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Hepatitis B Vaccine
Epidemiology and Prevention of Vaccine-
Preventable Diseases
HBcAg
HBeAg
Hepatitis B Clinical Features
Incubation period 6 weeks to 6
months (average 120 days)
Chronic viremia
70
60
50
40
30
20
10
0
Birth 1-6 mo 7-12 mo 1-4 yrs 5+ yrs
Age of infection
Hepatitis B Epidemiology
Reservoir Human. Endemic
Transmission Bloodborne
Subclinical cases
transmit
20000
Cases
15000
10000
Hepatitis B vaccine licensed
5000
0
1978 1982 1986 1990 1994 1998
HBV Disease Burden in
the United States*
Total infections 80,000/yr
Current carriers >1 million
New carriers >5,000
Death
fulminant hepatitis 200
liver cancer 1,500
cirrhosis 4,000
*1999 estimates
Age of Infection of Acute and Chronic
Hepatitis B Virus Infection
Adolescent Children Perinatal Adult
6%
8% 58%
12%
84% 4%
4%
24%
Household
contact Inj drug use
2% 15%
Homosexual
9%
Heterosexual
41%
CDC Sentinel Sites. 1992-1993 data.
Hepatitis B Virus Infection by
Duration of High Risk Behavior
IV drug user HCWs
Homosexual men Heterosexual
100
Percent infected
80
60
40
20
0
0 3 6 9 12 15
Years at Risk
Strategy to Eliminate Hepatitis B
Virus Transmission - United States
Prevent perinatal HBV transmission
Routine vaccination of all infants
Vaccination of children in high-risk
groups
Vaccination of adolescents
Vaccination of adults in high-risk
groups
Hepatitis B Vaccine
1965 Discovery of Australian antigen
Duration of
Immunity >15 years
Schedule 3 Doses
Engerix-B (GSK)
- 10 mcg/0.5 ml (pediatric)
- 20 mcg/1 ml (adult)
Recommended Dose of
Hepatitis B Vaccine
Recombivax HB Engerix-B
Dose (mcg) Dose (mcg)
Infants and children 0.5 ml (5) 0.5 ml (10)
<11 years of age
Year Recommendation
1981 Persons at high risk
1995 Adolescents
Indications for Hepatitis B Vaccine
Infants
Selected adults
Hepatitis B Vaccine
Routine Infant Schedule
Minimum
Dose Usual Age Interval
Primary 1 0-2 months* ---
Primary 2 1- 4 months 1 month
Primary 3 6-18 months 2 months
Flexible schedules
Hepatitis B Vaccine
Adolescent and Adult Schedule
Usual Minimum
Dose Interval Interval
Primary 1 --- ---
Primary 2 1 month 1 month
Primary 3 5 months 2 months*
Recommended for:
Infants born to HBsAg+ women
Dialysis patients
Immunodeficient persons
Certain health care workers
Postvaccination Serologic Testing
May be nonresponder or
"hyporesponder"
Email nipinfo@cdc.gov
Website www.cdc.gov/nip