What is Hepatitis B ?
Hepatitis B (HBV) is a viral infection that attacks the liver after entering the bloodstream; it is the most common liver infection in the world and can lead to both acute and chronic disease, causing serious consequences such as liver cancer and cirrhosis if left untreated.
What are the symptoms?
Following transmission and the average incubation period of 10 weeks (range of 2 to 6 months), some of those infected may have no symptoms – this is more common in children under 5 years of age. Between 30% and 50% of infected people older than 5 will experience gradually increasing fatigue, loss of appetite, nausea and pain in the right upper abdomen. A rash may present as one of the symptoms and also pain in the joints. These are followed by yellow discolouration of the skin (jaundice) and darkening of the urine. In a small number of cases, HBV infection results in rapid liver failure and death.
Up to 10% of adults and 30% of children who contract HBV will become chronic carriers; this means they will recover but will always remain capable of transmitting the disease. Most babies infected at birth will develop chronic hepatitis B infections and with it a higher risk of liver cancer or failure later in life.
Where is it found?
Hepatitis B prevalence is highest among some sub-Saharan African, East and Southeast Asian, and Pacific island populations but can also be found in high numbers in the Mediterranean countries, parts of Eastern Europe, Africa, and Central and South America. It is important to note that although there is a higher risk in certain countries or regions, hepatitis B occurs in all countries.
Some people may have a higher risk of contracting hepatitis B through their occupation, i.e. healthcare workers, police and other emergency services workers, funeral company employees, staff of residential care facilities, tattooists, acupuncturists, people who perform body piercings and sex workers.
Risk to travellers
While the risk of HBV infection is higher in individuals with greater exposure to bodily fluids and contaminated needles, it is also increased during adventure-style activities, where the risk of injury is higher.
Australian children are vaccinated against hepatitis B as part of the National Immunisation Program, but for unimmunised adults the best way to ensure protection when visiting countries at higher risk of hepatitis B is through vaccination. All travellers should consider hepatitis B vaccination.
How is Hepatitis B transmitted?
HBV is transmitted through contact with body fluids, such as blood, saliva, vaginal secretions and semen, as can occur when sharing needles, with needle-stick injuries, through sexual contact, but also from an infected mother to her baby at birth. The infection can also be contracted through tattooing and even via contaminated instruments used in medical or dental procedures. The virus can survive in the environment for seven days or more and remains capable of infecting a non-immune person (i.e. unvaccinated).
How is Hepatitis B treated?
Immunoglobulin, a passive immunisation, can be administered within 12 hours of an at-risk exposure to help prevent HBV infection. Treatment for chronic disease is through the use of antiviral medications and medications containing naturally-occurring proteins. A liver transplant may be necessary in the event of severe liver damage.
Immunisation is the best way to prevent hepatitis B.
Travelvax urges travellers to take common sense precautions to avoid exposure to the hepatitis B virus. The risk of infection is increased during travel however as accidents and injuries may require medical treatment and in many third world countries blood transfusions may not be adequately screened for Hepatitis (as well as STIs and HIV-AIDS), also needles may be re-used.
What is Hepatitis B Vaccination?
Australian children are vaccinated against Hepatitis B as part of the standard childhood immunisation schedule.
- Recombinant vaccine with adult and paediatric formulations
- Combined vaccine with Hepatitis A with adult and paediatric formulations
- Combination vaccines used in the childhood immunisation schedule
Contraindications: Anyone who has had anaphylaxis after a previous dose of any hepatitis B vaccine or any component of a Hep B vaccine, or to yeast.
The primary childhood immunisation series is given from birth: healthy babies receive their first hepatitis B vaccine soon after birth (and preferably within the first 24 hours), followed by three doses of a combination Hep B-containing vaccine at 2, 4 and 6 months of age (the 2 month dose may be given at 6 weeks of age).
Standard regimen for adults who did not receive a childhood vaccination series is one dose given at 0, 1 and 6 months.
School age children may have been administered a 2-dose schedule of adult hepatitis vaccinations. This regimen is only appropriate for children aged between 11 and 15 years.
There are 2 accelerated schedules for adults: Months 0, 1, 2 and 12 months, and for those people at imminent risk of exposure: Days 0, 7 and 21 with a booster at 12 months.
Level of protection
Greater than 90% immunity after three doses, and immunity is life-long. (Australian immunisation experts do not recommend testing for immunity unless in a high-risk group).
Possible Side Effects
Usually infrequent and mild but ay experience: Redness, swelling, a hard lump or bruising around the injection site, feeling unwell, headache, dizziness, tiredness, muscle aches and pains, coughing, sore throat, runny nose, mild fever, swollen glands, chills or sweating.
As with all vaccines, there is a small risk of allergic reaction.
Where can I get a Hepatitis B vaccination from?
If you require vaccination against Hepatitis B, head to a Travelvax clinic near you. Staffed by trained professionals who have access to state-of-the-art equipment, we can help keep you safe on your next trip.
Australian Institute of Health and Welfare https://www.aihw.gov.au/reports/immunisation/vaccine-preventable-diseases/contents
Australian Immunisation Handbook https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/hepatitis-b
Hepatitis B vaccination is included in the childhood vaccination schedule of the Australian National Immunisation Program for infants in a 4-dose schedule from birth to 6 months of age. Preventing Hep B infection in infants, which is often asymptomatic, will also remove the elevated risk of them developing chronic hepatitis B and its associated outcomes of cirrhosis or liver cancer in later life.
For older children, adolescents and adults not vaccinated as infants, there are particular risk groups for which the Hepatitis B vaccinations are advisable; they are given as a 3 or 4-dose schedule over 2-12 months. Adolescents aged 11–15 years receive an alternative 2-dose schedule over 6 months as part of the school-based immunisation program.
The recommendations for specified risk groups apply to those:
- who are immunocompromised
- with medical risk factors
- whose occupation increases their risk of acquiring hepatitis B
- whose lifestyle or other circumstances increase their risk of acquiring hepatitis B
- travellers to hepatitis B–endemic areas
Mothers infected with hepatitis B pass the virus to their babies through the womb or at the time of birth. If newborn babies are promptly immunised with one dose of the Hep B vaccine as well as hepatitis B immunoglobulin (HBIG) within 24 hours of birth, they can be protected from contracting the infection. This is known as vertical transmission and pregnant women are routinely screened for their Hep B status to determine the risk to their baby.
Infants whose mothers are not infected with Hep B receive a birth dose of the Hep B vaccine within the first 7 days after delivery in the event there may be close contact with relatives/others who may have a chronic hepatitis B infection – horizontal transmission.
The Hepatitis B virus is transmitted from an infectious person to another through broken skin or contact with mucosal surfaces from blood or other body fluids, such as vaginal fluids and semen. As a result those people considered at risk of infection would include anyone with an underlying medical condition, with background, occupational or lifestyle exposures, or for travel to medium to highly endemic Hep B countries.
Risk groups for Hepatitis B are:
- people who are immunocompromised, such as HIV
- severely impaired renal function, or on dialysis
- before solid organ transplant or after stem cell transplant
- people with hepatitis C or with chronic liver disease
- people who receive blood products
- people with developmental disabilities
- preterm and low birth weight infants
- infants born to mothers who are hepatitis B positive
- police, members of the armed forces, health workers, emergency services staff and staff of correctional facilities
- staff of facilities caring for people with developmental disabilities
- funeral workers and embalmers
- tattooists and body-piercers
- travellers to medium to highly endemic Hepatitis B areas
- Aboriginal and Torres Strait Islander people
- 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
- people who inject drugs and share needles
- inmates of correctional facilities
- sex industry workers
After completing the recommended course, protection is generally considered life-long. In infants, clinical trials have shown more than 97% protection after the course of vaccinations. In adults, trials show more than 90% protection following a course of age-appropriate vaccinations.
Testing for antibodies after completing the primary course of vaccinations is only carried out in specific groups of people considered at high risk of contracting Hepatitis B. These include people at significant occupational risk (i.e. healthcare workers who are frequently exposed to blood or body fluids), people at risk of severe or complicated hepatitis B (i.e. immuno-compromised or with non-Hep B liver disease), those less likely to develop immunity (i.e. on dialysis) and close contacts of people infected with Hep B. Additional doses may be required if testing shows inadequate immunity.
No. Although Hepatitis B virus can be found in saliva, it is in much lower concentration than in blood or other body fluids such as semen and vaginal fluids. The concentration of Hepatitis B virus in saliva is too low to allow transmission by kissing, sharing food or eating utensils, coughing or sneezing.
After you complete the vaccine series, you cannot contract hepatitis B through any modes of transmission. While you are considered to be protected for life against Hep B, there are other infections that can be transmitted in the same or similar ways e.g., contaminated medical/dental or tattooing equipment can lead to hepatitis C or even HIV/AIDS. As such, precautions are recommended.
The 3-dose vaccination schedule extends immunity to life-long protection. Only infants require a 4-dose schedule from birth to 6 months of age to gain life-long immunity.
Studies show that cellular immunity maintains protection even if antibody levels have declined.
Approximately 5-15% of people do not develop antibodies after the first course of the vaccination and are known as Hep B ‘non-responders’. They require further doses and antibody testing to determine if protection can be gained.
After a healthy person completes the vaccine series, no booster doses are required.
The hepatitis B vaccine is offered free of charge to all eligible infants and people up to 19 years of age who have not received the full schedule of NIP vaccinations (also for refugees and humanitarian entrants aged 20 years or older). For other requirements (travel or occupation), please call your nearest clinic for Hepatitis B vaccine pricing.
There is currently no effective medicine to treat acute Hepatitis B infection, although most people do go on to recover. Some develop chronic Hepatitis B. Medicines are available to treat chronic Hepatitis B infection but these medications (antiviral agents and interferon) rarely completely eradicate the virus. The aim of treatment is to lower the viral load and reduce symptoms. Some people will only have low levels of the infection and it is considered inactive - not causing any symptoms. The disease can flare up at any time and lead to liver damage, so regular check-ups are important.
All other risk groups who were not vaccinated at birth are recommended to have a course of Hepatitis B vaccinations.