And the hepatitis B vaccine is a purified vaccine, just containing the hepatitis B surface antigen. No other components. It’s an inactivated vaccine, no risk of acquiring hepatitis. It is produced in a yeast system so it does contain yeast protein, aluminum hydroxide as an adjuvant, as well as thimerosal. And if there’s time we’ll talk about the thimerosal issue which has resulted in some changes to the recommendations on the slides and in the syllabus, but these are very short term and for test-taking purposes we can just use the old schedule.
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The side effects of hepatitis B vaccine are mainly local side effects, local tenderness and these have an excellent vaccine response after immunization, greater than 95% immunogenicity in infants, greater than 90% efficacy and in general with this inactivated vaccine, giving the primary series of hepatitis B vaccine will result in at least an 8-10 year duration of immunity and this is still being followed up. But it looks very promising, in terms of long term immunity. In the future it may be required, but long duration immunity to date.
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There are two different hepatitis B vaccines. In the past this has been very confusing in terms of different schedules, but for pediatrics – less than 20 years of age – there are two different vaccines but there is a unit dose for each of them, and so that really simplifies things. So the schedule for vaccination, for universal immunization, the routine recommendation is for infants of hepatitis B surface antigen-negative mother, to give a three -dose vaccine series – and there is a little bit of leeway in the recommendation – to give the first dose at two months, the second dose one to two months later, and the third dose at 6-18 months of age. Therefore you have these common schedules that you will see that fit within these guidelines; 0, 1 and 6 months, 2, 4 and 12 or 2, 4 and 6 months of age. The one caveat relates to preterm infants less than 2 kg do not have as good of an immune response to hepatitis B vaccine so the first dose should be given when they are 2 kg or two months of age. Now there has been the recent thimerosal issue which has occurred, with new recommendations in July of this year, to delay the first dose of hepatitis B vaccine to at least two months of age because it does contain thimerosal. That is a temporary issue. The manufacturers of hepatitis B vaccine should have thimerosal-free hepatitis B vaccine available within the next few months. If there is a cutting edge issue, it is interesting how these recommendations came about, but for taking the Pediatric Board, I would just follow these old recommendations.
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Now for infants of hepatitis B surface antigen-positive mothers, they need also to get hepatitis B immune globulin, H-BIG, within 12 hours of birth and this provides immediate antibody. In addition, hepatitis B vaccine should be given at 0, 1 and 6 months of age. The first dose within 12 hours of birth and this will result in sustained antibody production. The hepatitis B Vaccine and H-BIG may be administered simultaneously but they should be at separate sites and obviously with separate syringes. There is no changes regarding the thimerosal issue in regards to infants of hepatitis B surface antigen-positive mothers. Also no changes in instances of mothers who have unknown hepatitis B surface antigen status. These children should get hepatitis B vaccine at 0, 1 and 6 months of age. The mother should be screened. If they are hepatitis B surface antigen-negative, then they can just complete the series. If they are hepatitis B surface antigen-positive then they should receive hepatitis B immune globulin as soon as possible, and complete the vaccine series as well.
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