2. Hepatitis B: Virus Infection
More than 350 million chronically infected
worldwide
Established cause of chronic hepatitis and
cirrhosis
Human carcinogen—cause of up to 80% of
hepatocellular carcinomas
More than 600,000 deaths worldwide in 2002
5. Hepatitis B:
Perinatal Transmission
If mother positive for HBsAg and HBeAg
70%-90% of infants infected
90% of infected infants become chronically
infected
If positive for HBsAg only
5%-20% of infants infected
90% of infected infants become chronically
infected
7. Hepatitis B Virus Infection by
Duration of High-Risk Behavior
Years at Risk
0 3 6 9 12 15
0
20
40
60
80
100
Percentinfected
IV drug user
Homosexual men
HCWs
Heterosexual
8. Hepatitis B Vaccine
Composition Recombinant HBsAg
Efficacy 95% (Range, 80%-100%)
Duration of
Immunity 20 years or more
Schedule 3 Doses
Booster doses not routinely
recommended
10. Dose+
Primary 1
Primary 2
Primary 3
Usual Age
Birth
1- 2 months
6-18 months*
Minimum
Interval
- - -
4 weeks
8 weeks**
Hepatitis B Vaccine
Routine Infant Schedule
* infants who mothers are HBsAg+ or whose HBsAg status is
unknown should receive the third dose at 6 months of age
** at least 16 weeks after the first dose
+an additional dose at 4 months is acceptable if the clinician prefers to
use a combination vaccine that contains hepatitis B vaccine
11. Dose
Primary 1
Primary 2
Primary 3
Minimum
Interval
- - -
4 weeks
8 weeks*
Usual
Interval
---
1 month
5 months
Hepatitis B Vaccine
Adolescent and Adult Schedule
*third dose must be separated from
first dose by at least 16 weeks
12. Adults at Risk for HBV Infection
Sexual exposure
sex partners of HBsAg-positive persons
sexually active persons not in a long-
term, mutually monogamous
relationship*
persons seeking evaluation or
treatment for a sexually transmitted
disease
men who have sex with men
*persons with more than one sex partner
during the previous 6 months
13. Adults at Risk for HBV Infection
Percutaneous or mucosal exposure to blood
current or recent IDU
household contacts of HBsAg-positive persons
residents and staff of facilities for
developmentally disabled persons
healthcare and public safety workers with risk
for exposure to blood or blood-contaminated
body fluids
persons with end-stage renal disease
14. Adults at Risk for HBV Infection
Other groups
international travelers to regions with
high or intermediate levels (HBsAg
prevalence of 2% or higher) of endemic
HBV infection
persons with HIV infection
15. Pre-vaccination: Serologic
Testing
Not indicated before routine vaccination of
infants or children
Recommended for
all persons born in Africa, Asia, the Pacific
Islands, and other regions with HBsAg
prevalence of 8% or higher
household, sex, and needle-sharing
contacts of HBsAg-positive persons
HIV-infected persons
Consider for
Groups with high risk of HBV infection
(MSM, IDU, incarcerated persons)
16. Post vaccination: Serologic Testing
Not routinely recommended
following vaccination of infants,
children, adolescents, or most adults
Recommended for:
Infants born to HBsAg+ women
Hemodialysis patients
Immunodeficient persons
Sex partners of persons with
chronic HBV infection
Certain healthcare personnel
17. Hepatitis B Vaccine
Adverse Reactions
Pain at injection site
Mild systemic complaints
(fatigue, headache)
Temperature ≥99.9°F (37.7°C)
Severe systemic reactions
Adults
13%-29%
11%-17%
1%
rare
Infants and
Children
3%-9%
0%-20%
0.4%-6%
rare
18. Hepatitis B Vaccine
Contraindications & Precautions
Severe allergic reaction to a vaccine component or
following a prior dose
Moderate or severe acute illness
This graphic shows the distribution of risk factors in 2001. Persons with multiple sexual contacts, men who have sex with men, and sexual contact with a person known to have HBV infection account for 54 percent of cases with a known risk factor. Injection drug use accounts for 20 percent of cases. About 3 percent of cases are in people who have household contact with a person with acute or chronic hepatitis B. Fifteen years ago, health care workers accounted for 2 percent of HBV infections- 2 or 3 thousand new infections each year. Since that time, the rate of infection among health care workers has declined by 95 percent, and is now lower than the rate for the general population. Hepatitis B vaccine has made occupational HBV infection a thing of the past.
