Hepatitis B vaccine

Indications

• Part of routine childhood immunizations.
• Populations with high risk of infection:
  • Adults and children who have immigrated to Canada from areas where there is a high prevalence of HB.
  • Children born in Canada whose families have emigrated from areas where there is a high prevalence of HB and who may be exposed to HB carriers through their extended families or when visiting their family’s country of origin.
  • Children and workers in child care settings in which there is a child or worker who has acute HB or is a HB carrier.
  • Household and sexual contacts of acute HB cases and HB carriers.
  • Household or close contacts of children adopted from HB-endemic countries if the adopted child is HBsAg positive.
  • Populations or communities in which HB is highly endemic.
  • Residents and staff of institutions for the developmentally challenged.
  • Staff and inmates of correctional facilities.
  • People with lifestyle risks for infection, including:
    • persons who have unprotected sex with new partners
    • persons who have had more than one sexual partner in the previous 6 months
    • persons with a history of sexually transmitted infections
    • persons seeking evaluation or treatment for a sexually transmitted infection
    • persons who engage in high-risk sexual practices
    • persons who use injection drugs
    • men who have sex with men (MSM)
  • Travellers to HB-endemic areas.
  • Health care workers, emergency service workers, and others with potential occupational exposure to blood, blood products and bodily fluids that may contain HB virus.
• People at high risk of severe disease:
  • People with chronic liver disease from any cause, including those infected with hepatitis C. While these persons may not be at an increased risk of HB infection, they may be at risk of more severe disease if infection occurs.
  • Hemophiliacs and other people receiving repeated infusions of blood or blood products.
  • People with chronic renal disease, including those undergoing chronic dialysis (hemodialysis or peritoneal dialysis).
  • People with congenital immunodeficiencies.
  • People who have undergone hematopoietic stem cell transplantation (HSCT) or are awaiting solid organ transplant.
  • HIV-infected person.
• Any person who wishes to decrease their risk of HB.

Dosing

• A higher dose of vaccine is required for:
  • Chronic kidney disease
  • Hemodialysis
  • HIV
  • Primary immunodeficiency
  • Solid organ transplantation
  • Hematopoietic stem cell transplantation
• Can detect HBsAg in blood for 18 days after vaccination

Post-Vaccine Serology

• A cutoff of 10 IU/mL defines protective antibody titres
• About 5% are primary non-responders and never had positive titres; they are not immune
• However, their titres may have waned over time but they maintain the ability to mount an antibody response once exposed
• Post-immunization serologic testing with anti-HBs titre should be done 1 to 6 months after completing the immunization schedule for:
  • Immunocompromised people
  • People with chronic kidney disease or who are on dialysis
  • People with advanced liver failure
  • Solid organ transplant candidates and recipients
  • Pregnant women at high risk of HB
  • People with potential percutaneous or mucosal exposure (delay for 6 months if they received HBIh)
  • Sexual and hosuehold contacts of acute cases and chronic carriers
  • Workers who require confirmation of immunity because of occupational exposure
• Periodic monitoring is recommended for:
  • Immunocompromised people
  • People with chronic kidney disease or who are on dialysis (monitored annually)
• Often need to revaccinate