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 other countries - these include sub-Saharan Africa, most of Asia and the Pacific islands.

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.

All pregnant women in the UK are offered testing for hepatitis B during each pregnancy.

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: 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.)
• Having unprotected 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, their sexual partners and children.
• People who change sexual partners frequently (in particular homosexual men and sex workers).
• People who live in close contact with someone infected with hepatitis B. (You 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 high or intermediate prevalence 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. Immunisation against hepatitis B is now recommended for all prisoners in the UK.
• 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 may need to have a blood test. You may need one if you are at risk of infection at work, especially as a healthcare or laboratory worker or have certain kidney diseases. Your doctor will be able to advise you if you need a blood test. This checks if you have made antibodies against the hepatitis B virus and are immune. This is because for about 1 in 10 people, three doses of the vaccine are not sufficient and a booster is needed after five years.

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

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.

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. The hepatitis B vaccine is very effective at preventing infection if given shortly after contact with hepatitis B. Even if you have had the hepatitis B vaccine and are at risk of infection (for example by having unprotected sex or sharing contaminated needles) you should ask your doctor for advice as you 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 two days after birth. This is followed by three further doses at 1 month, 2 months and 12 months of age.

Who should not receive hepatitis B vaccine?

• If you have an illness causing a high temperature it is best to postpone immunisation until after the illness.
• You should not have a booster if you have had a severe reaction to this vaccine in the past.

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

Further information

Information on immunisation

Web: www.immunisation.org.uk
From the NHS aimed at the general public.

The Hepatitis B Foundation UK

The Great Barn, Godmersham Park, Canterbury, Kent, CT4 7DT
Tel: 01227 738279 Web: www.hepb.org.uk
One of their aims is to raise awareness about the prevention of hepatitis B virus (HBV) infection, including the key role of immunisation.