All About the Hepatitis B Vaccine: What You Should Know

Hepatitis B is a potentially life-threatening infection caused by the Hepatitis B virus (HBV) that attacks and injures the liver.¹ This disease process may lead to mild illness lasting a few weeks or develop into a serious and lifelong disease, so it’s essential to know how to prevent it in our children.⁴ In this article, we will explain what hepatitis B is, how it spreads, and the hepatitis B vaccine.

Acute vs. Chronic Hepatitis B Infection

Acute hepatitis B infection is a short-term illness with symptoms such as fever, fatigue, loss of appetite, nausea, vomiting, jaundice (yellow skin or eyes, dark urine, clay-colored bowel movements), and muscle, joints, and stomach pain. These symptoms typically appear one to four months after becoming infected with the virus.^1,3,4,5

Chronic hepatitis B infection is a long-term illness that occurs when HBV remains in a person’s body. It is unpredictable; we don’t have any way to know who will develop the chronic form of the infection. Most people who go on to develop chronic hepatitis B do not have symptoms. However, it is still very serious and can lead to liver damage (cirrhosis) and/or liver cancer.^1,3,4,5 Liver cancer is the fourth leading cause of cancer deaths throughout the world, and chronic infection with hepatitis B and C is the cause of about 80% of all liver cancers.^6,7

How Common Is Hepatitis B?

An estimated 850,000 to 1.89 million people in the United States are currently living with lifelong hepatitis B infection.^2,8 Every year in the U.S., about 22,000 new hepatitis B infections occur, and approximately 2,000 people die from the infection and its complications.⁹

One of the reasons we prioritize vaccinating newborns is because when someone contracts HBV in infancy or early childhood, there is a 95% chance of it progressing to cirrhosis (chronic liver disease) and liver cancer, often when they are young adults.¹ In the U.S., this is relatively rare, thanks to high vaccination rates. Worldwide, it is still a serious problem and is one of the major causes of hepatic carcinoma (liver cancer).^1,2,7

According to the World Health Organization (WHO), in 2019, 296 million people lived with chronic hepatitis B infection, and 820,000 people died from it. WHO also states that there are 1.5 million new infections each year.¹

How Is Hepatitis B Spread?

Hepatitis B spreads when blood or other bodily fluids infected with the hepatitis B virus enter the body of a non-infected person.^1,8,10 Contact with the blood of someone who has hepatitis B, even via casual contact, is the most likely way to catch hepatitis B.⁹ The virus can live on objects for seven days or more.¹

Transmission Routes

Hepatitis B infections can be transmitted through:^1,4,5,8,10

• The birthing process, as newborns of mothers with hepatitis B can become infected
• Living in the same household as a person with a lifelong form of the infection
• Sharing items such as razors or toothbrushes (the virus is present in saliva as well!) with an infected person
• Contact with the blood or open sores of an infected person
• Exposure to blood from needlesticks or other sharp instruments (healthcare workers can be at risk for this)
• Having unprotected sex with an infected partner
• Sharing needles, syringes, or other drug-injection equipment

It is essential to note that hepatitis B can be transmitted by relatively casual contact with items contaminated with an infected person’s blood.^5,9 Because many people infected with the hepatitis B virus may not even know they have it, it is virtually impossible to be careful enough to avoid this infection.⁵ If your child accidentally gets a sharp injury and has had the vaccine, it is one less bloodborne infection to worry about. To give you some perspective, hepatitis B is 100 times more transmissible by needlestick than HIV!⁹

Transmission Facts

You may think your child is not at risk for exposure, and thus, they don’t need the vaccination. However, here are some transmission facts to consider that show otherwise:¹¹

• ⅓ of people infected with HBV in the U.S. do not know how they got it. Most do not feel sick and have no idea they carry this virus. They are surprised when they are told they are infected.
• Over half of adults in the U.S. who die from hepatitis B each year (over 5,000 people) caught the infection during their childhood.
• ½ of children with HBV acquire it from an infected mother, and ½ get it from casual contact or a silent carrier.
• Even if a mother’s test is negative during pregnancy, there’s no guarantee she isn’t infected for two reasons: no test is perfect, and a pregnant woman could inadvertently acquire hepatitis B after the test is performed.

Is There a Cure for Hepatitis B?

Unfortunately, there is no cure for hepatitis B.⁵ There is also no specific treatment for acute infection other than offering supportive care to maintain comfort and adequate nutrition balance.¹ There are medications to help those with lifelong hepatitis B infection, but no medicine “cures” it.⁴

Who Should Receive the Vaccination and When?

Infants should get their first dose of the hepatitis B vaccine at birth, preferably within the first 24 hours. They will usually complete the series at 6 months of age (sometimes, it will take longer than six months to complete the series). Babies who receive their first vaccine at birth are more likely to complete the three-dose series. Children and adolescents younger than 19 who have not received the vaccine yet should also get it.^3,8

One study from 2019 showed that certain unvaccinated adults should get the hepatitis B vaccine, such as:¹⁴

• People with certain medical conditions, such as kidney disease, HIV infection, or diabetes
• Anyone who has had sexual relations with someone with hepatitis B
• Those who share needles, syringes, etc.
• Healthcare workers (due to their exposure to patients’ blood and other body fluids)
• Those who work with people with developmental disabilities
• People living in prison or another type of correctional facility
• Those who have been a victim of sexual assault or abuse

What Are the Different Hepatitis B Vaccines?

There are five licensed hepatitis B vaccines currently available in the U.S.³ Three are single antigen vaccines:^15,16

1. Engerix-B: A three-dose series approved at birth and given via intramuscular injection
2. Recombivax HB: A three-dose series approved at birth and given via intramuscular injection
3. Heplisav-B: A two-dose series approved for those 18 years and older and given via intramuscular injection

Two combination vaccines include hepatitis B and are currently available in the U.S.:¹⁶

1. Twinrix (Hep A + Hep B): This three-dose series is approved for 18 years and older. It’s both inactivated Hep A and recombinant Hep B and given via intramuscular injection.
2. Pediarix (DTaP-HepB-IPV): This is a three-dose series given at two-, four-, and six-month doses. It is approved for 6 weeks through 6 years of age. Pediarix is inactivated and given via intramuscular injection.

According to the U.S. Department of Health and Human Services (HHS), an inactivated vaccine uses the killed version of the germ that causes a disease and doesn’t provide as much protection as a live one. You may need booster shots to maintain immunity over time. The HHS defines a recombinant vaccine as using certain pieces of the germ, leading it to provide strong immunity by targeting specific parts of the germ. Almost everyone who needs them can get these vaccines, including those with weak immune systems and chronic health issues.¹⁸

How Effective Is the Hepatitis B Vaccine?

The hepatitis B vaccine is a very safe and effective way to prevent the transmission of hepatitis B, as it provides almost complete protection.¹ About 95% of children who receive all the recommended vaccine doses have full protection against HBV.¹² Most people vaccinated with the hepatitis B vaccine are immune for life.¹³

What Are the Risks and Side Effects of the Hepatitis B Vaccine?

According to the Centers for Disease Control and Prevention (CDC), people who are moderately or severely ill should usually wait until they recover before getting the hepatitis B vaccine. People with minor illnesses, such as a cold, may receive vaccination. You may also not be able to get the vaccine if you’re allergic to certain things, like yeast. You might be able to get the Hepatitis B vaccine at the same time as other vaccines, but you should talk to your doctor about this.³

Vaccines, like any medicine, can also have side effects. These are usually mild and go away on their own in a couple of days. The side effects most common for the hepatitis B vaccine include soreness at the vaccination site, headache, and fever.³ Other possible side effects include fainting, severe allergic reaction, other serious injuries, or death. Keep in mind that the likelihood of this is very, very rare.¹⁷ Discuss any questions and concerns you have with your medical provider.

As with anything, we parents make decisions for our children based on the information in front of us and the risks and benefits related to our families. I hope this article was informative and helpful in understanding why your pediatrician routinely recommends this very safe and effective vaccine.

Disclaimer: While I am a doctor, I am not your doctor. All content presented in this article is for educational purposes only. It does not constitute medical advice and does not establish any kind of doctor/patient relationship. Speak to your healthcare provider about any questions or concerns you may have.