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- Includes Hepatitis A, Typhoid and Diptheria/Tetanus/Polio

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Hepatitis B
Hepatitis B

Hepatitis B Vaccinations

Hepatitis B

Hepatitis B is a viral infection that is found worldwide. An estimated 350 million people are thought to be chronic carriers of the infection and 686,000 people die every year from the complications of hepatitis B infection (WHO data). The countries with the highest prevalence of infection include Africa and East Asia where 5-10% of the population are chronically infected with the disease. High disease prevalence also occurs in the Middle East, Southern and Eastern Europe and the Indian Subcontinent.

Transmission

Hepatitis B is spread through contaminated blood via sexual intercourse, needle sharing, blood transfusions and medical interventions. The virus can also be passed from mother to baby. Tattooing, body piercing and acupuncture are other ways in which the virus may be spread. The virus can survive outside the body for 7 days.

Symptoms

The incubation period for hepatitis B infection is long varying between 60-90 days. Most people do not develop symptoms of hepatitis B infection. If symptoms occur in the acute stage of infection, they consist of fever, nausea/vomiting, diarrhoea and abdominal pain. Jaundice may also occur. A small subset can develop fatal acute liver failure in the acute stage.

The acute illness lasts for about six months and the virus is cleared from the body in the majority of adults.

However, 5% of adults and 30-50% of children aged 6 years and below develop chronic disease, where the virus persists. Chronic infection with hepatitis B is associated with progressive liver disease (cirrhosis) and liver cancer.

Treatment

There is no treatment available for the acute illness. Treatment for those chronically infected with hepatitis B is aimed at reducing the progression to chronic liver disease (cirrhosis) and preventing liver cancer.

Prevention

Vaccination is the mainstay of prevention. The vaccine against hepatitis B has been around since 1982 and is part of the routine childhood immunisation programme in many countries around the world.

The Hepatitis B Vaccine

The hepatitis B vaccine is an inactivated vaccine containing a surface protein from the hepatitis B virus. The vaccine is safe and 95% effective at preventing infection and development of chronic disease.

Inclusions

The hepatitis B vaccine can be given from birth onwards.

It should be given to travellers to endemic or high prevalence countries , especially if they may be at increased risk of exposure through their activities.

The vaccine is also recommended for anyone at risk through their occupation, such as healthcare workers or their lifestyle, such as men who have sex with men.

Hepatitis B Vaccine Schedules

1.  Adult Schedule
Vaccine BrandAgeMethod of AdministrationRecommended ScheduleNumber of doses
HBVaxProFrom 16 yearsIntramuscular injection to the deltoid muscle1. Standard-0, 1, 6 months
2. Accelerated-0, 1, 2 and 12 months
1. Standard schedule-3 doses
2. Accelerated schedule-4 doses
Engerix B (20mcg)From 16 yearsIntramuscular injection to the deltoid muscle1. Standard-0, 1, 6 months
2. Accelerated-0, 1, 2 and 12 months
3. Ultra-rapid-day 0, day 7 and day 21 and 12 months*
1. Standard schedule-3 doses
2. Accelerated schedule-4 doses
3. Ultra-rapid schedule-4 doses

*The ultra-rapid schedule can only be given to individuals over 16 years of age if there is insufficient before travel for the accelerated course.

For occupational purposes, the Accelerated or standard schedule should be used.

2. Children’s Schedule
Vaccine BrandAge RangeMethod of AdministrationRecommended Vaccine ScheduleNumber of Doses
HBVaxPro Paediatric (5mcg)Birth to 15 yearsIntramuscular Injection to the thigh or deltoid muscle1. Standard schedule-day 0, 1 month and 6 months
2. Accelerated schedule-day 0, 1 month, 2 months and 12 months
1. Standard schedule-3 doses
2. Accelerated schedule-4 doses
Engerix B (10mcg)Birth to 15 yearsIntramuscular Injection to the thigh or deltoid muscle1. Standard schedule-day 0, 1 month and 6 months
2. Accelerated schedule-day 0, 1 month, 2 months and 12 months
1. Standard schedule-3 doses
2. Accelerated schedule-4 doses

Children under 16 years of age-the fastest schedule that can be used is the accelerated schedule.

Booster Doses

In travellers, following completion of the full course, immunity is considered to be lifelong. A booster at 5 years is only required if there is high risk travel.

For occupational purposes, a booster is required at 5 years and further doses determined by blood testing.

Hepatitis A and Hepatitis B Combined Vaccine

Hepatitis A and B combined vaccines are available for travellers requiring protection against both diseases. For full Hepatitis A protection, all three doses of the vaccine are required. It is important to note that the protection against Hepatitis A will be provided later than with the single Hepatitis A vaccine as the dose of Hepatitis A in the combined vaccine is lower.

Brand NameAge RangeRecommended ScheduleMethod of AdminsitrationNumber of Doses 
Twinrix AdultFrom 16 years1. Standard schedule-day 0, 1 month and 6 months
2. Ultra-rapid schedule-day 0, day 7, day 21 and 12 months
Intramuscular injection to the deltoid muscle1. Standard schedule-3 doses
2. Ultra-rapid schedule-4 doses
Twinrix Paediatric1-15 yearsStandard schedule-day 0, 1 month and 6 monthsIntramuscular injection to the thigh or deltoid muscle3 doses
Booster Doses

For travellers receiving the full course of the combined Hepatitis A and B vaccines, it is assumed that the protection against Hepatitis B is lifelong and 25 years for Hepatitis A.

Exclusions

Hepatitis B vaccine should not be given if:

  • There is a history of previous severe allergic reaction to the vaccine or any of the components of the vaccine
  • There is an acute illness with a high temperature (greater than 38.5 degrees Celsius).

Pregnancy

The hepatitis B vaccine can be given to pregnant women if there is significant risk of exposure. Pregnant women who develop hepatitis B are more likely to have severe infection and the virus is transmitted causing infection in the newborn.

Breast Feeding

There is no evidence of harm when breast feeding mother have received inactivated vaccines. Therefore, the vaccine can be given to breast feeding mothers if there is significant risk of exposure.

Common Side Effects

  • Local reactions at the injection site-pain, swelling, redness.
  • Uncommon side effects include fever, muscle ache and “flu-like” symptoms.

Interactions with Other Vaccines

The hepatitis B vaccine does not interact with other vaccines can can be given at the same time as:

  • Hepatitis A
  • Typhoid, including oral typhoid vaccine
  • Diphtheria/Tetanus/Polio vaccine
  • Yellow fever
  • Rabies
  • Japanese encephalitis
  • MMR
  • BCG
  • All vaccines administered in the childhood immunisation programme

There is a current national shortage of hepatitis B vaccinations for children. Based on The Department of Health advice, for those babies or children who are at significant risk of being exposed to hepatitis B infection, we have the option of using the adult hepatitis B vaccines. We will aim to use  0.5mls of the adult Engerix B 20mcg vaccine vial (equivalent to the children’s dose of the vaccine). In those situations, where this vaccine is not available, we can use the HBVaxPRO 10mcg (full dose of 1ml). There is data available showing that using the full adult dose is not associated with additional safety concerns in infants and children. The risk of hepatitis B infection will be assessed by the clinician during the consultation. 

Frequently Asked Questions

1) Is the hepatitis B vaccine safe?

Hepatitis B vaccine is generally well tolerated and as an inactivated vaccine, it cannot cause infection in the vaccinated individual.

Rarely, suspected neurological reactions to the vaccine, such as Guillain-Barré syndrome and demyelinating disease have been reported, but a direct causal relationship with the vaccine has not been established. Recent studies indicate that there is no association between hepatitis B vaccination and the development of multiple sclerosis.

2) What does the vaccine contain?

The vaccine is produced in yeast cells.

  • Sodium chloride
  • Disodium phosphate dihydrate
  • Sodium dihydrogen phosphate
  • Water for injections
  • aluminium hydroxide

Additionally, HBVaxPro may contain traces of formaldehyde (a preservative) and Borax.

The vaccines do not contain:

  • Egg
  • Thiomersal
  • Latex
  • Gelatin

3) What happens if I do not have time to complete my hepatitis B vaccine course?

Two doses of hepatitis B vaccine provides 80% protection. Therefore, it is still worth starting  a hepatitis B vaccination course. The course can be completed on return from travel without needing to start again. A full course of hepatitis B vaccines provides longstanding protection with a single booster at 5 years only required in those at high risk of infection.

4) Can I have the vaccine if I am unwell on the day of vaccination?

If you have an illness with a high fever, the the vaccination should be delayed until you are recovered. In minor illnesses without a fever, the vaccination can take place provided the clinician feels this is appropriate.

5) When is blood testing required to check for immunity?

Blood testing for immunity is only required if hepatitis B is given for occupational purposes. This is because there is a higher exposure risk to the infection and satisfactory immune response must be determined. 

6) What does hepatitis B immunity testing involve?

Blood is sent to check Hepatitis B Surface antibody levels. Blood testing should take place 1-4 months after completion of the 3rd dose of Hepatitis B. 

  • If the antibody level is >100mIU/ml, a satisfactory response has occurred and booster dose is required just once at 5 years
  • If antibody  levels are 10-100mIU/ml, an adequate response has occurred, but a further booster is required immediately and again at 5 years.
  • If antibody levels are <10mIU/ml-there has been insufficient immune responses to vaccine and the course needs to be restarted.

7) Can you use a Two dose schedule in children?

Children can be given 2 doses of the adult strength Hepatitis B vaccine, which provides similar effectiveness as the three dose schedule. However, full protection against Hepatitis B is not achieved until after 6 months. At CityDoc, we only offer Engerix B Adult for the 2 dose schedule in children between 11-15 years.

The vaccine brands that can be used for this are:

Vaccine BrandAge RangeDosing scheduleComment
Ambirix1-15 yearsDay 0 and 6 monthsNOT PROVIDED AT CITYDOC CLINICS
Engerix B Adult (20mcg)11-15 yearsDay 0 and 6 months Can be provided at CityDoc clinics

 

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