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U.S Universal Adult Hepatitis B Vaccination

The Centers for Disease Control and Prevention (CDC) universally recommends the hepatitis B vaccine for all adults up to age 59 and for adults 60 and over at high-risk for hepatitis B in the United States.   

The new recommendation simplifies the previously complex guidelines by eliminating the need to screen for risk factors. Read the full recommendation and clinical guidance here.  

Universal Vax Promo banner for Provider webpage 09.01.2022

The CDC recommends three actions that healthcare providers should take to implement the new universal recommendation:  

  • Offer hepatitis B vaccination to all adults aged 19–59 years who have not previously completed vaccination, as well as adults > 60 years with risk factors for hepatitis B or without identified risk factors but seeking protection. 

  • Implement standing orders to administer the hepatitis B vaccine as part of routine services to adults who have not completed the vaccine series. 

  • Offer hepatitis B vaccination, when feasible, in outreach and other settings in which services are provided to persons at risk for HBV infection (e.g., syringe services programs, HIV testing sites, HIV prevention programs, homeless shelters). 

Available Hepatitis B Vaccines for Adults 

In the U.S., there are now five vaccines approved by the U.S. Food and Drug Administration for use in adults.  

3-dose Vaccine Brands 

Twinrix (Hepatitis A and Hepatitis B combination vaccine)  

2-dose Vaccine Brands 

Standing Orders for Adult Hepatitis B Vaccination  

Standing orders are recommended by the CDC and the Community Preventative Services Task Force as a way to improve vaccination rates based upon strong evidence.  

Resources for Providers from the CDC

The CDC has several available resources on the new recommendation, including clinical guidance, healthcare provider Q&As, and information about the types of vaccines available.  

Key Messaging to Promote Universal Adult Hepatitis B Vaccination  

The CDC has shared key messages about why universal adult hepatitis B vaccination is important. The messages listed below can be used to promote the new recommendation among the medical community. 

  • Despite major reductions in hepatitis B virus infections achieved through evolving hepatitis B vaccine policy over the past four decades, progress has stalled in the last 10 years, demonstrating the limits of previous risk-based hepatitis B vaccine recommendations. 

  • Reported cases of acute hepatitis B have plateaued at approximately 3,000 annually for at least nine years (2011-2019), and because hepatitis B is underreported, the estimated true number of cases in those years has been around 20,000 new infections per year.  

  • Each year more than $1 billion is spent on hepatitis B-related hospitalizations. 

  • The new language for adults aged ≥60 years without known risk factors is intended to prompt all providers to offer HBV vaccination to patients in that cohort, rather than wait for a patient to request vaccination, thus shifting the responsibility of initiating the consideration of HBV vaccination from the patient to the provider.  

  • Stigma and discrimination might cause people to avoid testing and treatment, and to fear disclosing their status to health care providers, friends, family members, and colleagues. This stigma can lead to worsening health outcomes and further viral hepatitis transmission. 

  • Disparities can be reduced with increases in vaccination facilitated by a universal adult recommendation.  

  • Dramatic reductions in rates of reported acute hepatitis B cases among children and adolescents were achieved following the introduction of universal vaccination for these groups. We can achieve similar impact among adults with universal adult recommendations, but right now, rates of reported acute hepatitis B cases among adults have increased among people 40 years and older. African American or Black non-Hispanic adults are disproportionately impacted, with rates triple those of Asian/Pacific Islander and approximately twice those Hispanic groups in the United States.

 

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