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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 3  |  Issue : 1  |  Page : 1-2

Demystifying hepatitis B vaccination for public: Aspiration for global eradication


College of Nursing, Institute of Liver and Biliary Sciences, New Delhi, India

Date of Submission07-Feb-2022
Date of Decision01-Mar-2022
Date of Acceptance05-Mar-2022
Date of Web Publication24-Mar-2022

Correspondence Address:
Ms. Tarika Sharma
College of Nursing, Institute of Liver and Biliary Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jascp.jascp_11_22

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How to cite this article:
Sharma T. Demystifying hepatitis B vaccination for public: Aspiration for global eradication. J Appl Sci Clin Pract 2022;3:1-2

How to cite this URL:
Sharma T. Demystifying hepatitis B vaccination for public: Aspiration for global eradication. J Appl Sci Clin Pract [serial online] 2022 [cited 2022 May 17];3:1-2. Available from: http://www.jascp.com/text.asp?2022/3/1/1/340876



Hepatitis B is considered a potentially life-threatening liver infection. According to WHO, an estimate of 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new infections occurring each year. In 2019, hepatitis B resulted in an estimated 820 000 deaths. Viral hepatitis has been included in the 2030 United Nations Sustainable Development Goals (SDGs), among which SDG 3.3 aims to combat viral hepatitis and eliminate hepatitis by 2030.[1] No known cure is there as prevention is the only safe strategy against the high prevalence of viral hepatitis B. Since 1982, a safe and effective vaccine that offers 98%–100% protection against hepatitis B is available. Despite the availability of hepatitis B Vaccines for around 40 years, there is a large proportion of unvaccinated people all across the world.[2],[3],[4],[5],[6],[7],[8] Various studies have explored many factors for nonvaccination or incomplete vaccination among the public, of which misinformation[9] and lack of awareness[8] remain common. Hence, the current editorial highlights the informative aspects of hepatitis B vaccination which might help the health-care workers to educate the general population in a better way.


  Development of Hepatitis B Vaccine Top


The first licensed hepatitis B vaccine was developed by the purification of hepatitis B surface antigen (HBsAg) from plasma of asymptomatic HBsAg carriers. Then, recombinant DNA technology enabled the development of recombinant hepatitis B vaccine.[10]


  Available Vaccines Top


There are currently four types of hepatitis B vaccines: Heplisav-B, Engerix-B, Recombivax Hemoglobin (HB), and Twinrix (for both hepatitis A and hepatitis B).

Hepatitis B vaccination regimen

According to the Centers for Disease Control and Prevention, a two- or three-dose series regimen is used for the prevention of hepatitis B among adults, as mentioned below:

  • Two-dose series with Heplisav-B at least 4 weeks apart or
  • Three-dose series with Engerix-B or Recombivax HB at 0, 1, and 6 months. The minimum interval between dose 1 and dose 2 must be 4 weeks, between dose 2 and 3 must be 8 weeks, and between dose 1 and dose 3 must be 16 weeks or
  • Three-dose series with Twinrix at 0, 1, and 6 months (minimum intervals: dose 1 to dose 2: 4 weeks/dose 2 to dose 3: 5 months)[11]


Engerix-B and Recombivax HB are available in both pediatric and adult formulations. Heplisav-B was approved by the Food and Drug Administration in November 2017 for persons 18 years of age and older.

In India, a three-dose series regimen with Engerix-B is most commonly used.

The current immunization schedule among pediatrics for hepatitis B vaccine includes a dose given as early as possible after birth, preferably within 24 h for all institutional deliveries because the birth dose of hepatitis B vaccine is effective in preventing perinatal transmission of hepatitis B. Irrespective of the birth dose, three doses are to be given at 6, 10, and 14 weeks at the same time as Diphtheria Pertussis Tetanus (DPT) and oral poliovirus vaccines.[12]

Vaccine dose

In adults, the hepatitis B vaccine dose is 20 μg. The dose is half (10 μg) the adult dose in the case of children.[13],[14],[15]

Preferred route for hepatitis B vaccine administration

Hepatitis B vaccine should be administered by intramuscular injection. The deltoid muscle is the preferred site of administration for adolescents and adults. Injection into the ventrogluteal or dorsogluteal site is associated with decreased immunogenicity.[16],[17]

In case of incomplete vaccination

  • When the hepatitis B vaccine schedule is interrupted, the vaccine series does not need to be restarted
  • If the series is interrupted after the first dose, the second dose should be given as soon as possible, and the second and third doses should be separated by an interval of at least 8 weeks
  • If only the third dose is delayed, it should be administered as soon as possible.[18]


If the person is not sure whether he/she has ever been vaccinated with hepatitis B vaccine

The vaccination can be started from shot one as there is no concern with repeating the hepatitis B vaccine series.

Vaccine safety during pregnancy or lactation

It is safe to get vaccinated during pregnancy or lactation.

Hepatitis B surface antibody (anti-HBs) testing after vaccination

Anti-HBs testing or serologic testing for immunity is not necessary or recommended after routine vaccination of infants, children, or adults. Testing for anti-HBs after vaccination is recommended for the high-risk groups whose subsequent clinical management depends on knowledge of their immune status. Testing for anti-HBs is done 1–2 months after administration of the final dose of the vaccine series.

Booster dose

As per the studies, the immunologic memory remains intact for at least 30 years and confers protection against clinical illness and chronic hepatitis B virus (HBV) infection, even though anti-HBs levels that once measured adequate might become low or decline below detectable levels. Hence, the booster doses of HBV vaccine are not indicated in persons with normal immune status. A booster dose should be administered to high-risk groups when the anti-HBs levels decline to <10 mIU/mL.[19]

Storage of hepatitis B vaccine

It has been recognized that Hep B vaccines are thermostable for at least 4 weeks at temperatures of 37°C and 40°C–45°C, although the recommended storage temperature is 2°C–8°C.[20] Hepatitis B vaccine should not be frozen.


  Conclusion Top


As a complete cure of hepatitis B is not available, prevention with the vaccine against this virus remains the main focus. Health-care workers must take initiatives to make the common public aware of various aspects of vaccination which, in turn, may help in comprehensive vaccination coverage and eventually global eradication.



 
  References Top

1.
Health – United Nations Sustainable Development. United Nations Sustainable Development; 2022. Available from: https://www.un.org/sustainabledevelopment/health/. [Last accessed on 2022 Feb 07].  Back to cited text no. 1
    
2.
Auta A, Adewuyi EO, Kureh GT, Onoviran N, Adeloye D. Hepatitis B vaccination coverage among health-care workers in Africa: A systematic review and meta-analysis. Vaccine 2018;36:4851-60.  Back to cited text no. 2
    
3.
Batra V, Goswami A,Dadhich S, Kothari D, Bhargava N. Hepatitis B immunization in healthcare workers . Ann Gastroenterol. 2015 Apr-Jun; 28(2): 276–280.  Back to cited text no. 3
    
4.
Topuridze M, Butsashvili M, Kamkamidze G, Kajaia M, Morse D, McNutt LA. Barriers to hepatitis B vaccine coverage among healthcare workers in the Republic of Georgia: An international perspective. Infect Control Hosp Epidemiol 2010;31:158-64.  Back to cited text no. 4
    
5.
Sukriti, Pati NT, Sethi A, Agrawal K, Agrawal K, Kumar GT, et al. Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India. J Gastroenterol Hepatol 2008;23:1710-5.  Back to cited text no. 5
    
6.
Getnet MA, Bayu NH, Abtew MD, W/Mariam TG. Hepatitis B vaccination uptake rate and predictors in healthcare professionals of Ethiopia. Risk Manag Healthc Policy 2020;13:2875-85.  Back to cited text no. 6
    
7.
Giordano P, Santoro N, Stefanizzi P, Termite S, De Nitto S, Bianchi FP, et al. Vaccination coverage among paediatric onco-haematological patients: An Italian cross-sectional study. Hum Vaccin Immunother 2021;17:818-23.  Back to cited text no. 7
    
8.
Khafagy A, AlJahdaly I, Goweda R. Hepatitis B Vaccine: Assessment of Immunologic Response, Coverage Rate, and Factors Influencing Seroreactivity. Clin Lab. 2020 Jul 1;66(7). doi: 10.7754/Clin.Lab.2019.191202. PMID: 32658415.  Back to cited text no. 8
    
9.
Sharma T. COVID-19 vaccine hesitancy: An area of concern. J Perioper Crit Intensiv Care Nurs 2020;6:S2e120.  Back to cited text no. 9
    
10.
Zhao H, Zhou X, Zhou YH. Hepatitis B vaccine development and implementation. Hum Vaccin Immunother 2020;16:1533-44.  Back to cited text no. 10
    
11.
Adult Immunization Schedule by Vaccine and Age Group | CDC; 2022. Available from: https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fschedules%2Fhcp%2Fadult.html. [Last accessed on 2022 Jan 26].  Back to cited text no. 11
    
12.
Verma R, Khanna P, Prinja S, Rajput M, Chawla S, Bairwa M. Hepatitis B Vaccine in national immunization schedule: A preventive step in India. Hum Vaccin 2011;7:1387-8.  Back to cited text no. 12
    
13.
Recommendations of the Advisory Committee on Immunization Practices (ACIP):Guidelines for Vaccinating Dialysis Patients and Patients with Chronic Kidney Disease.  Back to cited text no. 13
    
14.
Guidelines for the management of CKD. Indian J Nephrol 2005;15 Suppl 1:S72-4.  Back to cited text no. 14
    
15.
Danzinger-Isakov L, Kumar D; AST Infectious Diseases Community of Practice. Guidelines for vaccination of solid organ transplant candidates and recipients. Am J Transplant 2009;9 Suppl 4:S258-62.  Back to cited text no. 15
    
16.
Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/00000492.htm. [Last accessed on 2022 Jan 26].  Back to cited text no. 16
    
17.
Ukena T, Esber H, Bessette R, Parks T, Crocker B, Shaw FE Jr. Site of injection and response to hepatitis B vaccine. N Engl J Med 1985;313:579-80.  Back to cited text no. 17
    
18.
Appendix B: Immunization Management Issues; 2022. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a3.htm. [Last accessed on 2022 Jan 26].  Back to cited text no. 18
    
19.
Guidelines for vaccination in normal adults in India. Indian J Nephrol 2016;26 Suppl 1:S7-14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928530/. [Last accessed on 2022 Jan 31].  Back to cited text no. 19
    
20.
Parija PP, Mohan Kumar M. Hepatitis B vaccine birth dose in India: Time to reconsider. Hum Vaccin Immunother 2020;16:158-60.  Back to cited text no. 20
    




 

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