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Hepatitis B - Management
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How do I prevent hepatitis B?

  • For people at high risk of hepatitis B, offer immunization.
    • Consider taking blood for serology testing at the same appointment used for administering the first dose of vaccine. If serology results later show immunity, do not give the remaining doses of vaccine.
    • For further information on the hepatitis B vaccine, see Prescribing information.
  • If rapid protection from hepatitis B is important:
    • Consider using a rapid immunization schedule.
    • Prophylaxis with hepatitis B immunoglobulin may be indicated. Discuss this with an appropriate expert (such as a microbiologist) first.
      • Immunoglobulin may be indicated following accidental exposure to potentially infected blood or body fluids, where the person's vaccination status is unknown or where they have had a failed response to vaccination.
      • Immunoglobulin may also be given to babies that have been delivered by women who are hepatitis B-positive.
      • If the immunoglobulin is available in primary care, give it intramuscularly (ideally within 48 hours of exposure, and at the same time as the first dose of vaccine — in order to provide passive immunity).
  • If the person has hepatitis B, advise them about measures to prevent transmission of infection.

Basis for recommendation

These recommendations are based on advice from the British Liver Trust [British Liver Trust, 2009], and information from Immunisation against infectious disease (the 'Green Book') [DH, 2009a]. This guidance is valid for the UK where the use of vaccination is based on risk factors as, unlike many other countries, there is no routine childhood vaccination programme for hepatitis B.

How is the risk of occupational exposure to hepatitis B minimized?

  • To minimize the risk of occupational exposure, healthcare workers should be immunized against hepatitis B and they should:
    • Treat all blood and body fluids as being potentially infectious.
    • Wash their hands after each patient contact, and after contact with blood or body fluids.
    • Wear personal protective equipment (such as disposable gloves, plastic apron, and goggles) when there is the possibility of splashing with blood or body fluids.
    • Cover any cuts or abrasions with a waterproof plaster.
    • Immediately dispose of 'sharps' (for example needles, scalpel blades) into puncture-proof bins; which should not be overfilled. Needles should not be re-sheathed.
Basis for recommendation

Precautions to minimize the risk of exposure to hepatitis B are based on information provided in Guidance for health care workers: protection against infection with blood-borne viruses [DH, 1998] and a publication from the British Liver Trust [British Liver Trust, 2009].

Is a fee charged for hepatitis B vaccination in primary care?

  • Hepatitis B vaccine is not routinely available free of charge.
  • People requesting vaccination against hepatitis B in relation to travel abroad may be charged.
  • There is no charge if the vaccine is needed for treatment (for example following a human bite).
  • If the person is at occupational risk of hepatitis B, no fee is charged under schedule 5 for hepatitis B vaccination. However, a fee may be chargeable to the employer who has a statutory obligation to arrange and pay for the vaccine.
  • General practitioners may choose not to provide a hepatitis B vaccination service. In this event, the person should be referred to a suitable travel clinic or occupational health service.
Basis for recommendation

This information is based on the guidance Charging patients from the British Medical Association [BMA, 2008].

Prescriptions

For information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC) (http://emc.medicines.org.uk), or the British National Formulary (BNF) (www.bnf.org).

Hepatitis B vaccine - children

Age from 1 month to 15 years 11 months
Hepatitis B vaccine (HBvaxPRO)
HBvaxPRO 5micrograms/0.5ml suspension for injection vials
Give 0.5 ml by intramuscular injection. Give a second dose one month later, then give a third dose 6 months after the first dose.
Supply 1 0.5ml vial.
Age: from 1 month to 15 years 11 months
Licensed use: yes
Age from 1 year to 15 years 11 months
Hepatitis B vaccine (Engerix B paed)
Engerix B 10micrograms/0.5ml suspension for injection pre-filled syringes
Give 0.5 ml by intramuscular injection. Give a second dose one month later, then give a third dose 6 months after the first dose.
Supply 1 0.5ml prefilled syringe.
Age: from 1 year to 15 years 11 months
Licensed use: yes

Hepatitis B vaccine - adults

Age from 16 years onwards
Hepatitis B vaccine (Engerix B)
Engerix B 20micrograms/1ml suspension for injection pre-filled syringes
Give 1 ml by intramuscular injection. Give a second dose one month later, then give a third dose 6 months after the first dose.
Supply 1 1ml prefilled syringe.
Age: from 16 years onwards
Licensed use: yes
Hepatitis B vaccine (HBvaxPRO)
HBvaxPRO 10micrograms/1ml suspension for injection vials
Give 1 ml by intramuscular injection. Give a second dose one month later, then give a third dose 6 months after the first dose.
Supply 1 1 ml vial.
Age: from 16 years onwards
Licensed use: yes

Hepatitis B vaccine: rapid schedule - children

Age from 1 month to 15 years 11 months
Hepatitis B vaccine (HBvaxPRO): 3 month course
HBvaxPRO 5micrograms/0.5ml suspension for injection vials
Give 0.5ml by intramuscular injection. For primary immunization, give three doses at intervals of 1 month between doses.
Supply 1 0.5ml vial.
Age: from 1 month to 15 years 11 months
Licensed use: yes
Patient information: Give a fourth dose 12 months after the first dose.
Age from 1 year to 15 years 11 months
Hepatitis B vaccine (Engerix B paed): 3 month course
Engerix B 10micrograms/0.5ml suspension for injection pre-filled syringes
Give 0.5ml by deep intramuscular injection. For primary immunization, give three doses at intervals of 1 month between doses.
Supply 1 0.5ml prefilled syringe.
Age: from 1 year to 15 years 11 months
Licensed use: yes
Patient information: Give a fourth dose 12 months after the first dose.

Hepatitis B vaccine: rapid schedule - adults

Age from 16 years onwards
Hepatitis B vaccine (HBvaxPRO): 3 month course
HBvaxPRO 10micrograms/1ml suspension for injection vials
Give 1ml by intramuscular injection. For primary immunization, give three doses at intervals of 1 month between doses.
Supply 1 1ml vial.
Age: from 16 years onwards
Licensed use: yes
Patient information: GIve a fourth dose 12 months after the first dose.
Hepatitis B vaccine (Engerix B): 3 month course
Engerix B 20micrograms/1ml suspension for injection pre-filled syringes
Give 1ml by intramuscular injection. For primary immunization, give three doses at intervals of 1 month between doses.
Supply 1 1ml prefilled syringe.
Age: from 16 years onwards
Licensed use: yes
Patient information: Give a fourth dose 12 months after the first dose
Age from 18 years onwards
Hepatitis B vaccine (Engerix B): 3 week course
Engerix B 20micrograms/1ml suspension for injection pre-filled syringes
Give 1ml by intramuscular injection. For rapid primary immunization, give 3 doses on days 0, 7, and 21.
Supply 1 1ml prefilled syringe.
Age: from 18 years onwards
Licensed use: yes
Patient information: Give a fourth dose 12 months after the first dose.

Hepatitis A and hepatitis B combined vaccine

Age from 1 year to 15 years 11 months
Hepatitis A + hepatitis B vaccine (Twinrix Paed)
Twinrix Paediatric suspension for injection 0.5ml pre-filled syringes
Give 0.5 ml by intramuscular injection. Give a second dose one month later, then give a third dose 6 months after the first dose.
Supply 1 0.5ml prefilled syringe.
Age: from 1 year to 15 years 11 months
Licensed use: yes
Hepatitis A + hepatitis B vaccine (Ambirix)
Ambirix vaccine suspension for injection 1ml pre-filled syringes
Give 1ml by intramuscular injection.
Supply 1 1ml prefilled syringe.
Age: from 1 year to 15 years 11 months
NHS cost: £31.18
Licensed use: yes
Black triangle
Patient information: Give a booster dose 6 to 12 months after the initial dose.
Age from 16 years onwards
Hepatitis A + hepatitis B vaccine (Twinrix Adult)
Twinrix Adult suspension for injection 1ml pre-filled syringes
Give 1 ml by intramuscular injection. Give a second dose one month later, then give a third dose 6 months after the first dose.
Supply 1 1ml prefilled syringe.
Age: from 16 years onwards
Licensed use: yes

Hepatitis A + hepatitis B combined: rapid schedule

Age from 1 year to 15 years 11 months
Hepatitis A + hepatitis B vaccine (Ambirix)
Ambirix vaccine suspension for injection 1ml pre-filled syringes
Give 1ml by intramuscular injection.
Supply 1 1ml prefilled syringe.
Age: from 1 year to 15 years 11 months
NHS cost: £31.18
Licensed use: yes
Black triangle
Patient information: Give a booster dose 6 to 12 months after the initial dose.
Age from 16 years onwards
Hepatitis A + hepatitis B vaccine: rapid schedule
Twinrix Adult suspension for injection 1ml pre-filled syringes
Give 1ml by intramuscular injection. For rapid primary immunization, give 3 doses on days 0, 7, and 21.
Supply 1 1ml prefilled syringe.
Age: from 16 years onwards
Licensed use: yes
Patient information: Give a booster dose 12 months after the first dose.

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