Hepatitis B

Transmission 

Hepatitis B is transmitted by:

  • Exposure to infected blood/body fluids through contact sport, sharing needles, unprotected sexual intercourse
  • Contaminated medical (or other) equipment that pierces the skin, for example, acupuncture or body piercing/tattoos
  • From mother to foetus

Risk to most travellers is small, unless their behaviour puts them at increased risk. Travellers at risk include:

  • Frequent or long-term travellers who may need medical treatment whilst overseas
  • Those with underlying medical conditions who may require hospitalisation whilst abroad
  • Those travelling abroad to have medical procedures
  • Patients with chronic kidney failure, liver disease and haemophilia
  • Healthcare workers
  • Those planning on adopting a child from overseas

Vaccination schedule Hepatitis B only

Brand Vaccine information Primary course Booster
Engerix B 10mcg/0.5ml
  • Inactivated, adsorbed
  • Licensed up to 15 years of age (including neonates)
Three schedules:

  • Dose at zero, one and six months — effective after seven months
  • Accelerated: dose at zero, one, two and 12 months
  • In children aged 11 – 15 years, dose at zero and six month of Engerix B 20mcg/1ml

Check Summary of Product Characteristics  (SPC) for special group’s schedules

  • Consider after five years if traveller at continuing risk
Engerix B 20mcg/1ml
  • Inactivated, adsorbed
  • Licensed from 16 years of age; can also be given from 11–15 years of age
Fendrix
  • Inactivated, adjuvanted, adsorbed
  • Licensed from 15 years of age
  • Dose at zero, one, two and six months
  • Cannot interchange with other hepatitis B vaccines
  • Consider after five years if traveller at continuing risk
  • Can interchange with other hepatitis B vaccines
HBVAXPRO 5mcg
  • Inactivated, adsorbed
  • Licensed from birth to 15 years of age
Two schedules:

  • Dose at zero, one and six months
  • Accelerated schedule for HBVAXPRO 5mcg and 10mcg: dose at zero, one, two months

If accelerated schedule given to infants at continued risk, a fourth dose at 12 months  should be administered

  • Consider after five years if traveller at continuing risk
HBVAXPRO 10mcg
  • Inactivated, adsorbed
  • Licensed from 16 years of age
HBVAXPRO 40mcg
  • Inactivated, adsorbed
  • Licensed for patients undergoing dialysis and predialysis

 

Vaccination schedule — Hepatitis A and B combined

Brand Vaccine information Primary course Booster
Ambirix
  • Inactivated, adsorbed
  • Licensed from 1–15 years of age
  • Two doses — second dose within 6–12 months
  • Cannot interchange with other vaccines
  • Can interchange with monovalent vaccines — for dose information, refer to SPC
Twinrix Adult
  • Inactivated, adsorbed
  • Licensed from 16 years of age
Two schedules for Twinrix Adult:

  • Single dose at 0, 1 and 6 months
  • Accelerated: dose at 0, 7, 21 days, followed by dose at 12 months

Schedule for Twinrix Paediatric:

  • Single dose at 0, 1 and 6 months
  • Cannot interchange with other vaccinations
  • Twinrix Adult lasts up to 15 years
Twinrix Paediatric
  • Inactivated, adsorbed
  • Licensed from 16 years of age

The information below is based on Public Health England recommendations; individual SPCs should be referred to for manufacturer recommendations regarding individual brands.

Acute illness

If a patient is suffering from an acute illness, immunisation should be postponed until they have recovered. Patients with minor infections without fever or systemic upset do not need to postpone their vaccination schedule.

Administration with other vaccines

Hepatitis B vaccine can be given at the same time as other vaccines such as DTaP/IPV/Hib, hepatitis A, MMR, MenC, Td/IPV and other travel vaccines as long as they are administered at different sites.

Immunocompromised patients

Hepatitis B vaccine should be given to patients who are immunocompromised if they are at risk; however, it may not be as effective. Specialist advice may be required.

Pregnancy and breast-feeding

No harmful effects due to hepatitis B vaccination during pregnancy or breast feeding have been reported. Hepatitis B infection during pregnancy can lead to severe disease for the mother and chronic infection of the newborn, so where there is a risk of infection immunisation should not be withheld.