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• Diphtheria, Tetanus, and Pertussis
• Measles, Mumps, and Rubella
• Varicella-Zoster Virus (Chickenpox)
• Hepatitis A
• Hepatitis B
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Immunizations

Description

An in-depth report on the purpose of immunizations and recommended schedules.

Alternative Names

Measles; Rubella; Tetanus; Vaccinations; Whooping cough

Hepatitis B

About 350 million people carry hepatitis B virus (HBV) worldwide, and each year 600,000 people die, mostly due to cirrhosis and liver cancers that develop in people with the chronic form of this disease. In the US, more than 1 million people have chronic hepatitis B.

The average lifetime risk for acquiring the infection in the US is about 5%. Most of these infections are acquired during childhood. Pregnant women with hepatitis B can transmit the virus to their babies. Even if they are not infected at birth, unvaccinated children of infected mothers run a 60% risk of developing hepatitis B before age 5. Universal vaccination against this disease during childhood, then, is very important.

Vaccine for Hepatitis B

Several inactivated virus vaccines, including Recombivax HB, GenHevac B, Hepagene, and Engerix-B, can prevent hepatitis B. Twinrix is a vaccine against both hepatitis A and B. They are safe, even for infants and children. Vaccination programs are proving to reduce the risk for liver cancer.

Hepatitis B Vaccine for Early Childhood. Experts now recommend that all infants and children not previously vaccinated be immunized by the time they reach seventh grade. Typical schedules for hepatitis B vaccinations in childhood are as follows:

• All infants should receive the hepatitis B vaccine soon after birth and before hospital discharge. (The first dose may also be given by age 2 months if the mother has no evidence of infection.) The second dose should be given at 1 - 4 months (at least 4 - 6 weeks after first dose); and the third between 6 and 18 months (at least 16 weeks after first dose and 8 weeks after second dose). (A fourth dose may also be given as part of a combination vaccine.) This is a safe vaccine, even in newborns, and parents should be sure their infants are immunized.
• Infants of mothers infected with HBV should be treated with immune globulin plus the hepatitis vaccine within 12 hours of birth. The second dose should be given at 1 - 2 months and the third at 6 months. Infants should be tested for antibody status at 9 - 15 months to see if they are chronic virus carriers or need to be re-vaccinated. Immunization rates are still too low in this group.
• When it is not known if a mother is infected or not, the infant should receive the vaccine within 12 hours of birth. The mother's blood should then be tested right away. If she is infected, the infant should receive immune globulin as soon as possible (no later than a week).
• Children who are between 11 and 12 and who have not been immunized should receive two or three doses of the vaccine (depending on the brand) given over a few months.

Hepatitis B vaccine protection lasts at least 8 - 10 years. Booster shots after that may be recommended depending on continuing risk, such as sexual exposure.

Hepatitis B Vaccine for Adults. The following adults are at very high risk and should be vaccinated:

• Health care and public safety workers who may be exposed to blood products. Such individuals have a risk for HBV that ranges from 15 - 30%.
• People in the same household as HBV infected individuals. (Unvaccinated people who have had intimate exposure to people with HBV may be protected with immune globulin, which is sometimes administered with the vaccine.)
• Travelers to developing countries.
• Patients who require transfusions and have not been infected with HBV. (Those with blood clotting disorders should have the vaccination administered under the skin not injected in the muscle.)
• Sexually active homosexual or heterosexual individuals with multiple partners.
• People with any sexually transmitted diseases.

Other people at risk who would benefit from vaccinations include:

• Patients and workers in mental institutions
• Morticians
• Patients undergoing hemodialysis. (These people may need larger doses or boosters; they also may need to be revaccinated if blood tests indicate they are losing immunity.)
• People who use injected drugs
• Pregnant women at risk for the virus; there is no evidence that the vaccine is dangerous to the fetus.
• People receiving treatments or who have conditions that suppress the immune system may need the vaccination, although its benefits for this group are unclear except for those at high risk, such as people with HIV or spleen abnormalities.

The regimen in adults is typically three doses given over 6 months. One study reported that older adults would benefit from a fourth dose without incurring serious side effects. People with alcoholism may need high doses.

A small percentage of people do not develop immunity even after a vaccine has been given repeatedly. A more potent vaccine is proving to be effective for these people; it loses its effect after 5 years in about one-third of those who receive it.

Side Effects of Hepatitis B Vaccine

Soreness. Soreness at the injection site is the most common side effect.

Nerve Inflammation. There have been some reports of nerve inflammation after vaccinations for hepatitis B, and there has been some concern about three studies associating the vaccine with a nonsignificant increase in multiple sclerosis. A 2001 study of 121,700 nurses reported no association between the vaccine and a risk for multiple sclerosis, and an earlier report on 260,000 Canadian adolescents also found no higher incidence. In addition, a review article published in 2006 found no evidence that hepatitis B vaccine is associated with multiple sclerosis, sudden infant death syndrome, or chronic fatigue syndrome.

Because of even a small theoretical risk of nerve damage in infants, some groups oppose the vaccination in children who are not in high-risk groups. Worldwide, 65 million people with chronic hepatitis are expected to die from liver disease and vaccinations are saving lives. For example, in Taiwan, where infection rates are high and infants are at risk for hepatitis B from infected mothers, vaccination programs have significantly reduced the risk for liver cancer. [For more information see In-Depth Report #59: Hepatitis .]

• Review Date: 2/14/2007
• Reviewed By: A.D.A.M. Editorial: Greg Juhn, M.T.P.W., David R. Eltz, Kelli A. Stacy; previously reviewed by Harvey Simon, M.D., Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital (8/23/2006).

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