|Year : 2022 | Volume
| 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 Submission||07-Feb-2022|
|Date of Decision||01-Mar-2022|
|Date of Acceptance||05-Mar-2022|
|Date of Web Publication||24-Mar-2022|
Ms. Tarika Sharma
College of Nursing, Institute of Liver and Biliary Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|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. 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.,,,,,, Various studies have explored many factors for nonvaccination or incomplete vaccination among the public, of which misinformation and lack of awareness 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|| |
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.
| Available Vaccines|| |
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)
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.
In adults, the hepatitis B vaccine dose is 20 μg. The dose is half (10 μg) the adult dose in the case of children.,,
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.,
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.
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.
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.
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. Hepatitis B vaccine should not be frozen.
| Conclusion|| |
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|| |
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.
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.
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.
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.
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.
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.
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.
Sharma T. COVID-19 vaccine hesitancy: An area of concern. J Perioper Crit Intensiv Care Nurs 2020;6:S2e120.
Zhao H, Zhou X, Zhou YH. Hepatitis B vaccine development and implementation. Hum Vaccin Immunother 2020;16:1533-44.
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.
Recommendations of the Advisory Committee on Immunization Practices (ACIP):Guidelines for Vaccinating Dialysis Patients and Patients with Chronic Kidney Disease.
Guidelines for the management of CKD. Indian J Nephrol 2005;15 Suppl 1:S72-4.
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.
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.
Parija PP, Mohan Kumar M. Hepatitis B vaccine birth dose in India: Time to reconsider. Hum Vaccin Immunother 2020;16:158-60.