Hepatitis B Vaccines

The hepatitis B vaccination (synonym: HBV vaccination) is a standard vaccination (regular vaccination), which is carried out by means of an inactivated vaccine.Hepatitis B is an inflammation of the liver caused by the hepatitis B virus. The following are the recommendations of the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute on hepatitis B vaccination:

Indications (areas of use)

  • I: Persons in whom a severe course of hepatitis B disease is expected because of preexisting or anticipated immunodeficiency or suppression or because of preexisting disease, e.g., HIV-positive, hepatitis C-positive, dialysis patients. * Persons with an increased non-occupational risk of exposure, e.g. contact with HBsAg carriers in family/residential community, sexual behavior with high risk of infection, i. v. drug users, prison inmates, possibly patients of psychiatric institutions. *
  • B: Individuals at increased occupational risk of exposure, including trainees, interns, students, and volunteers at comparable risk of exposure, e.g., personnel in medical facilities (including laboratory and cleaning personnel), ambulance and rescue services, company first responders, police officers, personnel of facilities where an increased prevalence of hepatitis B-infected individuals is to be expected (e.g., prisons, asylum seekers’ homes, facilities for the disabled). * * *
  • R: Travel indication: individual risk assessment required. * * *

* The listed groups of people are exemplary in nature and do not represent a conclusive list of indications. The vaccination indication is to be based on an assessment of the actual exposure risk. * * In the field of occupational medicine, the recommendations of the ArbMedVV are to be observed. * * * In the case of persons belonging to the “travel indication” group, it must be weighed up on an individual basis whether, in view of the concrete exposure risk and the individual risk of vaccination failure, a vaccination success check appears necessary. Legend

  • I: Indication vaccinations for risk groups with individual (not occupational) increased risk of exposure, disease or complications and for the protection of third parties.
  • B: Vaccinations due to an increased occupational risk, e.g., after risk assessment in accordance with the Occupational Health and Safety Act / Biological Substances Ordinance / Ordinance on Occupational Medical Precautions (ArbMedVV) and / or for the protection of third parties in the context of occupational activities.
  • R: Vaccinations due to travel

Contraindications

  • Persons with acute diseases requiring treatment.
  • Allergy to vaccine components (see manufacturer’s supplements).

Implementation

  • Basic immunization: three doses of vaccine at 2, 4, and 11 months of age are recommended for basic immunization against hepatitis B in infancy.
    • Today, there is the possibility of performing combination vaccinations, so that children are effectively protected against the infectious diseases with relatively few vaccinations. The six-vaccination schedule protects against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B. The current reduced “2+1 schedule” for the six-vaccination schedule is as follows: At 8 weeks of age, the vaccination series is started and subsequent vaccinations are given at the recommended times at 4 and 11 months of age. Between the 2nd and 3rd vaccination doses, a minimum interval of 6 months must be observed.
  • Basic immunization at a later date (eg due toTravel): Three vaccinations: Day 0, Day 28 and after > 6 months. Before travel should usually be 2 vaccinations to ensure > 85% hepatitis B protection.
  • Combined hepatitis A+B vaccine:
    • Basic immunization consisting of 2 vaccine doses 4 weeks apart and another dose after 6 months or
    • Rapid schedule on days 0, 7, 21, 365.

    At least 2 injections must be administered before departure.

  • Repeat vaccination: age 15-23 months and 2-17 years, if necessary from the age of 18.
  • After completion of the basic immunization, a check of the vaccination status based on a blood test for hepatitis B antibodies (anti-HBs titers) is recommended (see below: vaccination status). This is not required for basic immunization of children/adolescents. In vaccinated infants / young children, a revaccination 10 years after basic immunization is not generally recommended.
  • For those vaccinated in childhood with newly emerged HB risk (see above patients/individuals/occupational groups at increased risk), one dose of HB vaccine followed by serologic control (anti-HBs and anti-HBc assay) 4-8 weeks after revaccination

Efficacy

  • Reliable efficacy
  • Vaccination protection usually after 2 weeks after the 2nd partial vaccination
  • Duration of vaccination protection after completed basic immunization > 10 years.

Possible side effects / vaccination reactions

  • Local reactions around the injection site
  • Joint discomfort (rare)

Vaccination status – control of vaccination titers

Following the completion of basic immunization, it is recommended (4-8 weeks after the 3rd dose of vaccine) to check the vaccination status based on a blood test for hepatitis B antibodies (anti-HBs titers):

Vaccination Laboratory parameters Value Rating
Hepatitis B Hepatitis B antibody(anti-HBs titer) <10 IU/l
  • Insufficient vaccine protection detectable (“non-responder”).
  • Determination of HBsAg and anti-HBc to exclude an existing chronic HBV infection. If both parameters are negative, further procedure as for “low-responders” (see below).
10-99 IU/l
  • “Low responders” (anti-HBS 10-99 IU/l) are recommended to receive an immediate further dose of vaccine with renewed anti-HBs control after a further 4-8 weeks
  • If anti-HBs still < 100 IU/l, up to 2 more vaccine doses each with subsequent anti-HBs control after 4-8 weeks.
  • Which procedure is reasonable, if after a total of 6 vaccine doses still anti-HBs < 100 IU/l, is controversially discussed
≥ 100 IU/l
  • After successful vaccination, i.e., anti-HBs ≥ 100 IU/l, no further booster vaccinations are generally required.
  • Exceptions:
    • Individuals with particularly high individual exposure risk (anti-HBs control after 10 years, booster vaccination if anti-HBs < 100 IU/l).
    • Patients with humoral immunodeficiency (annual anti-HBs control, booster vaccination if anti-HBs < 100 IU/l).

More hints

  • With complete and successful baseline immunization against hepatitis B, 125 participants (51%) in one study still had an antibody titer ≥ 10 mIU/ml against hepatitis surface antigen (HBs) 30 years later. Anti-HBs titers ≥ 10 mIU/ml were considered protective by the study authors, according to the WHO assessment.