How can hepatitis be vaccinated?
There are different forms of viral hepatitis: hepatitis A, B, C, D and E. Currently, only vaccination against hepatitis A and B is available. There are single vaccinations (hepatitis A vaccine, hepatitis B vaccine) and a combined hepatitis A and B vaccine (hepatitis A-B combination vaccine).
In Germany, hepatitis vaccination is not mandatory. However, the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute (RKI) recommends hepatitis vaccination in some cases.
Experts distinguish between active and passive hepatitis vaccination depending on the mode of action:
Active hepatitis vaccination
The vaccines used in active hepatitis vaccination are so-called dead vaccines. The hepatitis A vaccine usually contains killed viruses, whereas the hepatitis B vaccine contains only virus components (HBs antigen).
After administration of the active hepatitis vaccine, it takes some time for the immune system to produce the specific antibodies. The vaccine protection is therefore not immediate. On the other hand, it lasts for years.
Passive hepatitis vaccination
Passive hepatitis vaccination consists of ready-made antibodies against the hepatitis virus in question. They are usually obtained from the blood of infected patients and highly purified to produce a passive hepatitis vaccine.
At the same time, they are given the first dose of the active hepatitis vaccine, in this case a single vaccine, since combination vaccines contain too few of the required hepatitis antigens. Until this takes effect, the vaccinee is usually largely protected against disease thanks to passive immunization.
Hepatitis vaccination: Costs
In many cases, health insurance will cover the cost of hepatitis vaccination. The hepatitis B vaccination is a standard vaccination for all children. It is paid for by the statutory health insurance in accordance with the protective vaccination guideline. The same applies to adults with a health and/or occupational risk of hepatitis infection.
Many health insurance companies also cover the costs of a hepatitis vaccination for travel to high-risk countries. It is best to contact your health insurance company to find out in detail about the coverage of vaccination costs.
Hepatitis A vaccination
The hepatitis A vaccination is administered intramuscularly, i.e. injected into a muscle. Usually, the doctor chooses the upper arm muscle for this.
Hepatitis A vaccination: How often must vaccinations be given?
For the combined hepatitis A and B vaccination, however, three vaccine doses are necessary (see below).
What side effects can occur after hepatitis A vaccination?
In addition, there may be a general feeling of illness with fatigue, gastrointestinal complaints, fever or headache and pain in the limbs. Allergic reactions rarely occur. The symptoms rarely last longer than one to three days.
Hepatitis A vaccination: Who should be vaccinated?
The Standing Committee on Vaccination (STIKO) recommends hepatitis A vaccination only as an indication vaccination for certain risk groups. These include:
- People with liver diseases
- People who frequently receive blood components due to certain diseases (such as hemophilia, a disease of the blood)
- People with behavioral disorders or brain damage (such as stroke patients) who live in psychiatric institutions or similar care facilities
Have an occupational indication for hepatitis A vaccination:
- Healthcare workers who are at increased risk of infection (laboratory workers, etc.)
- Employees in day-care centers, children’s homes, workshops for the disabled, homes for asylum seekers, etc. (incl. kitchen and cleaning staff)
In addition, experts recommend hepatitis A travel vaccination for people who plan to travel to regions where hepatitis A is more common (such as the Mediterranean region, Eastern Europe, many tropical regions).
Hepatitis A vaccination: booster
Only in certain cases, such as in immunocompromised individuals, do experts recommend a titer check by means of a blood test – i.e., a measurement of the specific antibodies formed in response to the hepatitis vaccination. If the titer is too low, a booster may be advisable.
Passive hepatitis A vaccination
During this time, vaccinations with live vaccines (such as the vaccination against measles, mumps and rubella = MMR vaccination) should not be administered. The administered hepatitis antibodies may weaken their effectiveness.
Hepatitis B vaccination
The hepatitis B vaccine, like the hepatitis A vaccine, is injected into the muscle (intramuscularly), usually in the upper arm muscle.
Hepatitis B: How often do I need to be vaccinated?
The STIKO recommends four vaccinations for premature infants, as was previously the case. In the 3+1 vaccination scheme valid at that time, the physician injects an additional hepatitis B vaccination in the third month of life.
In addition to the six-dose vaccines, five-dose vaccines are also available. However, with one exception, these are not approved for the 2+1 vaccination schedule.
In contrast to the standard vaccination, a so-called indication vaccination is only recommended for certain groups of people or under certain conditions. For the indication vaccination in certain risk groups in adulthood, three vaccination doses are also provided: The second and third doses of hepatitis vaccination against HB viruses are administered one month and six months after the first dose.
What side effects can occur after hepatitis B vaccination?
Hepatitis B vaccination: Who should get vaccinated?
This hepatitis vaccination has been recommended by the STIKO as the standard vaccination for all infants and young children since 1995. Although hepatitis B disease is rare in these age groups, it carries a high risk of becoming chronic: Acute hepatitis B becomes chronic in only about ten percent of cases in adults, but in about 90 percent of cases in infants and young children.
- People in whom hepatitis B disease would be likely to be severe (this includes patients with existing or anticipated immunodeficiency or preexisting disease, e.g., hepatitis, HIV, kidney disease requiring dialysis)
- People who live with hepatitis B-infected persons in the family or in shared apartments
- People whose sexual behavior carries an increased risk of infection (for example, because the sexual partner is frequently changed)
- Pre-trial detainees and prisoners
- Occupational hepatitis B vaccination: people whose occupation exposes them to an increased risk of hepatitis B infection (such as medical personnel, workplace first responders, police officers, or social workers)
- Hepatitis B travel vaccination: travelers who spend extended periods of time in countries with high hepatitis B virus infestation or who have close contact with the local population
Hepatitis B vaccination: booster
According to the Robert Koch Institute, a hepatitis B booster is not generally necessary if a complete basic immunization was given in childhood. It is assumed that the protection of this hepatitis vaccination lasts at least ten to 15 years, possibly even for life. Even after a hepatitis B vaccination in adulthood, booster vaccinations are generally not necessary.
Sometimes no protective titer can be detected six months after basic immunization. For these so-called non-responders or low-responders, physicians recommend another one to three vaccinations. This is followed by further titer checks.
Hepatitis B vaccination: protection of newborns
Even in mothers with unknown hepatitis B vaccination status, the newborn receives this simultaneous vaccination. Infection in the child can thus be prevented with a high probability.
Hepatitis A and B vaccination in combination
The combination hepatitis A and B vaccine is not suitable for people who may have been infected by contact with hepatitis A/B patients and now want to protect themselves by vaccination. For this post-exposure prophylaxis, physicians always use a single hepatitis vaccine (plus a passive hepatitis vaccine). The reason: combination vaccines contain less hepatitis A antigen (for hepatitis B, the concentration remains the same).
No hepatitis C vaccination yet
As with hepatitis B, hepatitis C can also become chronic and lead to liver cirrhosis and liver cancer. Because the hepatitis C virus changes very rapidly, scientists have not yet succeeded in bringing a vaccine against it to market. There is also no vaccine yet against other forms of viral hepatitis. The hepatitis E vaccine available in China is not approved in Europe.
Both hepatitis vaccinations are also possible during pregnancy if there is an increased risk of infection. This is the case, for example, if the pregnant woman comes into contact with the pathogens of hepatitis A or B at work (e.g. as a laboratory employee). Hepatitis vaccination is also possible during breastfeeding. As a precaution, the following also applies here: Vaccination should only be carried out if it is really necessary.
