甲型肝炎
什么是流行性感冒？
Hepatitis A is an infection caused by the hepatitis A virus (HAV). HAV belongs to the family 小核糖核酸病毒科, genus Hepatovirus. It replicates primarily in liver cells and is one of the most common causes of acute hepatitis (inflammation of the liver) worldwide.
Unlike infection with hepatitis B and C viruses, HAV infection does not usually cause chronic liver disease.
流感症状
The incubation period for hepatitis A infection is 15 to 50 days. Infected children generally experience either no symptoms or mild symptoms only. Approximately 70% of infected adults will be symptomatic. Symptoms of infection fit into two distinct phases, a prodromal (pre-icteric) phase and an ictreric (jaundice) phase. Prodromal phase features include general malaise and exhaustion, 发烧， nausea and lack of appetite and abdominal pain. Icteric phase features include pruritus (itchy skin), dark urine, pale stools and yellowing of the eyes and skin.
The duration of symptoms can vary, lasting only a few weeks or as long as 6 months. Liver function tests can take 1 to 2 months to normalise after the onset of infection. In rare cases, infection can result in fulminant hepatitis (acute liver failure), which may be fatal without liver transplant.
Hepatitis A mortality rates increase with age and can be associated with the presence of underlying medical risk factors. Up to 10% of cases will relapse; all relapsed cases will recover.
Rarely, hepatitis A can also lead to pancreatitis, rash, nephritis (kidney inflammation) or glomerulonephritis (inflammation of the glomeruli, small blood vessels in the kidney), pneumonitis (lung tissue inflammation), pericarditis (inflammation of the lining of the heart muscle), haemolysis (the destruction of red blood cells), and acute cholecystitis (gallbladder inflammation). Guillain–Barré syndrome, encephalitis (brain inflammation) and central myelitis (spinal cord inflammation) have also been reported.
结核病是如何传播的？
Hepatitis A is highly infectious. Cases are considered infectious from two weeks prior to the onset of prodromal phase up until either one week after the onset of jaundice (if present) or two weeks after the onset of the prodromal phase (if there is no jaundice). People with asymptomatic infections can still transmit disease.
Transmission occurs through the faecal–oral route, close person-to-person contact, contaminated food and water, and via fomites (e.g. fabric and other surfaces contaminated by faeces). Common sources include:
- eating contaminated raw, frozen or undercooked food
- drinking contaminated water
- touching dirty nappies, linen or towels of a person with hepatitis A
- sharing personal items such as toothbrushes
- being in direct contact (including sexual) with a person with hepatitis A.
HAV can survive in the environment, persisting on unwashed hands for several hours and at least one month at room temperature on surfaces. It can withstand food production processes (heat and freezing) commonly used to inactivate pathogens.
流行病学
The World Health Organization (WHO) estimates that, globally, approximately 1.5 million are infected with HAV people each year. Transmission and infection are more common in low- and middle-income countries with poor sanitation.
In Australia rates of HAV infection are low, with most cases linked to travel to endemic countries or outbreaks relating to contaminated food.
Aboriginal and Torres Strait Islander children are at greater risk of infection than non-Indigenous children. The higher risk of infections stem from factors such as overcrowding and poor sanitation. Following the introduction of the National Immunisation Program (NIP)-funded hepatitis A vaccination for First Nations children in the Northern Territory, Queensland, South Australia and Western Australia, rates of infection and hospitalisations in this population have declined considerably.
预防
Hepatitis A risk can be mitigated though measures such as improved sanitation (water supply and sewerage) and food handling practices (handwashing practice before food preparation, before meals and after toileting).
It is likely that previous infection provides lifelong protection against hepatitis A.
Vaccination is highly effective in preventing infection.
Vaccination
Vaccination against HAV is available through either monovalent or combination vaccines (combined with hepatitis B ). Vaccines are administered intramuscularly (IM).
Vaccination is funded on the NIP for Aboriginal and Torres Strait Islander children living in the Northern Territory, Queensland, South Australia and Western Australia in a 2-dose schedule given at 18 months and 4 years of age.
Other populations at high risk of infection (e.g. those with pre-existing liver disease or other medical risk factors, people traveling to endemic countries, those with occupational exposure risk) may also be recommended vaccination, which is not funded. Refer to the Australian Immunisation Handbook: Hepatitis A – Recommendations for a full list of these recommendations.
Table 1: Hepatitis A vaccine brands available in Australia
| Vaccine brand, antigen, dose and route | 年龄 | Antigen content* | Recommended schedule |
| Monovalent vaccines | |||
| Vaqta Paediatric hepatitis A 0.5 mL 我是 | 1– < 18 years | 25 units of hep A virus protein | 2 doses, minimum 6 months apart^ |
| Vaqta Adult hepatitis A 1.0 mL 我是 | ≥ 18 岁 | 50 units of hep A virus protein | |
| Havrix Junior hepatitis A 0.5 mL 我是 | 2– < 16 years | 720 ELISA units of inactivated hep A virus | |
| Havrix 1440# hepatitis A 1.0 mL 我是 | ≥ 16 years | 1400 ELISA units of inactivated hep A virus | |
| Avaxim hepatitis A 0.5 mL 我是 | > 2 years | 160 antigen units of inactivated hep A virus | |
| Combination vaccines | |||
| Twinrix Junior (360/10) hepatitis A and B 0.5 mL 我是 | 1– <16 years | 360 ELISA units of inactivated hep A virus & 10 mcg hep B surface antigen protein | 3 doses, minimum 1 month between dose 1 and dose 2 and 6 months between dose 1 and dose 3 |
| Twinrix (720/20)# hepatitis A and B 1.0 mL 我是 | 1– <16 years | 720 ELISA units of inactivated hep A virus & 20 mcg hep B surface antigen protein | 2 doses, minimum 6 months apartΩ |
| ≥ 16 years | 3 doses, minimum 1 month between dose 1 and dose 2 and 6 months between dose 1 and dose 3 | ||
| ≥ 16 years | 4 doses, minimum 7 days between dose 1 and dose 2, minimum 21 days between dose 1 and dose 3, minimum 12 months between dose 1 and dose 4β |
* Different 疫苗 manufacturers use different methods and units of measurement for measuring the hepatitis A antigen content in vaccines.
^ All monovalent, age-appropriate hepatitis A vaccines can be used interchangeably to complete a course of vaccination.
# Twinrix (720/20) uses half the hepatitis A antigen content of Havrix 1440 – these vaccines are not interchangeable.
Ω Schedule not recommended for those who are imminently at risk of hepatitis B – refer to MVEC：乙型肝炎 for recommended schedules for those at imminent risk.
β This accelerated schedule should only be used if there is imminent risk of infection (i.e. very limited time before travel to regions with endemic HAV). Allow two weeks or more for optimal immune response to vaccination.
Boosters
There is no routine recommendation for boosters as there is good evidence that a primary course of hepatitis A vaccination provides long‑lasting protection.
副作用
Common side effects of hepatitis A vaccines include injection site pain, redness and swelling.
暴露后预防
Administration of ormal Human 我mmunoglobulin (NHIg) and/or hepatitis A vaccination within two weeks of exposure to the virus can prevent infection or reduce the severity of disease.
He type of product(秒) recommend编辑 depend秒 在 the presence of underlying 医疗风险因素的人群 age of the person needing post。exposure prophylaxis (PEP). THe dose of NHIg is calculated based on the weight of the 疫苗 recipient. Combination vaccines (hepatitis A/B) are not recommended for PEP due to their reduced hepatitis A antigen content.
资源
- The Australian Immunisation Handbook: Hepatitis A
- The Australian Department of Health and Aged Care: Hepatitis A – CDNA National Guidelines for Public Health Units
- ATAGI关于甲肝疫苗的临床建议
- Victorian Department of Health Hepatitis A disease information and advice
- Centers for Disease Control and Prevention: Hepatitis A
作者： Katie Butler (MVEC, Education Nurse Coordinator)
审核人： Rachael McGuire（MVEC，教育护士协调员）
日期： September 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.
B 型流感嗜血杆菌 (Hib)
什么是流行性感冒？
嗜血杆菌 流感病毒是一种 类型 细菌 那个c一个 居住 在人的鼻子和喉咙里。已经被考虑了 的一部分 普通的 植物区系 的 这 鼻咽（上呼吸道) 一般来说 不是 原因e 疾病症状. 然而，w母鸡 细菌 入侵 身体的其他部位, 严重 感染和 可能会发生并发症. 封装菌株 的 嗜血杆菌 流感杆菌 (细菌与 清楚的 多糖 胶囊） 更容易引起侵袭性感染秒 比非封装亚型 （不含多糖胶囊者）. 的 6 种封装亚型 (命名的 AF), B型 （希布） 是 唯一的疫苗–可预防的 拉紧.
流感症状
侵袭性 Hib 感染的症状取决于感染部位（例如大脑、肺部）。
脑膜炎（脑部炎症）是侵袭性 Hib 感染最常见的表现，通常伴有菌血症（血液感染）。侵袭性感染还可表现为中耳炎（耳部感染）、会厌炎（喉咙肿胀）、肺炎（肺部感染）、关节炎（关节感染）、蜂窝织炎（皮肤感染）、骨髓炎（骨骼炎症）和心包炎（炎症）到心脏周围的囊）。
即使进行治疗，发达国家发生的 Hib 脑膜炎病例中有 3% 将致命，10-30% 病例将出现永久性神经系统并发症。
怎样才能传播呢？
Hib 可以通过吸入感染者的呼吸道飞沫（咳嗽或打喷嚏产生）在人与人之间传播。在某些情况下，它也可以通过直接接触传染性分泌物（例如，接触组织或表面上的鼻粘液）来传播。
携带者可能有症状，也可能无症状。只要细菌存在于鼻咽部，人就可以传播细菌。
流行病学
在 1992 年疫苗接种被纳入国家免疫计划 (NIP) 之前，Hib 是澳大利亚儿童侵袭性细菌感染的最大原因。自那以后，报告的 Hib 感染数量减少了 95%。
原住民和托雷斯海峡岛民儿童比非原住民儿童承受更大的疾病负担。
无脾和脾功能减退 是与终生细菌感染风险相关的疾病。因此，患有这些疾病的个体如果没有接受适当的免疫接种，则面临更大的侵袭性疾病风险。
预防
通过肌肉注射灭活结合疫苗（组合疫苗和单抗原疫苗）提供保护。它们在 NIP 上提供：
- 6 weeks, 4 months, and 6 months- Infanrix® hexa/Vaxelis®
- 18 个月 - ActHIB®
注意：5 岁以下患有无脾和脾功能不全的儿童应遵守最新的常规时间表，如果没有，则应让他们接受 跟上来。 5 岁及以上未完成初级疫苗接种的人应接种单剂含 Hib 疫苗。
疫苗副作用
注射部位反应 据报道，接种含 Hib 疫苗后出现发烧症状。 症状通常在最初 4 小时内出现，并在 24 小时内消退 无需干预或 额外的 监控。
作者： Georgina Lewis（默多克儿童研究所 SAEFVIC 临床经理）和 Rachael McGuire（MVEC 教育护士协调员）
审核人： Rachael McGuire（MVEC 教育护士协调员）
日期： 7 月 4, 2023
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。
本站点的信息并非针对你个人健康或你家人个人健康的特定、专业的医疗建议。对于医疗方面的问题，包括有关免疫接种、药物治疗和其他治疗的决定，你务必咨询医疗保健专业人士。
低渗-低反应发作 (HHE)
背景
A hypotonic-hyporesponsive episode (HHE) is defined as the sudden onset of hypotonia (muscle limpness), reduced responsiveness or unresponsiveness, and skin colour changes (pallor or cyanosis) occurring after vaccination in early childhood (< 2 years of age).
HHEs can occur in the period immediately following vaccination, or up to 48 hours after vaccine administration (delayed HHE). The average episode lasts 6 to 30 minutes.
HHEs resolve spontaneously, with most children returning to their pre-vaccination state within 6 hours. There are no long-term sequelae (conditions caused by a previous disease or injury) from having an HHE.
诊断
HHEs are diagnosed based on clinical presentation (e.g. symptoms, timing, resolution of symptoms). Investigations are not helpful for confirming a diagnosis of HHE; this is because HHEs present with transient, self-limiting (resolve on their own) symptoms, and have no long-term sequelae.
Investigations may, however, be useful to exclude other diagnoses such as seizure activity or an allergic reaction (e.g. wheezing, rash or hives).
Immediate HHEs can appear like an immediate vasovagal phenomenon (a fainting episode) but there are some key differences. Fainting episodes present with similar signs and symptoms (e.g. muscle limpness, unresponsiveness, pallor) but with drops in blood pressure and heart rate, usually presenting in an older age group (≥ 2 years of age). HHEs are often preceded by crying and breath holding, with vital signs remaining stable.
协会和发病率
HHEs can occur after any immunisation regardless of the type of vaccine; historically, HHEs were most associated with whole-cell vaccines in early infancy. There has been a decrease in HHE incidence since the change from using whole-cell to acellular pertussis vaccines.
HHE has been observed most often after the first doses of vaccines at 6 to 8 weeks of age. In 2012, 2.2 cases of HHE were reported per 100,000 doses of pertussis-containing vaccine given to children under 1 year of age.
The cause of HHEs is yet to be determined.
治疗
HHEs self-resolve and do not need any active treatment.
Assessment of airway, breathing and circulation is advised as a basic precaution. This can exclude other diagnoses. Careful clinical observation and documentation of the event are vital for a differential diagnosis.
Suspected HHE should be assessed by a medical professional.
对未来剂量的影响
HHE is not a contraindication to further doses of vaccines, including pertussis-containing vaccines. Recurrence rates of a further HHE following subsequent immunisations are low (3.5%).
Your local 疫苗安全服务 can provide advice on whether subsequent vaccines needs to be administered under a period of observation.
Any adverse event following immunisation (AEFI), including HHEs, in Victoria should be reported to 赛维克.
资源
- 澳大利亚免疫手册：接种疫苗后
- 低渗-低反应发作——SAEFVIC 案例研究，2017 年 7 月
- Buettcher M, Heininger U, Braun M, et al. Hypotonic-hyporesponsive episode (HHE) as an adverse event following immunization in early childhood: Case definition and guidelines for data collection, analysis, and presentation. 疫苗. 2007;25(31):5875-5881. doi:10.1016/j.vaccine.2007.04.061
- Hansen J, Decker MD, Lewis E, et al. Hypotonic-hyporesponsive episodes after diphtheria, tetanus and acellular pertussis vaccination. Pediatr Infect Dis J. 2021;40(12):1122-1126. doi:10.1097/INF.0000000000003308
- Crawford NW, McMinn A, Royle J, et al. Recurrence risk of a hypotonic hyporesponsive episode in two Australian specialist immunisation clinics. 疫苗. 2018:36(41):6152-6157. doi:10.1016/j.vaccine.2018.08.062
- ScienceDirect: Hypotonic hyporesponsive episode
作者： Daniela Say（MVEC 免疫研究员）和 Teresa Lazzaro（墨尔本皇家儿童医院免疫服务儿科医生）
审核人： Rachael McGuire (MVEC Education Nurse Coordinator) and Melissa Humann (Research Nurse, SAEFVIC, Murdoch Children’s Research Institute)
日期： September 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.
人乳头瘤病毒 (HPV)
什么是流行性感冒？
人乳头瘤病毒 (HPV) 是一种双链 DNA 病毒，可以感染男性和女性。它会影响一个人的肛门生殖器或呼吸道。已知有 100 多种 HPV 亚型，其中 40 种影响肛门生殖器区域。
流感症状
大多数感染 HPV 的人根本没有表现出急性临床症状，但感染可能会发展为对健康产生重大影响或引发癌症等疾病。
HPV 亚型 6、11、40、42、43、44、54、61、70、72、81 和 89 与病变的发展有关，例如生殖器疣、皮肤疣和呼吸道乳头状瘤病（呼吸道中的疣样病变）道）。呼吸道乳头状瘤病的特征是呼吸道内长疣，可导致气道阻塞，严重时可能致命。
16、18、31、33、35、45、52 和 58 型是 HPV 的致癌（致癌）毒株，与宫颈癌、外阴癌、阴道癌、阴茎癌、肛门癌、口腔癌和口咽癌有关。 澳洲数据 2005-2015 年的一项研究表明，所有宫颈癌中有 77% 与 HPV-16 或 HPV-18 感染有关。
结核病是如何传播的？
HPV 是一种具有高度传染性的病毒，可通过不同形式的亲密接触传播。由于感染通常没有症状，人们往往不知道自己是携带者，并且会在不知不觉中将病毒传播给他人。
生殖器 HPV 通过性接触传播。接触 HPV 的风险可能与一个人拥有的性伴侣数量有关。避孕套可以降低生殖器 HPV 传播的风险，但是并不能完全消除风险。
受感染的母亲可以在分娩过程中将病毒传播给新生儿，导致新生儿口腔 HPV 感染。在某些情况下，这会导致呼吸道乳头状瘤病的发展。
流行病学
由于大多数感染是无症状的，因此 HPV 感染的监测很复杂。据估计，多达 90% 的人口在其生命中的某个时刻会感染至少一种类型的 HPV。宫颈癌是 影响全球女性的第四大常见癌症.
免疫功能低下的人，尤其是 HIV 感染者和男男性行为者 (MSM) 感染 HPV 和患 HPV 相关癌症的风险更高。
预防
疫苗接种可以防止 HPV 感染和 HPV 相关病变和癌症的发展。它最好在一个人变得性活跃之前进行。
澳大利亚有 2 种疫苗可用：
- Cervarix®- 2vHPV 重组疫苗可预防 16 型和 18 型
- Gardasil®9-9vHPV 重组疫苗可预防 6、11、16、18、31、33、45、52 和 58 型。
Gardasil®9 由国家免疫计划 (NIP) 资助，主要通过基于学校的计划为 7 年级（或同等年龄）具有免疫能力的男性和女性提供单剂。 A 资助的追赶 计划也适用于 ≤ 26 岁的个人。
ATAGI 进一步建议 ≥ 26 岁的男性以及任何年龄段的免疫功能低下的高危男性也应接种疫苗。 Gardasil®9 已注册用于 45 岁以下的男性和女性。 Cervarix® 仅注册用于 45 岁以下的女性。
任何年龄的免疫功能低下的人和 26 岁及以上的免疫能力强的人都需要 3 剂方案才能获得最佳保护。剂量应在 0、2 和 6 个月时给药。
副作用
HPV 疫苗接种通常耐受性良好，在最初 24-48 小时内通常会出现轻微的副作用，例如发烧、恶心、头痛、头晕和疲劳。
晕厥（昏厥）在青少年人群中也很常见，但可能与疫苗接种过程有关，而不是疫苗本身。任何容易发生晕厥发作的人都应该在接种疫苗之前和之后躺下 15 分钟，以尽量减少跌倒受伤的风险。
常见问题
我以为 HPV 计划是 2 剂？
对来自世界各地的疫苗效力、有效性和安全性的广泛证据的审查表明，对于 25 岁以下具有免疫能力的个体，单剂 Gardasil®9 提供的保护与接种两剂疫苗相当。因此，从 2023 年 2 月 6 日起，国家免疫计划 (NIP) 改为仅在第 7 年提供单剂接种。
这一建议也反映了世界卫生组织的建议和英国免疫专家的建议。
我在 2022 年接受了 1 剂，现在应该接受第 2 剂，我还需要这个吗？
从 2023 年 2 月 6 日起，1 剂 Gardasil® 9 被认为是一个完整的时间表，任何 25 岁或以下具有免疫能力且之前只接受过 1 剂的人现在都被认为是最新的，无需再接种。此最新状态应反映在 澳大利亚免疫登记 (AIR) 从 2023 年 2 月 11 日起。
免疫受损者的时间表是什么？
免疫力低下的人（无脾/脾功能低下者除外）仍建议接受 3 剂疫苗接种（在 0、2 和 6 个月时）以确保获得最佳保护。
对于已经性活跃的人来说，疫苗值得吗？
接种疫苗可能仍然对性活跃的人有益，因为它可以防止新的疫苗可预防的 HPV 感染、由其他疫苗可预防的 HPV 毒株引起的感染、再次感染他们已经接触过的疫苗可预防的 HPV 毒株以及防止其他部位存在的持续性 HPV 感染。
疫苗接种是一种预防措施，不会治疗当前感染或预防可能由 HPV 相关感染引起的疾病。
≥ 26 岁的人应该接种疫苗吗？
理想情况下，疫苗接种应在接触感染之前（即在性活动之前）进行，但是 26 岁及以上的人群接种疫苗可能会有一些好处。鼓励与医疗保健提供者进行个案讨论，讨论是否建议接种疫苗。
建议接种疫苗的 ≥ 26 岁的个人应接受 3 个剂量疗程（0、2 和 6 个月），费用由患者承担。
资源
- 澳大利亚免疫手册：人乳头瘤病毒
- 传染病免疫（英国）：人乳头瘤病毒章节
- 澳大利亚政府卫生和老年护理部：HPV（人乳头瘤病毒）疫苗
- 新闻：针对年轻澳大利亚人的 HPV 疫苗剂量时间表的变化_2023 年 2 月 6 日
作者： Nigel Crawford（默多克儿童研究所 SAEFVIC 主任）、Georgie Lewis（默多克儿童研究所 SAEFVIC 临床经理）和 Rachael McGuire（默多克儿童研究所 SAEFVIC 研究护士）
审核人： Rachael McGuire（MVEC 教育护士协调员）
日期： 5 月 10, 2023
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。
本站点的信息并非是针对您或您家人个人健康的特定、专业的医疗建议。对于医疗方面的问题，包括有关免疫接种、药物治疗和其他治疗的决定，请务必咨询医疗保健专业人士。
乙型肝炎
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 ski, 或者 when a person’s mucosal surface (nose, eyes or mouth) is exposed to 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 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
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 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。
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