- Hepatitis B is an infection caused by the hepatitis B virus resulting in jaundice, nausea, vomiting, pain and fever.
- Disease is transmitted via blood and body fluids of an infected person.
- Initial hepatitis B infection can often be asymptomatic, meaning a person may be unaware that they are carrying the infection.
- Following the acute infection, up to 10% of those infected in adulthood, and up to 90% of those infected in infancy will become chronically infected.
- Chronic infection with hepatitis B virus can lead to end stage liver failure (cirrhosis) and hepatocellular carcinoma.
Prevention of hepatitis B infection
- Hepatitis B vaccine is currently provided for free on the National Immunisation Program (NIP) at birth (within 7 days), 6-weeks, 4-months and 6-months.
- A single booster dose is also funded at 12-months of age for those who are born at < 32-weeks gestation and/or < 2000 grams [See MVEC: Preterm Infant Immunisation]
- Hepatitis B vaccination is also funded in Victoria for additional at risk groups:
- Aboriginal and Torres Strait Islander people
- Household contacts or sexual partners of people living with hepatitis B infection
- People who inject drugs or are on opioid substitution therapy
- People living with hepatitis C
- Men who have sex with men (MSM)
- People living with HIV
- Prisoners and remandees
- People who are no longer in a custodial setting but did not complete the vaccine course while in custody
- People from endemic countries who arrived in Australia in the last 10 years
- Certain occupations (including those directly involved in patient care and/or the handling of human tissue, blood or body fluids) also carry an increased risk of exposure to hepatitis B virus. In these instances the vaccine is recommended but not funded on the NIP.
- Performing hepatitis B serology following hepatitis B vaccination is not routinely indicated.
- Post vaccination screening, carried out 4-weeks after the final vaccine dose, is recommended for those at significant occupational risk (eg health care workers), those at risk of severe complications of hepatitis B disease (eg immunocompromised, those with pre-existing liver disease), those in whom poor immune response may occur (eg impaired renal function) and sexual partners and household contacts of people living with hepatitis B.
- If serology is performed more than 8-weeks post the final vaccination dose, results may be considered less reliable.
- Serology should be performed every 12-months in patients with impaired renal function +/- dialysis regardless of previous serological testing [see Table 1].
Patients with impaired renal function
- Patients with impaired renal function +/- dialysis are at increased risk of hepatitis B infection. In addition they often have a diminished immune response to the hepatitis B vaccine. The cause of this is not completely understood. It is well documented that the earlier a patient is immunised in the disease progression, the better the response and more long term protection they will have.
- Impaired renal function is defined as chronic kidney disease (CKD) 4-5 (GFR < 30ml/min)
- Some patients with impaired renal function may progress to a renal transplant [MVEC: Solid organ transplant recipient]
- There is evidence to suggest that by vaccinating patients with impaired renal function with a combination hepatitis A and B vaccine (Twinrix® Adult 720/20), seroconversion can be enhanced [see Table 1].
- If immune response remains sub-optimal following the immunisation recommendations in Table 1, please refer to the below recommendations for management of non-responders to hepatitis B vaccination.
Table 1: Recommended vaccine schedule for those with renal impairment using combined hepatitis A and B vaccine [Twinrix® Adult 720/20]
|Age at diagnosis of disease||Anti-HBs titre||Twinrix® Adult (720/20)#||Serology|
|< 12 months||
2 doses (separated by 6 months)
[Commence vaccine course at ≥ 12-months of age]
|≥ 12 months||If baseline titre at diagnosis is ≥ 10m IU/mL:||2 doses (separated by 6 months)||
|If baseline titre at diagnosis is < 10m IU/mL:||3 doses (4 weeks between dose 1 and 2; 5 months between doses 2 and 3)||
# Twinrix® Adult (720/20) is a combination Hepatitis A and B vaccine. It contains 720 ELISA units of HAV antigens and 20mcg of Hepatitis B surface antigen protein. Each dose is 1.0ml given intramuscularly
Non-responders to hepatitis B vaccination
- A non-responder to hepatitis B vaccination is any person with a documented age-appropriate vaccine history, who has a current Anti-HBs level of <10m lU/mL 4-8 weeks following the final vaccine dose.
- MVEC recommends the following immunisation pathway for all non-responders: Pathway for routine IM hepatitis B vaccine non-responders
- Persistant non-responders should be informed of their immune status and advised to minimise exposures.
- Hepatitis B immunoglobulin may be given to non-immune persons within 72 hours of exposure to prevent infection.
- Tung J, Carlisle E, Smieja M, Kim PT, Lee CH. A Randomized Clinical Trial of Immunization With Combined Hepatitis A and B Versus Hepatitis B Alone for Hepatitis B Seroprotection in Hemodialysis Patients. Am J Kidney Dis. 2010;56(4):713-9.
- Playford EG, Hogan PG, Bansal AS, Harrison K, Drummond D, Looke DF, Whitby M. Intradermal recombinant hepatitis B vaccine for healthcare workers who fail to respond to intramuscular vaccine. Infection Control and Hospital Epidemiology 2002 Feb;23(2):87-90
- Pathway for routine IM hepatitis B vaccine non-responders
- The Australian Immunisation Handbook: hepatitis B chapter
- Better Health Channel: hepatitis B
- DHHS: Immunisation schedule Victoria and vaccine schedule eligibility criteria
- MVEC: Solid organ transplant recipient
- MVEC: Preterm infant immunisation
- The Royal Children’s Hospital: Clinical Practice Guideline- Needle Stick Injury
Authors: Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute) and Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)
Reviewed by: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)
Date: July 2020
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.