Hepatitis B

Hepatitis B is a viral infection of the liver spread by direct contact with the blood or body fluids of an infected person. It occurs worldwide with highest rates reported in parts of East Asia and Sub Saharan Africa. Higher rates of infection are also found in the Amazon, southern parts of Eastern and Central Europe, the Middle East and the Indian subcontinent. The rates of infection in Western Europe and North America are low.

Risk for travellers is low although certain behaviours or activities put individuals at higher risk, particularly when these occur in areas where hepatitis B is more common. These behaviours and activities include:

  • unprotected sex
  • exposure to blood or blood products through occupation, such as healthcare work
  • exposure to contaminated needles through injecting drug use, or as a result of accessing medical or dental
  • participation in contact sports
  • adoption of children from risk countries
  • long stay travel

In the majority of cases of hepatitis B symptoms do not occur. Symptoms more commonly occur in adults than children and may include: jaundice (yellowing of the skin and eyes), loss of appetite, fever and abdominal pain. Persistent hepatitis B infection develops in 80 to 90 percent of those infected in the first year of life and in only five percent of those infected in adult years. Persistent infection may lead to liver failure or liver cancer.

Prevention

All travellers should avoid contact with blood and bodily fluids by:

  • avoiding unprotected sexual intercourse.
  • using appropriate protective precautions where contact is unavoidable e.g. due to occupation
  • avoiding tattooing, piercing and acupuncture (unless sterile equipment is used)
  • not sharing needles or other injection equipment.
  • not sharing shaving equipment

Any traveller can be at risk of an accident or require emergency treatment. Travellers should be aware that using precautions will also help protect against other blood and body fluid-borne viruses, such as HIV and hepatitis C, for which there are currently no vaccines. A sterile medical equipment kit may be helpful when travelling to resource poor areas.

Hepatitis B vaccine

Several well-tolerated inactivated hepatitis B vaccines, including combined hepatitis A/B products, are available and vaccination is recommended for all travellers considered at risk.

Vaccine schedules

Vaccine and antigen component Schedule Age
Ambirix®
Combined hepatitis A (720 ELISA units) and B (20mcg)
2 dose schedule given 6-12 months apart Children from 1 to 15 years
Engerix B®
Monovalent hepatitis B (20mcg/1ml)
  • 3 doses: 0, 1 and 6 months
  • Accelerated schedule: 0, 1 and 2 months and a fourth dose at 12 months
  • Super accelerated schedule of 4 doses: 0, 7 and 21 days; 4th dose at 12 months

In children aged 11-15 years, 2 doses of the adult dose at 0 and 6 months

  • From 16 years (dose 20mcg)
  • Note 10mcg dosage for children up to and including 15 years of age
  • Super accelerated schedule: Adults, 18 years and above (can consider ‘off license’ for 16-17 year olds.

 

Engerix B®
Monovalent hepatitis B (10mcg/0.5ml)
  • 3 doses: 0, 1 and 6 months
  • Accelerated schedule: 0, 1 and 2 months
    (with a 4th dose at 12 months for infants at continued risk)
  • From birth to 15 years
  • From birth  to 15 years

 

HBVAXPRO Paediatric®
Monovalent hepatitis B (5mcg/0.5ml)
  • 3 doses: 0, 1 and 6 months
  • Accelerated schedule: 0, 1 and 2 months (with a 4th dose at 12 months for infants at continued risk)
From birth  to 15 years
HBVAXPRO Adult®
Monovalent hepatitis B (10mcg/ml)
  • 3 doses: 0, 1 and 6 months
  • Accelerated schedule: 0, 1 and 2 months
16 years and older
Twinrix Adult®
Combined hepatitis A (720ELISA units) and B (20mcg)
  • 3 doses: 0, 1 and 6 months
  • Super accelerated schedule of 4 doses: days 0, 7 and 21; 4th dose at 12 months.
  •  Adults and children from 16 years of age 
  • Adults, 18 years and above.

 

Twinrix Paediatric®
Combined hepatitis A (360ELISA units) and B (10mcg)
3 doses: 0, 1 and 6 months Children from 1 to 15 years.

Public Health England advises that for travellers who have completed a hepatitis B vaccine course, a single booster dose of vaccine at five years is not required, unless they are considered at continuing risk of infection. A blood test to check immunity (hepatitis B surface antibody levels) is only recommended for people with kidney failure or those at risk of occupational exposure particularly healthcare and laboratory workers

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