For a one-page sheet reviewing the hepatitis B dosing schedule for children and adults, consult IAC�s Hepatitis A and B Vaccines: Be Sure Your Patients Get the Correct Dose. For complete dosing information, consult the ACIP hepatitis B vaccine recommendations for adults.
Which adults should be vaccinated against hepatitis B?
According to CDC recommendations, adults in the following groups are recommended to receive hepatitis B vaccine:
General
- All people age 18 years and younger. [CDC includes 18-year-olds in their child/teen immunization recommendations.]
- Anyone 19 years and older who wants to be protected from hepatitis B.
People at risk for infection by sexual exposure
- Sex partners of people who are hepatitis B surface antigen [HBsAg]-positive.
- Sexually active people who are not in long-term, mutually monogamous relationships.
- People seeking evaluation or treatment for a sexually transmitted disease.
- Men who have sex with men.
People at risk for infection by percutaneous or permucosal exposure to blood or body fluids
- Current or recent illegal injection drug users.
- Household contacts of people who are HBsAg-positive.
- Residents and staff of facilities for developmentally challenged people.
- Healthcare and public safety workers with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids.
- People with end-stage renal disease, including predialysis, hemo-, peritoneal- and home-dialysis patients.
Others
- International travelers to regions with intermediate or high levels of endemic HBV infection.
- People with chronic liver disease.
- People with HIV infection.
- People with diabetes who are age 19 through 59 years. For those age 60 and older, clinicians should make a determination of need for
- vaccination based on their patients' situation.
According to ACIP recommendations, patients do not need to identify [or admit to] a particular risk factor in order to be eligible for vaccination. Anyone who wishes to be protected from hepatitis B should be vaccinated.
Some patients [e.g., foreign-born persons from regions with medium or high levels of HBV infection] are recommended to have their blood tested for evidence of past or present hepatitis B virus infection at the same time that they receive the first dose of hepatitis B vaccine. Blood testing should be done at the same visit as administering the first dose of hepatitis B vaccine. Blood should be drawn prior to hepatitis B vaccine being administered.
In a future issue, we will review the various hepatitis B serologic tests, who needs testing, and when they need it [pre- or post-vaccination].
Hepatitis B virus [HBV] infection is highly prevalent around the globe. An estimated 3.6% of the world's population [or 248 million persons] are positive for hepatitis B surface antigen [HBsAg] [1], and HBV causes significant morbidity and mortality. In 2013, approximately 686 000 HBV-infected persons died from causes related to acute infection [69 000 deaths], cirrhosis [317 000 deaths], and HBV-associated liver cancer [300 000 deaths] [2]. The age of acquisition of HBV infection is the main determining factor in the clinical expression of acute disease and the development of chronic infection. Genetic characteristics of HBV might also contribute to the outcome of infection [3, 4].
Safe and effective hepatitis B vaccines have been commercially available since 1982, and, over the years, recombinant DNA vaccines have replaced plasma-derived vaccines. Gaps in hepatitis B vaccination policy were first addressed in 1992, when the World Health Organization called for all countries to incorporate hepatitis B vaccination into their national childhood immunization services. In the following decade, hepatitis B vaccination coverage grew rapidly, and by the end of 2014, 184 countries had integrated hepatitis B vaccine into their national childhood immunization systems, and the global coverage with 3 doses of hepatitis B vaccines was estimated at 82% [5]. Elimination of HBV transmission is an achievable public health goal, particularly in light of the proven effectiveness and safety of hepatitis B vaccine. In general, studies conducted in areas with high HBV endemicity have demonstrated declines in the prevalence of chronic HBV among children to