Hepatitis B Immunisation

Understanding hepatitis B

Hepatitis B is an infection caused by the hepatitis B virus. The infection mainly affects the liver. However, if one is infected, the virus is present in body fluids such as blood, saliva, semen and vaginal fluid.

This infection is more common in countries of sub-Saharan Africa and East Asia.

If one is infected with the hepatitis B virus, the initial symptoms can range from no symptoms at all to a severe illness. After this initial phase, in a number of cases the virus remains in the body long-term. These people are called carriers. Some carriers do not have any symptoms but can still pass on the virus to other people. About 1 in 4 carriers eventually develop a serious liver disease such as cirrhosis. In some cases liver cancer develops after a number of years.

If one is pregnant and is infected with the hepatitis B virus, it can get passed on to the baby as the baby is being born. Vaccinations for the baby can prevent this happening. So all pregnant women should be offered testing for hepatitis B during pregnancy. If the baby is positive, the baby can be protected.

Communication of hepatitis B

The hepatitis B virus is passed from person to person in one of these ways:

A human bite from an infected person. However this is very rare.

Having unprotected sex with an infected person.

Blood to blood contact. For example, drug users sharing needles or other equipment which may be contaminated with infected blood. (Blood used for transfusion is now screened for hepatitis B virus.)

Healthcare workers can be infected through accidental needle-stick injuries.

An infected mother passing it to her baby.

Susceptibility to hepatitis B

Anyone who is at increased risk of being infected with the hepatitis B virus should consider being immunised. This includes:

Workers who are likely to come into contact with blood products, or are at increased risk of needle-stick injuries, assault, etc. For example:

Nurses.

Doctors.

Dentists.

Medical laboratory workers.

Cleaners in healthcare settings.

Morticians.

Prison wardens.

Police officers and fire and rescue workers

Staff at day care or residential centres for people with learning disabilities where there is a risk of scratching or biting by residents.

People who inject street drugs. Also:

Their sexual partners.

The people they live with.

Their children.

People who change sexual partners frequently (in particular, sex workers).

People who live in close contact with someone infected with hepatitis B. (One cannot catch hepatitis B from touching people or normal social contact. However, close regular contacts are best immunised.) People who regularly receive blood transfusions (for example, people with haemophilia).

People with certain kidney or liver diseases.

People who live in residential accommodation for those with learning difficulties. People who attend day centres for people with learning difficulties may also be offered immunisation.

Families adopting children from countries with a higher risk of hepatitis B, when the hepatitis B status of the child is unknown. (It is, however, advisable for the child to be tested for hepatitis B.)

Foster carers or if you live with foster children.

Prison inmates.

Travellers to countries where hepatitis B is common. In particular, those who place themselves at risk when abroad. The risk behaviour includes sexual activity, injecting drug use, undertaking relief work and/or participating in contact sports. Also, if you may need a medical or dental procedure in these countries and the procedure may not be done with sterile equipment.

Babies who are born to infected mothers.

The vaccination program

Three doses of the vaccine are needed for full protection. The second dose is usually given one month after the first dose. The third dose is given five months after the second dose.

One to four months after the third dose one may need to have a blood test. One may be needed if one is at risk of infection at work, especially as a healthcare or laboratory worker or if one has certain kidney diseases. One’s doctor is best to advise if blood test is needed. This checks if the body has made proteins to protect one (antibodies) against the hepatitis B virus. If one has, one can consider oneself immune to infection of hepatitis B.

A booster dose may be needed five years later. There is no need for a blood test before or after this.

The schedule is the same for the combined hepatitis A and B vaccine which is also available.

Rapid vaccination program

A schedule of giving three doses more quickly than usual may be used in some situations. That is, three doses with each dose a month apart. An even quicker schedule is also sometimes used. That is, the second dose given seven days after the first and the third dose given 21 days after the first.

These rapid schedules may be used if one is at very high risk of infection and needs to be immune as soon as possible. For example, if one is soon to travel abroad, is new to prison or is sharing needles to inject drugs. However, a more rapid schedule may not be as effective for long-term immunity unless a fourth dose is given 12 months after the first dose.

Possible Intricacies arising from hepatitis B vaccination

Side-effects are uncommon. Occasionally, some people develop soreness and redness at the injection site. Rarely, some people develop a mild high temperature (fever) and a flu-like illness for a few days after the injection.

Coming in contact with hepatitis B without having been vaccinated

Seek medical attention as soon as possible if one has been at risk from a possible source of infection and one is not immunised. For example, if one has a needle-stick injury or has been bitten by someone who may have hepatitis B.

One should have an injection of immunoglobulin as soon as possible. This is an injection which contains antibodies against the virus. It gives short-term protection. One should also start a course of immunisation. The hepatitis B vaccine is very effective at preventing infection if given shortly after contact with hepatitis B. Even if one has had the hepatitis B vaccine and is at risk of infection (for example, by having unprotected sex or sharing contaminated needles), one’s doctor should be asked for advice. One may be advised to have a booster vaccine or even an injection of immunoglobulin.

Babies who are born to infected mothers should have an injection of immunoglobulin as soon as possible after they are born. They should also be immunised. The first dose of vaccine is given within the first day after birth. This is followed by three further doses at 1 month, 2 months and 12 months of age. At 12 months, immunised babies have a blood test to check that the vaccine has worked.

Cancelling or postponing of hepatitis B immunisation

If one has an illness causing a high temperature, it is best to postpone immunisation until after the illness.

One should not have a booster if one had had a severe reaction to this vaccine in the past.

The vaccine may be given if one is pregnant or breast-feeding and immunisation against hepatitis B is necessary.

CONCLUSION:

Hepatitis B Immunisation should be provided to people at increased risk of contracting hepatitis B. The hepatitis B vaccine can also be used to prevent infection if, for example, one had had a needle stick injury and one is not immunised. Some people need blood tests to check if they are immune.​