什么是流行性感冒？
Hepatitis B is an infection caused by the hepatitis B virus (HBV). It can affect both adults and children, causing acute liver inflammation.
Once acute infection has resolved, it is estimated that up to 10% of those infected in adulthood, and up to 90% of those infected in infancy, will go on to develop chronic infection.
Chronic hepatitis B (CHB) can lead to cirrhosis (scarring of the liver) and liver failure and/or hepatocellular carcinoma (liver cancer). Liver cancer is the second leading cause of cancer deaths globally. There is no cure for CHB, although there are some antiviral medications that can reduce potential liver damage.
流感症状
The incubation period for hepatitis B ranges from 45 to 180 days. The infectious period starts from several weeks before the onset of symptoms (if present), and usually lasts approximately 4 to 5 months. Those who develop CHB usually remain infectious for life.
Initial hepatitis B infection is often asymptomatic, meaning a person may be unaware that they are carrying the infection. In those who develop signs of acute hepatitis B infection, symptoms may include:
- loss of appetite
- nausea and vomiting
- abdominal pain
- 发烧
- pain in the joints
- jaundice (yellowing of the skin and eyes).
HBV infection is confirmed via A blood test (serology), which may also be used to determine whether infections are newly acquired or chronic.
结核病是如何传播的？
乙型肝炎 是 transmitted through broken or penetrated skin, 或者 when a person’s mucosal surface (nose, eyes or mouth) is exposed 到 blood, semen 或者 其他 body fluids of an infected person. Transmission can occur:
- from an infected mother to baby during delivery
- during sexual contact
- with exposure to contaminated sharp objects (e.g. during tattoos or piercings, or injecting drugs)
- through sharing a toothbrush or razor
- through contact with contaminated surfaces.
HBV can survive on surfaces for at least 7 days 和 remains capable of causing infection during this time.
流行病学
Humans are the only known host for HBV. Around 296 million people globally 是 living with CHB.
In Australia, it is estimated that there are over 200,000 people living with diagnosed CHB, representing around three quarters of the total number of cases (with one quarter remaining undiagnosed). Over 90% of new CHB cases in Australia are contracted overseas.
Aboriginal and Torres Strait Islander peoples, people who inject drugs, men who have sex with men (MSM), and those born in areas endemic with HBV carry the highest burden of disease in Australia.
预防措施
The spread of hepatitis B can be reduced by:
- promoting and practicing safe sex
- not sharing injecting, piercing or tattooing equipment
- maintaining infection control measures in healthcare settings
- washing your hands thoroughly with soap and water after any contact with blood, body fluids, or contaminated surfaces
- ensuring appropriate antenatal care, including HBsAg screening
- vaccination.
Vaccination
Vaccination provides high levels of protection against HBV infection. In Australia, vaccination is available through either monovalent or combination vaccines.
Hepatitis B vaccination is funded via the 国家免疫计划 (NIP); a single dose 为了 neonates at birth and a 3-dose course given at 6 weeks, 4 months and 6 months of age. Additional doses and/or boosters are recommended for certain groups (e.g. preterm babies, people with renal failure and those with 免疫抑制).
The birth dose of hepatitis B vaccine is recommended to prevent transmission of HBV during childbirth. Due to the long incubation period and high rates of asymptomatic infection, administration is recommended regardless of a mother’s infection status.
Table 1: Hepatitis B vaccine brands and schedules available in Australia
| Vaccine brand and antigen | 年龄 | Dose, hepatitis B antigen content and route | Recommended schedule* |
| Monovalent vaccines | |||
| Engerix-B (paediatric formulation) 乙型肝炎 | < 20 years | 0.5 mL (10 µg) 我是 | 3 doses, minimum 1 month between doses 1 & 2, minimum 4–6 months between doses 1 & 3* |
| H-B-Vax II (paediatric formulation) 乙型肝炎 | < 20 years | 0.5 mL (5 µg) 我是 | |
| Engerix-B (adult formulation) 乙型肝炎 | ≥ 20 years^ | 1.0 mL (20 µg) 我是 | 3 doses, minimum 1 month between doses 1 & 2, minimum 4–6 months between doses 1 & 3* |
| H-B-Vax II (adult formulation) 乙型肝炎 | ≥ 20 years^ | 1.0 mL (10 µg) 我是 | 3 doses, minimum 1 month between doses 1 & 2, minimum 4–6 months between doses 1 & 3 |
| H-B-Vax II (dialysis formulation) 乙型肝炎 | ≥ 20 years | 1.0 mL (40 µg) 我是 | 3 doses, minimum 1 month between doses 1 & 2, minimum 6 months between doses 1 & 3 |
| Combination vaccines | |||
| Infanrix hexa OR 瓦克斯利斯 DTPa, polio, hepatitis B, Hib | ≥6周 | 0.5 mL (10 µg) 我是 | 3 doses, minimum 1 month between dose 1 & 2, minimum 2 months between dose 2 & 3# |
| Twinrix Junior (360/10) hepatitis A and B | 1– <16 years | 0.5 mL (10 µg) 我是 | 3 doses, minimum 1 month between doses 1 & 2 minimum 6 months between doses 1 & 3 |
| Twinrix (720/20) hepatitis A and B | 1– <16 years | 1.0 mL (20 µg) 我是 | 2 doses, minimum 6 months apartΩ |
| ≥ 16 years | 3 doses, minimum 1 month between doses 1 & 2, minimum 6 months between doses 1 & 3* |
* Refer to Australian Immunisation Handbook for advice on accelerated schedules for those at imminent risk of exposure to hepatitis B.
^ Adolescents aged 11–15 years can receive a 2-dose schedule of Engerix-B adult formulation or HB-Vax II adult formulation, given 6 months apart as an alternate schedule.
# Infants vaccinated overseas who received a dose at birth, 1–2 months and > 6 months are considered fully vaccinated (birth dose is considered as a valid dose 1, no need to complete a 4th dose).
Ω Do not use this schedule if individual is at imminent risk of hepatitis B exposure (e.g. close contact).
shaded boxes indicate NIP-scheduled vaccines.
Interchangeability of brands
Infanrix hexa 和 瓦克斯利斯 能 be used interchangeably to complete a vaccine course.
Switching brands between Engerix B and H-B-Vax II to complete a vaccine course is not recommended due to the different processes utilised to manufacture these vaccines. If the brand required to complete an already commenced course in unavailable, adults are recommended to receive 2 doses of the corresponding paediatric vaccine simultaneously (ensuring they are injected 2.5 cm apart when using the same limb). Refer to Updated ATAGI clinical advice regarding alternatives during supply shortage of the adult formulations of hepatitis B vaccines 了解更多信息。
副作用
常见副作用 following vaccination include irritability, drowsiness, injection site pain, redness and swelling, and low-grade fever, nausea and general aches and pains.
Hepatitis B serology
Performing serology following hepatitis B vaccination is not routinely recommended, however may be indicated in some circumstances such as for:
- those at risk of severe complications of hepatitis B (e.g. people who have HIV , people with pre-existing liver disease)
- sexual partners or household contacts of people living with hepatitis B
- those with impaired renal function
- infants born to mothers who are chronically infected with HBV.
It is important to note that serology may be less reliable when conducted more than 4 to 8 weeks post the last dose of vaccination. This is because circulating anti-HBs levels decline over time even when immune memory remains, meaning results are not a reliable indicator of immunity. The exception to this is in infants born to mothers chronically infected with hepatitis B; serology should be performed 3-12 months after completion of the infant schedule (and no younger than 9 months of age) to avoid detecting maternal antibodies and HBIG (hepatitis B immunoglobulin) given at birth.
Table 2: Interpretation of hepatitis B serology and actions required
| Result | Outcome | Action required |
| anti-HBs ≥ 10 m IU/mL | immune | no further action required |
| anti-HBs < 10 m IU/mL | non-immune | 1. administer single age-appropriate dose of vaccine (4日 dose) 2. check anti-HBs 4 weeks later - if anti-HBs ≥ 10 m IU/mL, no further action required - if anti-HBs < 10 m IU/mL, investigate possibility of HBV infection by ordering HBsAg and Anti-HBc blood test - if no infection, follow MVEC's pathway for hepatitis B non-responders (detailed below in the section: Recommendations for specific populations) |
Further guidance can be found at The Australian Immunisation Handbook: Hepatitis B; Laboratory diagnosis.
Recommendations for specific populations
Infants born to mothers known to be HBV positive
Infants born to mothers known to have chronic hepatitis B must receive:
- a birth dose of monovalent hepatitis B vaccine
- hepatitis B immunoglobulin (HBIG).
These are recommended, and ideally administered on the day of birth (preferably within 12 hours), at the same time, in separate thighs. HBIG needs to be administered within 48 hours after birth (efficacy is significantly reduced if administration is delayed > 48 hours after birth) and the vaccine up to 7 days after birth. The routine scheduled 3 dose course of hepatitis B vaccine should also be completed at 6 weeks, 4 months and 6 months (as per the NIP).
If these precautions are followed it is safe for the infant to be breastfed.
The infant should have serology performed 3 to 12 months post the 6-month dose of hepatitis B vaccine (and no earlier than 9 months of age).
Refer to the Immunisation Handbook: Hepatitis B, recommendations for other groups for detailed guidance.
People with impaired renal function
People with impaired renal function (defined as chronic kidney disease 4-5, GFR < 30ml/min +/- requiring dialysis) are at increased risk of hepatitis B infection. This is complicated by this patient cohort having a diminished immune response to hepatitis B vaccination. Whilst the cause of this suboptimal response is not completely understood, it has been established that the earlier a patient is vaccinated in the disease progression, the better the response and more long-term protection they will have.
MVEC recommends using the combination hepatitis A and B vaccine, Twinrix (720/20) in this patient group (see Table 3). There is evidence to suggest that using this vaccine can enhance seroconversion. It also has the added benefit of providing hepatitis A protection. If immune response to hepatitis B remains sub-optimal following the vaccination recommendations in Table 3, please refer to the below information on hepatitis B non-responders in this section.
Table 3: Recommended vaccine schedule for those with renal impairment using combined hepatitis A and B vaccine (Twinrix (720/20))
WordPress Tables Plugin疾病诊断年龄 Twinrix (720/20)* Serology required < 12 months 2 doses, 6 months apart
(commence vaccine course at ≥ 12 months)- at diagnosis
- 1 month after 2nd dose of Twinrix (720/20) (month 7)
- every 12 months thereafter≥12个月 if baseline anti-HBs titre ≥ 10 m IU/mL at diagnosis:
2 doses, 6 months apart- at diagnosis
- 1 month after 2nd dose of Twinrix (720/20) (month 7)
- every 12 months thereafterif baseline anti-HBs titre < 10 m IU/mL at diagnosis:
3 doses, 1 week between doses 1 & 2, 5 months between doses 2 & 3- at diagnosis
- 1 month after 2nd dose of Twinrix (720/20) (month 2)
- 1 month after 3rd dose of Twinrix (720/20) (month 7)
- every 12 months thereafter* Twinrix (720/20) is a combination hepatitis A and B vaccine. It contains 720 ELISA units of hepatitis A virus and 20mcg of hepatitis B surface antigen protein. Each dose is 1.0 mL given intramuscularly.
Hepatitis B non-responders
A non-responder to hepatitis B vaccination is any person with a documented age-appropriate vaccine history, who has an anti-HBs level of <10 m lU/mL 4 to 8 weeks following the final vaccine dose.
Recommendations for how to promote seroconversion in this population vary with different studies. MVEC recommends the following immunisation pathway for hepatitis B non-responders: MVEC pathway for hepatitis B non-responders ≥ 12-months of age (December 2024).
Persistent non-responders should be informed of their immune status and advised to minimise the risk of exposure.
Hepatitis B immunoglobulin (HBIG) may be given to non-immune persons within 72 hours of exposure to prevent infection. Refer to The Australian Immunisation Handbook: Table: Post-exposure prophylaxis for non-immune people exposed to a source that is positive for hepatitis B surface antigen or has an unknown status 了解更多信息。
资源
-
- Australian Immunisation Handbook: Hepatitis B
- Better Health Channel: Hepatitis B
- B Positive: A Guide for Primary Care Providers
- MVEC pathway for hepatitis B non-responders ≥ 12-months of age (December 2024)
- MVEC：实体器官移植受者
- MVEC：早产儿免疫接种
- MVEC: Breastfeeding and vaccines
- RCH 临床实践指南：针刺伤
- Tung J、Carlisle E、Smieja M、Kim PT、Lee CH。甲型和乙型肝炎联合免疫与乙型肝炎单独免疫对血液透析患者乙型肝炎血清保护作用的随机临床试验。 Am J Kidney Dis。 2010；56(4)：713-9。
- Playford EG, Hogan PG, Bansal AS, Harrison K, Drummond D, Looke DF, Whitby M. 皮内重组乙型肝炎疫苗，适用于对肌肉注射疫苗无反应的医护人员。感染控制和医院流行病学 2002 年 2 月；23(2)：87-90
作者： Nigel Crawford（默多克儿童研究所 SAEFVIC 主任）和 Rachael McGuire（默多克儿童研究所 SAEFVIC 研究护士）
审核人： Rachael McGuire (Education Nurse Coordinator, Melbourne Vaccine Education Centre), Katie Butler (Education Nurse Coordinator, Melbourne Vaccine Education Centre), Nigel Crawford (Director, SAEFVIC and MVEC, Murdoch Children’s Research Institute) and Laura Voss (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)
日期： December 2024
本章节内的材料将随着新信息和新疫苗的出现而进行更新。墨尔本疫苗教育中心（MVEC）职员定期审阅材料的准确性。
You should not consider the information on 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.