 doses of 10 micrograms:
- First dose: at birth with Hepatitis B immunoglobulin injection (separate site)
- Second dose: 1 month after first dose
- Third dose: 2 months after first dose
- Fourth dose: 12 months after first dose
For travellers departing within 1 month, adult over 18 years,
- First dose: at elected date
- Second dose: 7 days after first dose
- Third dose: 21 days after first dose
- Fourth dose: 12 months after first dose
Renal insufficiency (including haemodialysis patients), adult and child over 16 years 4 doses of 40 micrograms–
- First dose: at the appropriate date
- Second dose: 1 month after first dose
- Third dose: 2 months after first dose
- Fourth dose: 6 months after first dose
Immunization schedule and booster doses may need to be adjusted in those with low antibody concentration.
Booster vaccinations: For persons with normal immune status who have been vaccinated, booster doses of
Hepatitis B vaccine has not been established. However, booster doses are recommended for hemodialysis patients or other immunocompromised persons.
Preparation for administration: The vaccine should be shaken well before use to obtain a homogenous turbid white suspension. Do not shake vigorously. The vaccine should be inspected visually for particulate matter and discoloration prior to administration. If either of these conditions exists, the vaccine should not be administered. The vaccine should be used as supplied; no dilution is necessary
Co-administration: Hepatitis B vaccine can be given at the same time with other vaccine as Diphtheria, Tetanus, Pertussis (DTP), Polio (OPV), Measles, Mumps and Rubella (MMR), Haemophilus influenzae b, Hepatitis A and BCG vaccines at separate sites and with separate syringes. It should not be mixed with other vaccines or medicinal products in the same syringe.