Hepatitis B Immunisation

What is hepatitis B?

Hepatitis B is a disease caused by the hepatitis B virus. The disease mainly affects the liver. However, if you are infected the virus is present in body fluids such blood, saliva, semen and vaginal fluid. In the UK it is estimated that about 1 in 1000 people are infected with the hepatitis B virus. It is much more common in certain other countries.

If you are infected with the hepatitis B virus, the initial symptoms can range from no symptoms at all to a severe illness. After this 'acute 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 chronic hepatitis, cirrhosis, and in some cases liver cancer develops after a number of years. See separate leaflet called 'Hepatitis B' for more details of the disease.

How is hepatitis B passed on?

The hepatitis B virus is passed from person to person as a result of:

• Blood to blood contact. For example, from: needles or other medical equipment which is contaminated with infected blood, infected blood being spilt onto a wound, etc. (Blood used for transfusion is tested for hepatitis B virus and so is not now a cause of infection.)
• Having sex with an infected person.
• From an infected mother passing it to her baby.
• A human bite from an infected person.

Who needs hepatitis B immunisation?

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

• Workers who are likely to come into contact with blood products, or are at increased risk of needlestick injuries, assault, etc. For example: nurses, doctors, dentists, medical laboratory workers, prison wardens, etc. Also, 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, and their sexual partners and children.
• People who change sexual partners frequently.
• People who live in close contact with someone infected with hepatitis B. This includes all prison inmates. Also, families who adopt or foster a child may be offered immunisation when the hepatitis B status of the child is not known. (You cannot catch hepatitis B from touching people or just normal social contact. So, household visitors and friends are not usually at risk. However, close regular contacts are best immunised.)
• People who regularly receive blood transfusions.
• 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. 
• Travellers to countries where hepatitis B is common 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.

The immunisation schedule

You need three doses of the vaccine 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 month after the third dose you need to have a blood test. This checks if you have made antibodies against the hepatitis B virus and are immune. This is because in some people, three doses of the vaccine are not sufficient and further doses are needed.

Once you are immunised (and have been confirmed that you are immune with a blood test), it is thought that you remain immune for life.

Rapid immunisation schedule
A schedule of giving three doses quicker 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 quicker schedules may be used if you are at very high risk of infection and need to be immune as soon as possible. For example, if you are soon to travel abroad, are new to prison, or are 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. Your doctor will advise on the best schedule for your circumstances.

Are there any side-effects from hepatitis B immunisation?

Side-effects are uncommon. Occasionally, some people develop soreness and redness at the injection site. Rarely, some people develop a mild fever and a flu-like illness for a few days after the injection. This usually goes away without any consequence.

What if I come into contact with hepatitis B and am not immunised?

Seek medical attention as soon as possible if you have been at risk from a possible source of infection and you are not immunised. For example, if you have a needlestick injury or have been bitten by someone who may have hepatitis B, etc.

You should have an injection of immunoglobulin as soon as possible. This contains antibodies against the virus and gives short term protection. You should also start a course of immunisation.

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 two days after birth. This is followed by three further doses at one month, two months, and 12 months of age.

Further information