Hepatitis B and Vaccine

What is Hepatitis B?

Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV).  Acute hepatitis generally begins with mild symptoms that may or may not become severe.  Many people have no symptoms and are not aware that they have the illness.  Initial symptoms may include loss of appetite, extreme tiredness, nausea, vomiting, joint and abdominal pain, and skin rashes.  More serious symptoms such as dark urine and jaundice (yellowed eyes and skin) may show up later.  Some infected persons (6-10% of adults) will become chronic carriers of hepatitis B for life.  These people have a high risk of developing serious long-term liver diseases and the potential to spread HBV to others.

Transmission of hepatitis B may occur through transfusion of infected blood or blood products, through the use of contaminated syringes and needles or other dental and medical instruments.  Hepatitis B is one of the fastest-spreading sexually transmitted diseases and can be contracted by any behavior in which a person's mucous membranes are exposed to an infected person's blood, semen, vaginal secretions or saliva.  Hepatitis B can also be transmitted by practices involving skin puncture such as tattooing, acupuncture, ear piercing or even sharing a razor.

Hepatitis B Vaccine:

Hepatitis B vaccine (recombinant) is a sterile solution of inactivated virus, given intramuscularly, that provides active immunity against hepatitis B.  The completed course of vaccine is 80-100% effective.  The need for booster doses has not yet been determined.

Routine immunization is recommended for all infants, as well as, children and adults who are at increased risk of hepatitis B infection, including health care workers, those sexually active with multiple partners, users of injectable drugs, recipients of large quantities of blood products, and travelers to areas outside of the USA that have high hepatitis B risk.

Possible Side Effects:

• Local redness, tenderness, or swelling at the injection site.

• Generalized reactions such as fatigue, fever, headache and nausea.

• Rarely allergic reactions such as hives, swelling, or anaphylaxis.

Contraindications:

• Known hypersensitivity to any component of the vaccine, including thimerosal (a preservative found in some vaccines and some contact lens solutions), or yeast.
• Moderate or severe illness, with or without a fever.

Precautions:

• Bleeding disorder, thrombocytopenia or on anticoagulant therapy.

• Immunosuppressive persons may require additional doses of vaccine.

• Pregnancy or nursing mothers.

Schedule:

The vaccine is given in a series of three injections:

• 1st injection - Day 1

• 2nd injection - Day 30 (There must be at least five months between second and third injections)

• 3rd injection - 6 months from Day 1

Titer: 1 to 2 months after third injection

Optimal Protection is not obtained until after the third Hepatitis B vaccine is given.  A titer (antibody level) is drawn to assess the ability of the body to fight off Hepatitis B infection.  If there is an inadequate immune response, a booster may be needed.

NOTE:  Olin Health Center suggests a post-vaccination titer because *"when persons who do not respond to the primary vaccine series are revaccinated, 15-25% produce an adequate antibody response after one additional dose and 30-50% after three additional doses.  Therefore, revaccination with one or more additional doses should be considered for persons who do not respond to vaccination initially."

Questions or side effect reporting: Call Olin Health Center Allergy/Immunization Clinic.

Sources: Travel & Routine Immunizations, 1996.
*Centers for Disease Control, MMWR, November 22, 1991, Vol.40, No.RR-13, p.8.
Epidemiology & Prevention of Vaccine-Preventable Diseases, Center for Disease Control, 1995.