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Category Archives: Hepatitis B Prevention

Recap of NAIRHHA Day 2020 Celebration

 

 

 

 

By Beatrice Zovich

On Monday September 21st, a virtual celebration was held in honor of the sixth anniversary of National African Immigrant and Refugee HIV and Hepatitis Awareness (NAIRHHA) Day. This day, which itself is commemorated on September 9th, was created to build awareness and dismantle stigma around HIV and viral hepatitis in African immigrant and refugee communities. It takes place in September because this is the month that has been designated as National African Immigrant Month (NAIM) in the United States to celebrate the diverse and remarkable contributions African immigrants have made to enrich the United States, in spheres ranging from sports to writing to politics.

The virtual celebration that occurred last Monday included a discussion of the history of NAIRHHA Day and how it came to exist in its present form, a conversation with a hepatitis B advocate who is living with the disease, discourse about the importance of NAIRHHA Day on the national level and implications for making it a federally recognized day, and trivia questions about HIV and hepatitis B.

History of NAIRHHA Day: The Journey from 2014 to Present

Moderator: Chioma Nnaji, MPH, MEd, Program Director, Multicultural AIDS Coalition
Panelists: Augustus Woyah, Program Officer for Minority AIDS Initiative, Maryland Department of Health
Amanda Lugg, Director of Advocacy and LGBTQ Programming, African Services Committee

The idea for NAIRHHA Day was first conceived in 2006 at a convening of the Ethiopian Community Development Corporation in Washington, DC, at a session sponsored by Office of Minority Health about HIV in African immigrant communities. Conferences started to occur, primarily in the Northeast, although there was also interest in Atlanta and Seattle. It seemed that an opportunity had finally become available for advocates, researchers, and providers to all come together and focus on data collection, community mobilization, and policy work around HIV and viral hepatitis in African immigrant communities. The African National HIV/AIDS Alliance was established in 2010 and awareness days started in 2012 (Augustus played a large role in this). In 2014, Chioma Nnaji became connected to Sylvie Bello, the Executive Director of the Cameroonian Association in Washington, DC, and they, along with Amanda and Augustus, worked to get NAIRHHA Day off the ground. Chioma has largely spearheaded efforts to have NAIRHHA Day recognized nationally.

In terms of some of the challenges that have and continue to exist around NAIRHHA Day, obtaining community leadership and organizational buy-in, as well as national attention, are at the forefront. Social media and other digital platforms have been widely used in order to amplify the cause and try to obtain federal recognition. Additionally, maintaining relationships with government agencies has been quite difficult and has become a clash of visions of sorts. There is a strong belief that NAIRHHA Day should be a community-driven effort, but government agencies often have their own priorities, which can be distinct from those of the community and grassroots organizers. This is not to discount the government and organizational partners that are still involved, however, including NASTAD, the Hepatitis B Foundation, CHIPO, CHIPO-NYC, and Africans for Improved Access at the Multicultural AIDS Coalition. Another challenge has been reinforcing the distinction between African immigrant and African American communities and not treating the Black community as a monolith. Drawing this distinction in both data and policy remains difficult, thus often rendering African immigrant communities invisible.

When pondering what areas could use improvement going forward, a number of different items were considered. These included incorporating COVID-19 into the conversation, along with viral hepatitis and HIV; addressing social and environmental determinants of health that lead to the over-prevalence of both infectious and non-communicable diseases in minority, and particularly African immigrant communities; adhering to the primary goal of community mobilization and including advocates and researchers to influence policy that provides linguistically and culturally appropriate services that address the most pressing issue of stigma; securing national attention; and obtaining resources. It is critical to remember that advocacy never ends, the need to magnify work and amplify voices is always present, there is no room for complacency, and there exists intersectionality in all issues (social and health justice are all-encompassing).

#justB Storyteller Interactive Discussion

Moderator: Farma Pene, Community Projects Coordinator in Viral Hepatitis Program, New York City Department of Health & Mental Hygiene
#justB Storyteller: Bright Ansah

In this session, Bright spoke about his experience with living with hepatitis B, including his diagnosis, treatment, and communication with his family. He spoke about being able to put a face to hepatitis B, which has helped many people and also allowed him to build strong relationships with a broader community. Bright found out about his status in 2014 and initially felt very lost. The first couple of years were a big struggle, as he did not want to worry his family and it took a while for him to come to peace with his diagnosis. This peace eventually came from a lot of extensive research, after which he found out that hepatitis B is not a death sentence and can be managed very well. He then started to think about what he could do to prevent someone else from becoming “a statistic.”

When asked what message he would share with newly diagnosed people, Bright stated that stress and anxiety are normal, but you are not alone. Every day, people find out they are infected. Bright has given his contact information to many different people and he emphasized the incredible importance of having a support system in place. When asked about how he overcame stigma and barriers, Bright replied that the biggest barrier is the mental hurdle. It took him about two years to not feel overwhelmed. Bright does still struggle with feeling rejected from clinical trials and finds this very frustrating – he still feels like he is being punished for having chronic hepatitis B.

The best advice that Bright can offer is to always be your own advocate and do your own research. If the first doctor or liver specialist that you find does not take you seriously or you feel that they are not doing enough for you, you do not need to stay with them and you can absolutely find another doctor. Bright went through this process himself and eventually found a doctor he likes at Johns Hopkins, through a friend of his. This can be a challenge with language barriers, but there are organizations that can help and there is a Specialist Directory tool on the Hepatitis B Foundation website, a resource that Bright stated he found very helpful, along with the website of the National Institutes of Health (NIH). Farma reiterated that the HBF website is a great place to visit to understand lab results in plain language, and offers a good collection of resources for family and community members of people living with hepatitis B. Bright finds that the most important questions to ask are: What exactly is your status and viral load? What should reasonable expectations for your life and health be? Is treatment appropriate and if so, which one? It is crucial to establish mutual respect with your doctor, and to iterate what expectations you have for your doctor as well. The most important messages are: Reach out. Ask questions. Stand up for yourself. You are not alone.

The Important Role that NAIRHHA Day Plays from a National and Policy Prospective

Moderator: Chioma Nnaji, MPH, MEd, Program Director, Multicultural AIDS Coalition
Panelists: Boatemaa Ntiri-Reid, JD, MPH, Hepatitis Director, NASTAD
Jennease Hyatt, Community Liaison for Boston/New England, GILEAD

The final conversation focused on why NAIRHHA Day should become a nationally recognized holiday. VIral hepatitis is the seventh leading cause of death globally. Nineteen million African adults are living with hep C, and 5-8% are living with hep B. Hep B and HIV need to be considered part of the health portfolio of African immigrants, with care taken that this does not compound stigma. NAIRHHA Day is really an opportunity to focus on this community specifically. You get things done by doing them yourselves and we are who we’ve been waiting for.

There is a strong need for a multi-faceted approach to this work and for local, state, and national partnerships. African immigrants need to be at the forefront of the HIV/AIDS conversation. In Massachusetts specifically, over half of new HIV infections are in immigrant communities: These communities need to be leading the conversation. In terms of the role that government agencies play in NAIRHHA day, this needs to be more than a supportive role. We need to talk about novel approaches. We know that there are healthcare disparities. We need to consider how to use funding to build capacity and engagement, and make sure this work moves forward. This should include counting in community members and small businesses and bringing people to the table who are not usually there. The community really wants to be engaged. Promoting testing and awareness at soccer games, for example, is a great idea. We need strong partnerships and leadership from the beginning and to determine different approaches and thus different outcomes. Community members are the experts and we need to treat them as such.

Across the country, there are jurisdictions that have a prevalence of 40,000 people living with hepatitis in a state and viral hepatitis staff have teams of 1-7. Local and state health departments have more of a role to play. CDC publishes a list of viral hepatitis coordinators by state. It would be great to close the gap with them and discuss more about what they are doing generally and how to get them more involved in NAIRHHA Day specifically. In thinking about a vision for NAIRHHA Day next year, thoughts included that everyone who serves African immigrant communities (including health centers and multi-service organizations) needs to see themselves as part of the solution. Additionally, federal representation should be part of NAIRHHA Day next year.

Trivia and Conclusion

The event concluded with trivia questions about HIV and hepatitis B prevention, testing, and treatment. Amazing music was provided by DJ WhySham and Laura O (@LauraO_TV) served as an excellent moderator. Thanks to everyone who participated and we look forward to another wonderful event next year!

Addressing Hepatitis B in Africa

Conference on Liver Disease in Africa

To discuss the latest advances in addressing viral hepatitis and other liver diseases in Africa,  there will be a virtual Conference on Liver Disease in Africa (COLDA) from September 10th to 12th, 2020. COLDA is organized by Virology Education on behalf of the organizing committee led by Drs. Manal Al-Sayed, Mark Nelson, and Papa Saliou Mbaye. This virtual conference will gather clinicians, patients, other healthcare professionals, and policymakers from African regions, with international experts to support and exchange innovative ideas and knowledge about liver disease. The conference will consist of lectures discussing viral hepatitis infections, hepatitis co-infections, non-viral hepatitis-related infections, non-infectious induced liver disease, hepatocellular carcinoma, and end-stage liver disease. This virtual conference is important for addressing viral hepatitis since fewer than 1 in 10 people in Africa has access to testing and treatment for viral hepatitis. The World Health Organization (WHO) states that viral hepatitis is a bigger threat to Africa than HIV/AIDS, malaria, or tuberculosis with over 1.34 million deaths a year attributed to it.1 Over 60 million people in Africa have hepatitis B which annually accounts for an estimated 68,870 deaths.1 These statistics demonstrate the need for conferences like COLDA to discuss best practices and reduce viral hepatitis in Africa.

Mother-to-Child and Early Childhood Transmission

Hepatitis B is commonly transmitted from mother-to-child and close contact with infected individuals during the first 5 years of life. These modes of infection transmission are preventable with proper birth prophylaxis. There are two types of mother-to-child and early childhood transmission of hepatitis B resulting in chronic infection: vertical and horizontal. Vertical transmission refers to the transmission of hepatitis B from an infected mother to her baby during delivery. Horizontal transmission refers to infection with hepatitis B from direct blood-to-blood contact with an infected individual. Most early childhood transmission cases in sub-Saharan Africa are from horizontal transmission especially during the first 5 years of life from contact with family members or close friends infected with hepatitis B2, though vertical transmission from a hepatitis B infected mother to her baby is also common and completely preventable with birth prophylaxis.

 The best way to prevent the transmission of hepatitis B (HBV) from mother to child is through a “birth-dose”, meaning infants are vaccinated against hepatitis B within 24 hours of birth. However, in the WHO Africa region, only 6% of infants are administered the birth-dose.1 Only three countries in Africa: Cameroon, Rwanda, and Mauritania, have national guidelines addressing mother-to-child transmission of hepatitis B.2 Additionally, healthcare providers do not routinely screen future mothers for hepatitis B which contributes to a higher burden.2 This lack of screening demonstrates the need for universal guidelines to provide information to future mothers about hepatitis B. The World Health Organization recently released updated guidelines for hepatitis B which recommends a universal birth dose for all infants, as soon as possible, preferably within 24 hours followed by an additional 2-3 doses (often fulfilled with the pentavalent vaccine). Additionally, the WHO newly recommends that pregnant women testing positive for a hepatitis B infection (HBsAg positive) with an HBV DNA ≥ 5.3 log10 IU/mL (≥ 200,000 IU/mL) receive tenofovir from the 28th week of pregnancy until at least birth, to prevent mother-to-child transmission of HBV.4 This is in addition to the three-dose hepatitis B vaccination in all infants, including the timely birth dose. The WHO also strongly recommends that in settings in which antenatal (pre-birth) HBV DNA testing is not available, HBeAg testing can be used as an alternative to HBV DNA testing to determine eligibility for tenofovir prophylaxis to prevent mother-to-child transmission of HBV.4 Testing for hepatitis B in early pregnancy, a timely birth-dose, pentavalent vaccination, and administration of antivirals in the last trimester if needed would prevent vertical transmission and in turn, prevent horizontal transmission.

HIV/HBV Co-infection

There is a high burden of HIV/HBV co-infection in African countries because both diseases share similar transmission routes such as mother-to-child, unsafe medical and injection practices, and unscreened blood transfusions.2 Chronic HIV/HBV infection is reported in up to 36% of people who are HIV positive, with the highest prevalence reported in west Africa and southern Africa. The co-infection of HIV and HBV is especially dangerous because it accelerates liver disease such as fibrosis and cirrhosis. In fact, liver-related mortality is twice as high among people with an HIV/ HBV co-infection.2

Nosocomial Transmission

Another common way hepatitis B is transmitted in Africa is through nosocomial transmission or transmission from a hospital setting.3 The World Health Organization estimates 24% of blood donations in lower-income countries are not systematically screened for hepatitis B or hepatitis C. Additionally, countries have inconsistent screening procedures and use non-WHO prequalified test kits. Implementation of screening guidelines would significantly assist in reducing the risk of transmitting hepatitis B.

Barriers

 There are numerous barriers to eliminating hepatitis B in African countries. Screening is costly and often inaccessible, especially in rural areas. Moreover, there is an irregular supply of test kits for screening for healthcare providers.2,3 Lack of public awareness and often provider knowledge also contributes to the higher hepatitis B burden. Research has found that less than 1% of Gambian adults previously knew their status when tested positive for HBsAg.3 Additionally, there are financial constraints when it comes to hepatitis B treatment and care. The World Hepatitis Alliance and the WHO found that 41% of the world’s population live in countries where there is no public funding for hepatitis B treatments.3 This financial barrier prevents people from accessing important screening and vaccination prevention services. A collaborative effort among governments, local health officials, and community members is needed to manage hepatitis B in African countries.

Importance of Conference

Hepatitis B disproportionately affects the WHO Africa Region where 6.1% of the adult population is infected.1 The Conference on Liver Disease in Africa will address problems and discuss potential solutions for this neglected preventable disease. COLDA will help to make eliminating hepatitis B in Africa a reality by engaging the global community to collaborate on public health efforts, develop innovative ideas, and discuss best practices to reduce barriers. We hope to see you there!

Learn more and register for the conference.

 

References:

  1. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
  2. Spearman, C. W., Afihene, M., Ally, R., Apica, B., Awuku, Y., Cunha, L., Dusheiko, G., Gogela, N., Kassianides, C., Kew, M., Lam, P., Lesi, O., Lohouès-Kouacou, M. J., Mbaye, P. S., Musabeyezu, E., Musau, B., Ojo, O., Rwegasha, J., Scholz, B., Shewaye, A. B., … Gastroenterology and Hepatology Association of sub-Saharan Africa (GHASSA) (2017). Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets. The lancet. Gastroenterology & hepatology, 2(12), 900–909. https://doi.org/10.1016/S2468-1253(17)30295-9
  3. Maud Lemoine, Serge Eholié, Karine Lacombe, Reducing the neglected burden of viral hepatitis in Africa: Strategies for a global approach, Journal of Hepatology, Volume 62, Issue 2, 2015, Pages 469-476, ISSN 0168-8278, https://doi.org/10.1016/j.jhep.2014.10.008
  4. Prevention of mother-to-child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

Get Vaccinated for Hepatitis B!

 

August marks the start of National Immunization Awareness Month! This month highlights the importance of vaccines for people of all ages. Let’s talk about why you should get vaccinated for hepatitis B.

Understanding Your Status

Before becoming vaccinated for hepatitis B, it is important to understand your status. You can test through a simple triple panel blood test for HBsAg, HBcAb total and HBsAb. This will tell you if you have a current infection, have recovered from a past infection and if you need to be vaccinated. More details about the blood tests can be found here. Many people with hepatitis B do not look or feel sick so it is important to get tested. Learning your status early can help manage your hepatitis B and identify at-risk close contacts (household/family members or sexual partners) who can then be vaccinated and protected against hepatitis B.

 Why You Should Be Vaccinated

The hepatitis B vaccine is the first anti-cancer vaccine because it successfully prevents a hepatitis B infection which is the leading cause of liver cancer worldwide. It’s important for people to receive the vaccine since most people with hepatitis B are not aware they are infected. Hepatitis B is known as a silent infection as many people can live with hepatitis B for years without knowing they are infected. With chronic hepatitis B, when symptoms do finally present, often the infection may have already caused severe liver damage. The hepatitis B vaccine can prevent hepatitis B and also the health consequences that can come from hepatitis B, including the increased risk for cirrhosis, liver failure and liver cancer

It is especially important for future mothers to be tested for hepatitis B and vaccinated if needed. Mothers can easily pass hepatitis B to their infant during childbirth through either vaginal delivery or c-section. The most common mode of transmission of hepatitis B is from mother to child, so administering the vaccine to infants at birth is one of the most effective ways to reduce the number of hepatitis B cases worldwide. Read more about preventing perinatal transmission both in the U.S. and internationally.

In fact, it is very important to vaccinate children, starting with a birth dose, because greater than 90% of acute (short-term infection lasting less than 6 months) cases in infants and up to 50% of infected young children of hepatitis B will progress to chronic (lasting a lifetime) infections while only 5%-10% of adult cases will become chronic. That said, vaccination rates in adults are low and due to the nature of hep B, even those who recover from infection are at risk of reactivation. Left untreated, chronic infections can harm your liver and cause poor health outcomes. That is why the Hepatitis B Foundation calls for universal testing for hepatitis B. Luckily, you can expect to live a long and healthy life when you manage chronic infections of hepatitis B. Learn more about hepatitis B management here.

In the United States, you can get the vaccine through your healthcare provider or health clinics. Ask your doctor if you can get vaccinated today!

Hepatitis B is a preventable virus so why not take steps to become a healthier you!

About the Hepatitis B Vaccine

Hepatitis B can cause long-term serious damage to the liver like cirrhosis, fibrosis, and liver cancer. Fortunately, a safe and effective vaccine exists which can prevent a hepatitis B infection in all persons.

The World Health Organization recommends the vaccine for infants at birth and children up to age 18. Additionally, the WHO recommends high-risk groups become vaccinated for hepatitis B such as:

  • Pregnant women
  • People who frequently require blood to blood products
  • People who inject drugs
  • People in prison
  • Household and sexual contact of people with chronic HBV
  • Healthcare workers with blood to blood contact
  • People with multiple sexual partners
  • Travellers without completion of their vaccine series to endemic areas.

The WHO recommends that infants receive the vaccine within 24 hours of birth followed up with two additional doses. Children up to the age of 18 can also receive this series if they either were not vaccinated for hepatitis B at birth or did not complete the series. The series should be as followed:

  • 1st Dose: Anytime, but for infants, it should be administered at birth
  • 2nd Dose: One month (28 days) after the first dose
  • 3rd Dose: 4 months (16 weeks) after the 1st shot (and at least 2 months after the 2nd shot). Infants should be a minimum of 24 weeks old at the time of the 3rd shot.

Find out more about the vaccine schedule here!

You do not need to restart the hepatitis B vaccine series if you miss any of the shots.

In November 2017, a vaccine was approved by the FDA for use in the U.S. Heplisav-B (Dynavax) is a two-dose vaccine approved for use in adults aged 18 and older. The vaccine is administered as two doses given one month apart.

Ask your doctor about the 2-dose vaccine. You can now find Heplisav-B at more than 1,700 Albertsons Companies’ store pharmacies across the US. For assistance accessing this vaccine, you can contact Heplisav-B’s Access Navigator at 1-844-375-4728. 

For more information on the hepatitis B vaccine, read here.

New Resource: Guide To Hepatitis B Management for Primary Care Providers

The Hepatitis B Primary Care Workgroup has released a new resource that helps primary care providers prevent, diagnose, and manage hepatitis B! Hepatitis B experts from diverse health disciplines have contributed to making this comprehensive guide, which is available to download for free on the University of Washington’s website. 

Hepatitis B is a complex condition that typically is managed by a liver specialist (hepatologist). However, many people in the U.S. and other parts of the world do not have access to a hepatologist. Many primary care doctors do not feel comfortable or know how to properly care for someone living with hepatitis B. This leaves a large gap in managing and treating the infection. Hepatitis B Management: Guidance for the Primary Care Provider helps to close this gap by giving all providers the tools to understand the virus and how to manage it.

Dr. Amy Tang, Director of Immigrant Health at NorthEast Medical Services and one of the hepatitis B experts involved in creating the guide, answered a few questions about why this resource is so important: 

 

Why was a guide on hepatitis B management needed? What gaps will this help fill? 

 

Primary care providers are recommended to screen and vaccinate for hepatitis B in at-risk individuals.  However, when an individual tests positive for hepatitis B, they are typically referred to a specialist for care.  Because the majority of persons with chronic hepatitis B in the United States are foreign-born with limited English proficiency and often face both linguistic and access barriers to specialists, referral and retention in specialty care for chronic hepatitis B can often lead to lost follow-up.  Chronic hepatitis B management involves visits at least every 6 months for lab monitoring as well as routine ultrasounds for liver cancer surveillance for patients who fulfill high-risk criteria for liver cancer including Asian and African men over 40 years of age and Asian women over 50 years of age.  Because primary care is already performing routine blood tests and cancer screening for a variety of other chronic diseases such as diabetes, hypertension, and breast, cervical, and colon cancers respectively, we believe that empowering primary care providers with a simple to use hepatitis B algorithm would promote increased access and retention in care for persons with chronic hepatitis B.

 

How does this tool work towards the elimination of hepatitis B? 

 

The National Academies of Science, Engineering, and Medicine report for viral hepatitis elimination by 2030 recommends that primary care providers work closely with hepatitis B specialists and their organizations, e.g., the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (IDSA), to increase primary care capacity for HBV screening, vaccination, monitoring, and treatment. Thus the National Taskforce on Hepatitis B in collaboration with ECHO Institute and San Francisco Hep B Free—Bay Area hosted a meeting at the 2018 AASLD Annual Liver Meeting in San Francisco to convene a workgroup of hepatitis B specialists in hepatology, infectious disease, public health, primary care, and pharmacy, as well as representatives from American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) to discuss how we can increase primary care capacity for not only hepatitis B screening and vaccination, but also management and treatment.

Currently, the majority of hepatitis B care is managed by specialists.  AASLD puts forth guidelines and guidance for hepatitis B every couple of years, however, the guidelines can be lengthy, difficult to access, or intimidating for busy primary care providers to utilize. We polled over 100 primary care providers across the country through the National Association of Community Health Centers’ network of providers and found that primary care providers were interested in managing hepatitis B but felt like they did not have the tools and resources at their fingertips to do it manage it confidently.  They reported using web-based references like Up-to-Date for easily accessible guidance on conditions they were less familiar with. Thus, we wanted to create an easy to use document that would be easily accessible and free online. We teamed up with University of Washington’s Hepatitis B Online to host our Hepatitis B Guidance for Primary Care Providers as a means to widely disseminate our recommendations and work towards the elimination of hepatitis B in the United States and globally.

 

How and when should primary care providers use this? 

 

Primary care providers should use this hepatitis B guidance document when they decide to screen a patient for hepatitis B as the document guides them through how to properly screen for hepatitis B in asymptomatic individuals, how to interpret their lab results and provide appropriate counseling, and for patients who screen positive for hepatitis B, how to perform their initial evaluation, monitoring, treatment, and liver cancer surveillance.  We also have a dedicated section on perinatal management of women screened for hepatitis B that clearly illustrates the simple steps that can be taken by the primary care provider to prevent transmission of hepatitis B from mother to child. 

The guide includes detailed information on the following topics:

  • Chronic Hepatitis B Testing and Management Algorithm
  • Interpretation of hepatitis B test results
  • Tests to run on a hepatitis B surface antigen positive (HBsAg +) individual and how to counsel them
  • Monitoring and management of the HBsAg + individual 
  • Managing pregnant women who are HBsAg + 
  • Monitoring for liver cancer

The guide is part of Hepatitis B Online – a free suite of materials for providers that supplies information on all topics related to hepatitis B such as when a person should begin treatment and liver cancer screenings. The website also includes prescribing information for approved hepatitis B treatments, and clinical calculators to aid in interpreting predictors of liver damage such as the AST to Platelet Ratio Index (APRI) and fibrosis score. 

 To access and download the new tool, click here! 

New Resource: Guide To Hepatitis B Management for Primary Care Providers

The Hepatitis B Primary Care Workgroup has released a new resource that helps primary care providers prevent, diagnose, and manage hepatitis B! Hepatitis B experts from diverse health disciplines have contributed to making this comprehensive guide, which is available to download for free on the University of Washington’s website. 

Hepatitis B is a complex condition that typically is managed by a liver specialist (hepatologist). However, many people in the U.S. and other parts of the world do not have access to a hepatologist. Many primary care doctors do not feel comfor table or know how to properly care for someone living with hepatitis B. This leaves a large gap in managing and treating the infection. Hepatitis B Management: Guidance for the Primary Care Provider helps to close this gap by giving all providers the tools to understand the virus and how to manage it.

Dr. Amy Tang, Director of Immigrant Health at NorthEast Medical Services and one of the hepatitis B experts involved in creating the guide, answered a few questions about why this resource is so important: 

Why was a guide on hepatitis B management needed? What gaps will this help fill? 

Primary care providers are recommended to screen and vaccinate for hepatitis B in at-risk individuals.  However, when an individual tests positive for hepatitis B, they are typically referred to a specialist for care.  Because the majority of persons with chronic hepatitis B in the United States are foreign-born with limited English proficiency and often face both linguistic and access barriers to specialists, referral and retention in specialty care for chronic hepatitis B can often lead to lost follow-up.  Chronic hepatitis B management involves visits at least every 6 months for lab monitoring as well as routine ultrasounds for liver cancer surveillance for patients who fulfill high-risk criteria for liver cancer including Asian and African men over 40 years of age and Asian women over 50 years of age.  Because primary care is already performing routine blood tests and cancer screening for a variety of other chronic diseases such as diabetes, hypertension, and breast, cervical, and colon cancers respectively, we believe that empowering primary care providers with a simple to use hepatitis B algorithm would promote increased access and retention in care for persons with chronic hepatitis B.

How does this tool work towards the elimination of hepatitis B? 

The National Academies of Science, Engineering, and Medicine report for viral hepatitis elimination by 2030 recommends that primary care providers work closely with hepatitis B specialists and their organizations, e.g., the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (IDSA), to increase primary care capacity for HBV screening, vaccination, monitoring, and treatment. Thus the National Taskforce on Hepatitis B in collaboration with ECHO Institute and San Francisco Hep B FreeBay Area hosted a meeting at the 2018 AASLD Annual Liver Meeting in San Francisco to convene a workgroup of hepatitis B specialists in hepatology, infectious disease, public health, primary care, and pharmacy, as well as representatives from American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) to discuss how we can increase primary care capacity for not only hepatitis B screening and vaccination, but also management and treatment.

Currently, the majority of hepatitis B care is managed by specialists.  AASLD puts forth guidelines and guidance for hepatitis B every couple of years, however the guidelines can be lengthy, difficult to access, or intimidating for busy primary care providers to utilize. We polled over 100 primary care providers across the country through the National Association of Community Health Centers’ network of providers and found that primary care providers were interested in managing hepatitis B but felt like they did not have the tools and resources at their fingertips to do it manage it confidently.  They reported using web-based references like Up-to-Date for easily accessible guidance on conditions they were less familiar with. Thus, we wanted to create an easy to use document that would be easily accessible and free online. We teamed up with University of Washington’s Hepatitis B Online to host our Hepatitis B Guidance for Primary Care Providers as a means to widely disseminate our recommendations and work towards the elimination of hepatitis B in the United States and globally.

How and when should primary care providers use this? 

Primary care providers should use this hepatitis B guidance document when they decide to screen a patient for hepatitis B as the document guides them through how to properly screen for hepatitis B in asymptomatic individuals, how to interpret their lab results and provide appropriate counseling, and for patients who screen positive for hepatitis B, how to perform their initial evaluation, monitoring, treatment, and liver cancer surveillance.  We also have a dedicated section on perinatal management of women screened for hepatitis B that clearly illustrates the simple steps that can be taken by the primary care provider to prevent transmission of hepatitis B from mother to child. 

The guide includes detailed information on the following topics: 

  • Chronic Hepatitis B Testing and Management Algorithm
  • Interpretation of hepatitis B test results
  • Tests to run on a hepatitis B surface antigen positive (HBsAg +) individual and how to counsel them
  • Monitoring and management of the HBsAg + individual 
  • Managing pregnant women who are HBsAg + 
  • Monitoring for liver cancer

The guide is part of Hepatitis B Online – a free suite of materials for providers that supplies information on all topics related to hepatitis B such as when a person should begin treatment and liver cancer screenings. The website also includes prescribing information for approved hepatitis B treatments, and clinical calculators to aid in interpreting predictors of liver damage such as the AST to Platelet Ratio Index (APRI) and fibrosis score. 

 To access and download the new tool, click here

Exposed to Hep B? What Steps You Should Take To Prevent Infection

As a blood-borne virus, it is extremely difficult to track exposure to hepatitis B unless you are aware of somebody’s hepatitis B status. Exposure to the virus can occur at work, through sexual intercourse, unsterile tattoo or drug equipment, or even medical procedures with equipment that was not properly sterilized. Precautions – such as vaccination –  should always be taken to avoid a possible infection, but timely actions can also be taken to prevent an infection if an exposure does occur. 

Post- Exposure Treatment  

If you believe you were exposed to hepatitis B, Post-Exposure Prophylaxis (PEP) is the key to preventing the development of a hepatitis B infection. The first step is to seek medical care as soon as possible and let a healthcare professional know that you may have been exposed to hepatitis B. If you do not have a regular doctor or they cannot fit you in for an appointment, you can also visit a hospital’s emergency department or health care center. 

Be sure to be honest with the healthcare professional about how you may have been  exposed to hepatitis B, as this will help them to determine your exposure risk and the correct actions to take.  PEP is typically given in the form of one dose of the hepatitis B vaccine, but in certain circumstances, the healthcare provider will give one dose of the vaccine in addition to a shot of hepatitis B immune globulin (HBIG) to provide additional protection. Even if HBIG is unavailable, you should still receive the a dose of the hepatitis B vaccine

Both vaccinated and unvaccinated individuals can receive PEP.  However, recommendations for PEP can differ based upon the exposure and whether or not a person has been fully vaccinated. If the source of exposure is known to be hepatitis B surface antigen-positive (HBsAg), the healthcare provider will take the following steps based upon your vaccination status: 

  • Source of exposure is known to be HBsAg positive and individual is unvaccinated – HBIG and hepatitis B vaccine are given as soon as possible within a 24 hour window. Complete full vaccine series as recommended after PEP. 
  • Source of exposure is HBsAg positive and individual is partially vaccinated (less than 3 doses or less than 2 doses of Heplisav-B) – receive HBIG. Complete vaccine series as recommended. 
  • Source of exposure is HBsAg positive and individual has proof of a completed vaccinate series – one dose of hepatitis B vaccine booster is given.

If the source has an unknown hepatitis B status, the recommendations are as follows:

  • Source has unknown HBsAg and individual is unvaccinated – receive first dose of the hepatitis B vaccine as soon as possible within a 24 hour window.
  • Source has unknown HBsAg and individual is not fully vaccinated – complete vaccine series.
  • Source has unknown HBsAg and individual has proof of completed vaccination – no treatment is needed.

The most important part of PEP is the time between the exposure and treatment. PEP is most effective at preventing hepatitis B if it is given as soon as possible after the exposure. This means that the treatment should be given within 24 hours of exposure. 

Pregnancy and PEP

PEP is safe and recommended for both pregnant and breastfeeding mothers who have been exposed to hepatitis B; the vaccine will not harm the baby. For pregnant women who are HBsAg positive, PEP must be administered to the newborn to prevent the baby from developing chronic hepatitis B! In this case, the doctor delivering the newborn should be aware of the mother’s hepatitis B infection so that they can have HBIG and the vaccine on hand during the birth. After the baby is born, one dose of HBIG and the first dose of the hepatitis B vaccine should be given to the newborn within 12 hours of delivery. It’s important to note that HBIG may not be available in all countries. In this case, it is even more important to make sure that babies receive the first dose of the hepatitis B vaccine within 24 hours of birth. The newborn should receive the remainder of the vaccine according to the vaccine schedule.  

PEP for Healthcare Workers

It’s important to note that occupational procedures have a different set of guidelines, although the timeline and standard PEP treatment recommendations remain the same. Healthcare institutions should always have infection control guidelines and precautions in place to prevent an exposure, but accidents can still occur. All healthcare workers who are exposed to hepatitis B at work should follow the standard protocol for the post exposure process, as explained by the CDC guidelines. The workplace is also responsible for making sure that all employees have access to PEP and all other post-exposure procedure materials as soon as possible after the exposure. 

After the 24 Hour Window and No Access to PEP 

If you are unable to receive PEP within the recommended time frame, you should still visit a healthcare provider to receive treatment as soon as possible. The CDC estimates that treatment may be effective at preventing infection if given up to 7 days after the initial exposure, but not enough research has been done to confirm how effective PEP is if given after that timeline. The earlier PEP is received, the more likely it is to be effective. 

The World Health Organization also recommends that standard first-aid be applied immediately to all cuts and wounds that may have been exposed to infected blood. The standard first aid includes 1) letting the wound bleed freely and; 2) washing the wound immediately with soap, gel, or hand-cleaning solution. Be sure to treat the wound gently, and to not use harsh solutions or soaps when cleaning the area. WHO also provides instructions on how properly cleanse eyes, the mouth, and unbroken skin after a potential exposure. 

If you believe that you were exposed to hepatitis B and never received PEP, you should be tested to know your hepatitis B status. It takes up to 9 weeks for the hepatitis B virus to show in the bloodstream. Therefore, it is important to get tested for the hepatitis B 3 panel blood test (HBsAg, HBcAb, HBsAb) at least 9  weeks after the exposure to determine if you have been infected. If you remain uninfected after that time period and are HBsAb negative, the completion of the hepatitis B vaccine series is strongly recommended. 

 

Why Your Family Health History Matters with Acute and Chronic Hep B

National Family Health History Day is November 28th, and it is the perfect time to sit down and talk to your family about health; it gives your loved ones an opportunity to provide the gift of a healthy future! As hepatitis B rarely has any symptoms, many people do not discover that they are infected until a family member is diagnosed or they develop liver damage or liver cancer. 

Approaching the topic and starting the conversation can help to break this cycle of transmission within families, and allow your loved ones to protect themselves. If you need some tips on how to start the discussion on family health, you can check out our blog post here!

Your family’s health history tells a powerful story. It guides us on what behaviors to avoid and actions that we can take to prevent developing certain illnesses or diseases. It can also help inform us on how to best navigate the health system. Do I need to be tested for liver cancer? Is the medication that I’m taking actually dangerous to my health? 

When a family member is living with or has lived with hepatitis B, family health history can become even more critical to creating a healthy future. Hepatitis B is one of the world’s leading causes of liver cancer, so it is extremely important to be aware of your risk! Although hepatitis B is not genetic or hereditary – it is only spread through direct contact with infected blood or through sexual contact –  multiple family members can be infected without knowing. This is because hepatitis B often does not have any symptoms and can be spread from mother to child during childbirth or by sharing sharp objects such as razors, toothbrushes, or body jewelry that may contain small amounts of infected blood. Knowing about a family members’ current or past infection is a signal to get tested for hepatitis B using the 3-panel hepatitis B blood test (HBsAg, HBsAb, HBcAb). Testing is the only way to be sure of your hepatitis B status. The test will let you know if you have a current infection, have recovered for a past infection, or need to be vaccinated. 

Why does this matter if myself or a family member has recovered from a past infection? 

If someone has recovered from a past infection (either acute or chronic), this is great news! Loss of the hepatitis B surface antigen may be exciting, but it does not mean that you don’t need to proceed with caution! Recovery from a past infection means that while the virus is no longer in your blood, it is still living in the liver in an inactive state. You cannot infect anyone else at this stage, but family members, and sexual partners should still get tested for the 3-panel hepatitis B blood test (HBsAg, anti-HBc, anti-HBs) because they may have been exposed in the past. Check out this helpful fact sheet on what it means to have recovered from an acute or chronic infection!

A past infection should be a part of all medical records as well. Various medications and treatments for other conditions, such as cancer or Rheumatoid arthritis have the potential to reactivate the virus that is sleeping in your liver.  Some medications can suppress the immune system, which gives hepatitis B a chance to reawaken and attack the liver. Healthcare providers need to be aware if you had a past infection so that they can monitor you and potentially prescribe medications to prevent the virus from reactivating in your body. 

Not every treatment will cause hepatitis B to reactivate, so it is important to be aware of the ones that carry a risk! Any treatment that suppresses the immune system such as chemotherapy and other cancer therapies, and certain arthritis, Crohn’s disease, Ulcerative colitis, asthma, and psoriasis drugs may pose a risk of hepatitis B reactivation. You can find a list of specific drug names and their risk levels on our website, but you should always consult your doctor or provider for the most accurate information. 

Every medication also comes with a warning label that you should read carefully. This section will let you know if there is a risk of reactivation. You can also use the National Institute of Health’s LiverTox website to search the name of treatment and see if there is a risk!

Talking to Your Family 

Hepatitis B may increase a person’s risk of liver disease and liver cancer but with knowledge of an infection, you can take measures to help manage it. For family members who have not been infected, they can take action to prevent future infection by getting vaccinated! Many people assume that they have already been vaccinated, but this is not always the case. Globally, adult completion rates of all 3 doses of the vaccine are low, meaning that most adults are vulnerable to infection. The vaccine is highly effective and is the best form of protection against the virus. Don’t assume you have been vaccinated; check your immunization records or ask your doctor! 

Spending your holiday talking about health may not sound like fun, but it is extremely important – it may even change your life! Set 30 minutes aside to sit down with your loved ones and talk about any diseases or disease risk factors, that are in your family. Awareness is the key to prevention! 

RANN Foundation – Raising Hepatitis B Awareness in India

This post is written by guest blogger Surender, who founded the RANN Foundation – a non-profit organization in India dedicated to educating women and children in a variety of topics – including hepatitis! 

India has one-fifth of the world’s population and carries a large proportion of the global burden of hepatitis B. India harbors 10 to 15 percent of the entire pool of hepatitis B carriers in the world, estimated to be 40 million HBV carriers. About 15 to 25 percent of HBsAg [the hepatitis B surface antigen] carriers are likely to suffer from cirrhosis and liver cancer and may die prematurely. Infections that occur during infancy and childhood have the greatest risk of becoming chronic. Of the 26 million infants born every year in India, approximately one million run the lifetime risk of developing chronic hepatitis B.

RANN Foundation focuses on developing the potential of women and girls to drive long-lasting equitable changes deeply focusing on SDGs mainly 3.3 aims to combat Viral Hepatitis by 2030.

We believe that the best way to unlock human potential is through the power of creative collaboration. That’s why we build partnerships between businesses, NGOs, governments, and individuals everywhere to work faster, leaner, and better; to find solutions that last; and to transform lives and communities from what they are today to what they can be, tomorrow.

My Story:

I was a Human Resource Executive in leading thermal power generation company in India. It was 2010 when during a blood donation camp, I got to know that I have Hepatitis B infection. I had never heard about hepatitis b before this incident. It was a shocking moment for me because I had never gone through any blood transfusion. I discussed with family and prepared all of them for screening of hepatitis B. The results were shocking to all of us as three members had infection of Hepatitis B in my family. It was mother to child transmission. I decided to leave my job, which was the only source of earning for me/family, & started education about the diseases in most vulnerable slums & villages in India. Being a survivor, it was my duty to protect future generations. I started my organization RANN Foundation which aims for awareness and prevention of viral hepatitis in India.

The social stigma surrounding Hepatitis B

I never hide my hepatitis B positive status. In fact, on every occasion, I share my story, but anyone who is living with hepatitis B cannot reveal his/her status due to discrimination in family & society. Discrimination and marginalization of people living with the chronic infection is a major concern that majorly impacts the lives of patients in India. Misconceptions and stigma attached to the disease often leads to marginalization and discrimination against patients. My fight against the disease focuses on multiple fronts – prevention of hepatitis B through vaccination camps of dropout children, conducting education programs on viral hepatitis in schools & urban slums, and providing psychosocial support to patients. Around 1.5 lakh deaths annually and almost 60 million Indians affected, Viral Hepatitis continues to be a serious public health concern. Most of the mortality due to viral hepatitis is attributed to hepatitis B and C, which are also known as silent killers as more than 80% of the infected aren’t aware of their infection.

Project NOhepDelhi: A School Awareness Program

Under Project NOhep Delhi a school awareness program is initiated by RANN Foundation in collaboration with Delhi Commission for Protection of Child Rights (Govt of Delhi) to educate students and teachers about viral hepatitis. The role of students in creating awareness and causing behavioral changes among the general population could go a long way in preventing the spread of viral Hepatitis.

The effort aimed at increasing students’ awareness and knowledge of hepatitis transmission and prevention should, therefore, be of special interest, especially among adolescents and young adults.

At this stage, most detrimental lifelong lifestyles and behaviors are adopted like substance use, alcoholism, etc. which are also a predisposing factor for the contraction of hepatitis infection and other infections. The school is a place where viral hepatitis information can get to adolescents and the teachers are potent instruments for giving out this information. Hence, the need to assess the knowledge of teachers & students about viral hepatitis.

Training of the Students: Senior girls are in the process of taking sessions on viral hepatitis to educate their juniors and other people living nearby their home. Girls were excited while giving their names for the training and showed dedication throughout the program.

Achievements

Project HASI:- RANN in collaboration with Cognizance (IIT- Roorkee) has taken the initiative to educate and empower the rural and urban-rural women of Uttarakhand. We launched the project in October 2018. So far, we have impacted and supported over 4,000 beneficiaries directly and over 1500 indirectly through our community trainers in Haryana & Uttarakhand.

NOhep With Max India Foundation :- We have successfully conducted immunization camps with Max India Foundation catering to 800 children and have provided with hepatitis B vaccinations.

Project NOhep Delhi :- RANN in collaboration with Delhi Commission for Protection of Child Rights (Govt. of Delhi) has taken the initiative to educate and empower the urban slums women & students of govt schools of New Delhi. We have started project Nohep Delhi in 17 govt schools – appox 35 thousand children) & 3 major slums to conduct awareness program on viral hepatitis. An intensive campaign for awareness generation will be held using different methodS such as health awareness camp, meeting, events, street plays, one to one communication, big events and sensitization with various groups of the society

Hepatitis B is NOT A Genetic Disease – And Here’s Why

There are many misconceptions about the hepatitis B virus. One recurring one is the myth that hepatitis B is a genetic or hereditary disease. The belief is that because multiple family members can be infected by hepatitis B, it must be a virus that runs in families. This is not true. Hepatitis B is NOT genetic. Hepatitis B is spread through direct contact with infected blood. Although transmission can occur a number of different ways, it does not happen at conception or while the child is developing in the uterus. 

Let’s start by breaking down what it means for something to be genetic or hereditary: 

A genetic disease is caused by an error in a person’s genes and is   carried by an individual in their genes. This type of disease may be passed on to a person’s child (which means it is hereditary) or it can occur spontaneously as a result of a gene mutation while a child is growing in the womb. Genes – which make up each of our unique DNA strands – are passed on to a child from both the mother and the father. Therefore, if a mother or father carries a certain hereditary disease or genetic trait, such as brown hair or green eyes, the child has the ability to have that as well. 

Hepatitis B is not a genetic disease because it does not exist in a person’s genes. It is not carried in the egg of a woman or the sperm of a man. The hepatitis B virus exists in the liver cells and circulates in the bloodstream. Unlike a genetic disease, a person is not born with the hepatitis B virus already in their bodies. Instead, the virus is passed from mother to baby during childbirth through infected blood passing from the mother to the child during the physical delivery process. If a pregnant woman tests positive for hepatitis B, she can pass the virus to her newborn through infected blood and tiny tears in the skin that occur during childbirth. Oftentimes, these tears are unable to be seen by the human eye but can still allow for the virus to pass through and make direct contact with mucous membranes (“wet skin”) of the eyes, ears, nose, and mouth of the infant

A number of different factors play a role in determining if a newborn will contract hepatitis B from their mother: the mother’s viral load levels, the mother’s knowledge of her infection, and if the newborn receives post-exposure prophylaxis. Post-exposure prophylaxis is the key to preventing mother-to-child transmission and consists of two parts: the first dose of the hepatitis B vaccine and hepatitis B immunoglobulin (HBIG). Both shots need to be administered 1) in two different limbs and 2) within 12 hours of birth in order to be as effective as possible. Once the shots have been given, the infant should complete the standard hepatitis B vaccine schedule in order to ensure that they are protected for life! *Please note that HBIG is not recommended by WHO, so it may not be recommended or available in all countries.

Commonly Asked Questions: 

It can be difficult to understand facts when they do not align with what you have been told for many years, so we’ve answered some of the most common responses to our information below: 

  1.  If it is not genetic, how is it sexually transmitted? 

 This question goes back to the topic of genes. A genetic disease differs from a sexually transmitted disease because of where the virus is hosted during transmission from one individual to another. A genetic disease is given to a person via cellular DNA while a baby is developing in the mother’s womb. Sexual transmission occurs because the virus is present in blood and sexual fluids and can be transmitted through very tiny, microscopic tears as a result of sexual intercourse.

2.  If it’s not genetic, why do multiple members of my family have it? 

Families tend to share objects – and that’s okay! However, sharp objects like earrings and body jewelry or personal care items like razors, nail clippers, or toothbrushes, can make tiny, microscopic cuts and abrasions in our skin that bleed. Sometimes, we don’t even notice! When a family member uses an object with trace amounts of infected blood and they also have a wound, such as a mouth sore,  cut, or freshly shaved skin, the virus can spread to the uninfected individual. Because hepatitis B is so infectious (at least 50 times more infectious than HIV!), even small amounts of infected blood can cause a person to become infected. Therefore, it is recommended that personal items and sharp objects are not shared – even between family members, or ensure all family members are properly vaccinated for hepatitis B and confirm they are protected

Accidents also occur frequently in households, and sometimes blood is spilled. The virus can live on surfaces outside of the body, so it is essential to properly clean up any blood spills. The key to safely cleaning up blood and killing the virus is to wear gloves and use a fresh diluted bleach solution of 1 part bleach mixed with 9 parts water. 

It’s extremely important to note that infected blood must come into contact with uninfected blood or a mucous membrane for transmission to occur. A person cannot become infected from skin-to-skin contact such as shaking hands or hugging, sharing utensils or food prepared by an infected individual, or even kissing.

Prevention: 

The best thing to remember is that hepatitis B is preventable, even if a child is born to a mother living with chronic hepatitis B! Always remember to wash your hands thoroughly with soap and hot water after any possible exposure to blood. In addition, any family members and loved ones who test negative for the hepatitis B surface antigen (HBsAg) and did not recover from a past infection (HBcAb total negative) should get vaccinated to prevent any possible transmission. The vaccine is one of the most effective vaccines in the world! 

Hepatitis B Vaccine Schedule: Standard, Accelerated, and Combination

Getting poked with a needle is never fun, but it’s an extremely important part of protecting yourself and others from infectious diseases! The hepatitis B vaccine is known to be one of the most effective vaccines in the world – and very safe too! As a blood-borne disease that typically has no symptoms, hepatitis B can easily be spread by accident – simply because people are unaware that they have it! Modes of transmission include mother-to-child during birth, unprotected sex, injection drug use, unsafe medical procedures, and the sharing of personal items that may contain blood remnants, such as body jewelry, razors, and toothbrushes. Although certain precautions can be taken to prevent transmission, the only way to completely protect yourself is to get vaccinated. Once you have been vaccinated, you are protected for life!

There are a few options for receiving the hepatitis B vaccination. In most countries, the vaccine is available through a doctors office or a health clinic. The most common option is the standard three-dose vaccine. This consists of three separate doses of the vaccine given through intramuscular injections. In order for the vaccine to be effective, there must be a minimum amount of time between doses. If the minimum amount of time is not followed, the vaccine will not provide full, long term protection from the infection.

3 Dose Schedule:

  • 1st Shot – At any given time, but newborns should receive this dose in the delivery room within 24 hours of birth
  • 2nd Shot – At least one month (or 28 days) after the 1st shot
  • 3rd Shot – At least 4 months (16 weeks) after the 1st shot (or at least 2 months after the 2nd shot). Infants should be a minimum of 24 weeks old at the time of the 3rd shot.

In the United States, there is an FDA approved 2-dose vaccine called Heplisav-B. However, Heplisav-B is only approved for adults. Both doses must be from the Heplisav-B vaccine only.

2-Dose Schedule (U.S. Only):

  • 1st shot – At any given time
  • 2nd shot – At least 28 days after the first shot.

Accelerated Vaccine Schedule

At the moment, Heplisav-B is the only vaccine that is approved on a shortened schedule. Some doctors may offer an accelerated vaccine schedule for special circumstances. However, the accelerated schedule is generally not recommended for individuals who do not need the vaccine within a certain time period. The Centers for Disease Control and Prevention only recommends the accelerated vaccine schedule to those who are traveling on short notice and have a high risk of facing exposure, or to emergency responders in disaster areas. Multiple studies have shown that the minimum time between doses is necessary in order to receive full protection against the infection. If doses are given too close together, the body does not have enough time to create an immune response to the vaccine’ leaving you vulnerable to transmission. If you must complete an accelerated schedule, four doses of the vaccine are required in order to achieve full, long-term immunity.

4 Dose Schedule:

    • 1st Shot – At any given time
    • 2nd Shot – 7 days after the first shot
    • 3rd Shot – Between 21 and 30 days after the 1st shot

 

  • 4th Shot –  1 year after the first shot

 

 

Combined Vaccines

In some cases, the hepatitis B vaccine is administered along with other vaccines or as part of a combination vaccine. Examples of combination vaccines that offer protection against HBV include: 1) The pentavalent vaccine which is used for children and protects against a total of five infectious diseases and 2) the combination hepatitis A and B vaccine. While the pentavalent vaccine is offered as the first dose for children in many countries, it is not ideal unless the child is able to get the birth dose of the HBV vaccine. It can only be given once the child is six weeks old, leaving the infant unprotected during the gap. Therefore, it is strongly recommended that children receive a monovalent hepatitis B dose of the vaccine at birth. For women that are HBsAg positive, the birth dose is the best chance to prevent hepatitis B transmission to the next generation and must be given within 24 hours of birth.

Pentavalent Vaccine Schedule         

  • 1st Shot –      Monovalent at birth                                                                         
  • 2nd Shot-      Pentavalent at 2 months of age                     
  • 3rd Shot –      Pentavalent at 4 months of age
  • 4th Shot –      Pentavalent at 6 months of age                         

The combined hepatitis A & B vaccine – which is only for adults – can follow the 3 dose vaccine schedule or, if necessary, the 4 dose accelerated schedule. More information on combination vaccines can be found here.

Before you get vaccinated, it is important to get tested for hepatitis B! The vaccine will not work for those who are currently infected or have previously been infected. Those who have recovered from a past infection will produce antibodies to the virus and will not have to worry about becoming reinfected or infecting others – but the virus can become reactivated if they undergo immune suppression, so it is important for you and your doctors to know if you have recovered from a past hepatitis B infection. However, those who are currently infected will still be able to transmit the virus – even if they receive the vaccine. Therefore, it is important to know your current status. Ask your doctor or local healthcare provider for the 3-panel hepatitis B blood test (HBsAg,HBsAb,HBcAB) to find out your status today!