Hepatitis B Vaccine: Indications, Action, Side Effects, and Contraindications - Dr Mahadeva Pokhale

The hepatitis B vaccine is used to prevent hepatitis B infection, which can lead to a wide variety of clinical presentations from acute viral hepatitis to chronic liver failure, liver cirrhosis, and hepatocellular carcinoma (HCC).

In this article, we’ll discuss the indications, action, side effects, and contraindications of the hepatitis B vaccine for the prevention of hepatitis B infection.

The Hepatitis B vaccine received FDA approval in 1981, this recombinant version was available in the market by 1986 that replaced the original blood-derived vaccine. In 1991, the United States started a strategy to achieve universal vaccination of infants beginning at birth for hepatitis B.

Hepatitis B vaccination prevents active infection with the hepatitis B virus, which may lead to chronic liver failure, cirrhosis & HCC. The virus is highly infectious and can be transmitted through percutaneous or mucosal exposure to blood and body fluids. The virus even remains viable on environmental surfaces for more than seven days.

The vaccine is indicated in all infants and unvaccinated children. This vaccine is also indicated in:

• Persons at risk for sexually transmitted disease
• Imprisoned personals.
• Persons whose sex partner is hepatitis B surface antigen (HBsAg) positive
• HBsAg positive household contacts
• Homosexual men.
• Intravenous drug users
• Healthcare workers, dialysis patients
• Persons with diabetes aged 19 to 59 years’ old
• Persons with hepatitis C
• Travelers to countries endemic for hepatitis B
• Persons with HIV
• Persons with chronic liver disease
• All persons seeking protection from hepatitis B

The vaccine works by improving immunity by producing antibodies against the outer protein coat or surface antigen by injecting a non-infectious subunit of the virus.This protects an individual against all genotypes (A through H) of the virus and gives a broad immunity.

The vaccine is administered in an individual usually intramuscularly in deltoid muscle, as intradermal route of administration is not preferred. The current regimen of three doses of the recombinant vaccine over six months.

The protection against infection initially was considered to be for 8 years. But more recent research has confirmed ongoing immunity until 25 years in those individuals who demonstrated a good immune response from the vaccine course. But now it is considered as lifelong protection.

After completing the three vaccination series, patients need a blood test for one to four months to determine the immune response, which is defined as an anti-hepatitis B surface antigen (anti-Hbs) antibody level exceeding 100mIU/mL.

The immune response is not well-developed in a few patients such as patients with age above 40 years, obesity, inflammatory bowel disease, tobacco smokers, or alcoholics. In such patients, antibody levels between 10 and 100 mIU/mL are suggestive of inadequate response; these patients should get a single booster shot but do not require a retest.

Responses below 10 mIU/mL require additional testing to check for prior hepatitis B infection, and these patients should receive another three-dose regimen with testing again at the one to four-month mark.

Continued failed response warrants may require more aggressive interventions, including intradermal administration, high-dose vaccine, or double dosing of a combination of hepatitis A and hepatitis B vaccine. Should this fail, the patient will need hepatitis B immunoglobulin upon any exposure to the hepatitis B virus.

The Advisory Committee on Immunization Practices (ACIP) does not generally recommend titers after vaccination, except for some healthcare workers and immunocompromised persons.

Hepatitis B vaccine is usually considered safe for individuals of all age groups. Other than Some minor adverse effects like pain at the site of infection, fever, body ache. Few studies have shown that this vaccine increases sensitivity to yeast.

Individuals should avoid taking vaccines in case of any history of reaction to hypersensitivity after previous hepatitis B vaccine dose or take with caution after having any previous incidence of any hypersensitivity reaction to any other vaccine.

The vaccine contains a non-infectious surface antigen, which poses no risk of transmission to the fetus and, therefore, is safe in pregnancy.

The vaccine does not cause any toxicity, especially with newer nanoparticle formulations.

To enhance the outcome of this vaccination regime is to educate the general masses about the herd immunity effect, safety, need, generally safe side effect profile, and the relatively few contraindications.

There is a need to increase the rate of vaccination by training the hospital nursing staff to verify the patient's vaccination status regarding hepatitis B (as well as other vaccines) and report their findings to the clinician. Motivational interviewing techniques have been shown to increase the rate of completion of a vaccine regime.