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What do I need to understand about prevention of and vaccination for hepatitis B?

Key takeaways:

  • Australia’s approach to prevention of hepatitis B includes universal infant and childhood vaccination through the National Immunisation Program as well as vaccinating adults at risk of hepatitis B.
  • Vaccination should be offered after completing testing in at-risk groups.

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Who should I offer hepatitis B vaccine to?

How many doses of hepatitis B vaccination are required and how far apart?

Is there an accelerated hepatitis B vaccination schedule?

Do I need to test my patient for hepatitis B before I vaccinate them?

Is my patient eligible for a funded hepatitis B vaccination?

What about hepatitis B vaccine non-responders? Do I need to check?

What prevention information should I provide to people living with hepatitis B?

Are there any specific precautions I need to take when looking after people living with hepatitis B?

Support your patients with information about hepatitis B prevention and vaccination.

Who should I offer hepatitis B vaccine to?

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Hepatitis B vaccination is recommended for the following groups of people.

  • Infants – as part of the National Immunisation Program
  • Aboriginal people
  • People who are immunocompromised, including those:
    • with HIV
    • with severely impaired renal function
    • on dialysis
    • before solid organ transplant
    • after haematopoietic stem cell transplant
  • People with medical risk factors, including:
    • people with hepatitis C
    • people with chronic liver disease
    • preterm and low-birthweight infants (need an additional booster at 12 months)
    • people who receive blood products
    • people with developmental disabilities
  • People whose occupation increases their risk of acquiring hepatitis B, including:
    • healthcare workers
    • police, members of the armed forces, people working in emergency services and correctional facilities
    • people who work at facilities caring for people with developmental disabilities
    • funeral workers and embalmers
    • tattooists and body-piercers
  • Travellers to hepatitis-B-endemic areas who may be at increased risk (most of East and Southeast Asia (except Japan), Pacific Island countries, parts of central Asia and the Middle East, the Amazon Basin, sub-Saharan Africa)
  • People whose circumstances increase their risk of acquiring hepatitis B, including:
    • infants born to mothers who are HBsAg positive
    • household or other close contacts of people with hepatitis B
    • sexual contacts of people with hepatitis B
    • men who have sex with men
    • migrants from hepatitis-B-endemic countries (most of East and Southeast Asia (except Japan), Pacific Island countries, parts of central Asia and the Middle East, the Amazon Basin, sub-Saharan Africa)
    • people who inject drugs
    • inmates of correctional facilities
    • sex industry workers

If you are offering vaccination to someone who is also considered at risk, it is recommended that testing is undertaken prior to vaccination. See here.

Quick Links

Hepatitis B | The Australian Immunisation Handbook | Website | Australian Government Department of Health and Aged Care

Hepatitis B vaccine | Website | Australian Government Department of Health and Aged Care

Detailed Information

National Immunisation Program and state-funded vaccines for eligible Victorian adults | Website | Victorian Government Department of Health

B Positive: Primary prevention of hepatitis B infection | Website | ASHM

How many doses of hepatitis B vaccination are required and how far apart?

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Catch up vaccines: People who have not had documented Hepatitis B vaccination as per the National Immunisation Program schedule may require additional doses and/or a catch-up schedule.


See here for more details.

Quick Links

Hepatitis B | The Australian Immunisation Handbook | Website | Australian Government Department of Health and Aged Care

Catch up vaccination | Website | Australian Government Department of Health and Aged Care

Detailed Information

This is a comprehensive fact sheet on hepatitis B disease and vaccines: Hepatitis B vaccines for Australians | PDF | National Centre for Immunisation Research and Surveillance

B Positive: Primary prevention of hepatitis B infection | Website | ASHM

Catch-up immunisation in refugees | Website | Royal Children’s Hospital Melbourne

Is there an accelerated hepatitis B vaccination schedule?

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For people at imminent risk of exposure to hepatitis B an accelerated vaccination schedule is available. For information on dose, vaccine, age of recipient, recommended schedule and minimum intervals, see here.

Quick Links

Accelerated hepatitis B vaccination schedules for people with imminent risk of exposure | Website | Australian Government Department of Health and Aged Care

Do I need to test my patient for hepatitis B before I vaccinate them?

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It depends. Serological testing may be warranted for some adolescents and adults without evidence of previous vaccination, particularly those at increased risk, who would usually be indicated for testing. 

Is my patient eligible for a funded hepatitis B vaccination?

Hepatitis B vaccination is free for Medicare-eligible people when administered as per the National Immunisation Program schedule (at birth, 2, 4 and 6 months). Catch up hepatitis B vaccination is also funded for people under 20 years of age. 

Refugee and humanitarian entrants are eligible for these funded vaccines if missed in childhood.

The Victorian Government also funds routine and catch-up hepatitis B vaccine where clinically indicated including for:

  • Vulnerable citizens – people who have experienced socioeconomic disadvantage that compromised their equitable access to the vaccine during their period of eligibility. This is based on an individual assessment by an immunisation provider.
  • People at risk of hepatitis B infection:
    • all Aboriginal people – if hepatitis B non-immune, there are no restrictions
    • household contacts and sexual partners of people living with hepatitis B
    • people who inject drugs or are on opioid substitution therapy
    • people living with hepatitis C
    • men who have sex with men
    • people living with HIV
    • people no longer in a custodial setting who started but did not complete a free vaccine course while in custody
    • people born in priority hepatitis-B-endemic countries and arrived in Australia in the last 10 years. (Priority countries include China, Philippines, Malaysia, Vietnam, Afghanistan, Thailand, South Korea, Myanmar (Burma), Indonesia, Singapore, Hong Kong, Taiwan and Cambodia.)

Although a person may be eligible for a funded vaccination, ensure you advise them about any fees they may incur from the vaccine provider.

If cost is a barrier and a person is eligible for funded vaccination they may be able to access this for free at bulk-billing clinics, community health services or sexual health clinics. 

The inclusion of Aboriginal peoples as a priority for vaccination highlights the enduring traumatic legacy of colonisation, recognising the historical disadvantage perpetuated by institutional racism and systemic failures that collectively contribute to health disparities between Aboriginal peoples and non-Indigenous Australians.

Important: See here for information on testing prior to vaccination.

Quick Links

Immunisation schedule Victoria and vaccine eligibility criteria | Website | Victorian Government Department of Health

National Immunisation Program Schedule | Website | Australian Government Department of Health and Aged Care

Detailed Information

Order form for funded vaccine| Online Form | Onelink Australia  

What about hepatitis B vaccine non-responders? Do I need to check?

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Performing hepatitis B serology following hepatitis B vaccination is not routinely indicated.

Post-vaccination screening, is recommended for: 

  • people at significant occupational risk (eg healthcare workers)
  • people at risk of severe complications of hepatitis B disease (eg people who are immunocompromised, or those with pre-existing liver disease)
  • people who may have a poor immune response (eg those with impaired renal function)
  • sexual partners and household contacts of people living with hepatitis B.

This should be completed 4 weeks after the final vaccine dose.

If there is a current Anti-HBs level of < 10 mlU/mL 4–8 weeks following the final vaccine dose with a documented age-appropriate vaccine history, the person is deemed a non-responder. In this instance, you should follow the pathway provided here.

If a non-response persists, the patient should be informed of their immune status and advised to minimise exposures. If exposed, hepatitis B immunoglobulin can be given within 72 hours.

What prevention information should I provide to people living with hepatitis B?

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People living with hepatitis B often have questions about transmission risk and how to reduce this.

It is important to discuss the testing and vaccination of close contacts who are not immune. Vaccination is the best prevention.

Give additional advice to prevent transmission: avoid sharing sharp items (eg razor, toothbrush, nail clipper, earrings), cover open cuts or skin wounds and clean blood or body fluid spilled onto surfaces with bleach.

Testing all family members, household contacts and intimate partners is crucial to diagnosing those with hepatitis B and then vaccinating to protect those who are not immune.

When diagnosed as part of antenatal screening, pregnant people may have concerns and questions about vertical transmission. See further information on hepatitis B and pregnancy here.

There are a number of commonly held myths regarding transmission that have a negative impact on a person’s wellbeing.

It is important to ensure your patient understands the following:

  • Casual contact such as hugging and kissing is safe.
  • Sharing and preparing food is safe.
  • Breastfeeding is safe. See further information here.
  • Hepatitis B is not spread via mosquito bites.

At subsequent consultations, check understanding about transmission as self-stigmatisation can increase isolation post diagnosis.

Quick Links

Australian consensus recommendations for the management of hepatitis B infection | PDF | Gastroenterological Society of Australia

Detailed Information

For further training on hepatitis B transmission and prevention, complete the Clinical Extensions of Hepatitis B: Transmission and Natural history module | Online learning module | ASHM

Are there any specifical precautions I need to take when looking after people living with hepatitis B?

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No. Clinicians and healthcare workers should follow standard infection control procedures for all people. These are adequate to prevent hepatitis B transmission.

No further precautions are required beyond these standard precautions when you are providing care for someone living with a blood-borne virus, including hepatitis B. Ineffective and unnecessary methods such as double gloving, wearing gowns or placing a person last on a consult list only perpetuate stigma and discrimination. This can negatively impact a person’s wellbeing and result in reduced engagement in healthcare.

Healthcare workers should be vaccinated and aware of their vaccination and immune status.

Quick Links

B Positive: Infection control and occupational health | Website | ASHM

Detailed Information

Australian Guidelines for the Prevention and Control of Infection in Healthcare | PDF | National Health and Medical Research Council   

Support your patients with information about hepatitis B prevention and vaccination.

“They say Hepatitis B is contagious, so I thought I had to stop sharing utensils with family members to protect them.” – Community member with lived experience of hepatitis B  

“I was too scared to tell my partner about having hepatitis B. What if he thought I’d been unfaithful and stopped loving me?” – Community member with lived experience of hepatitis B 

See below for a list of relevant community resources

Vaccination

Hepatitis B immunisation | Website | Better Health Channel

Hepatitis B vaccination | Website | Hepatitis Australia

Hepatitis B and relationships | Website | Hepatitis Australia

Transmission and prevention

This plain English resource is designed to support health workers discussing chronic hepatitis B with patients, including refugee and migrant communities: The Hepatitis B Story (multiple languages available) | Website & PDF | St Vincent’s Hospital Melbourne    

Hepatitis B: It’s family business (multiple languages available) | Website | Multicultural HIV and Hepatitis Service

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