An Evidence-based Practical Guide to Vaccination for Hepatitis B Virus

Abstract

The hepatitis B virus (HBV) is highly infectious, with over 292 million chronically infected people worldwide and up to 2.4 million in the United States. Following infection, clinically silent liver damage can ensue, but symptoms or signs of advanced disease, including cirrhosis and hepatocellular carcinoma, can take decades to emerge. HBV has the heaviest public health burden of all hepatitis viruses and has now surpassed other major communicable diseases (eg, HIV, diarrheal disease, malaria, tuberculosis) as a leading cause of death globally. Preventing transmission is essential, and efforts are in place to reinforce screening, vaccination, and routine follow-up. Three safe and effective vaccines are available in the United States and other countries for HBV prevention, and the benefits of vaccination in preventing infection and its sequelae have been substantiated. For the first time in over 25 years, a new Food and Drug Administration-approved vaccine is available that offers a high degree of immunogenicity after 2, rather than 3, injections. Persistent challenges include the underutilization of vaccination, choice of vaccine, incomplete vaccinations, varying needs in different populations, management of nonresponders or those with undocumented or incompletely documented vaccination courses, and questions about whether and when booster injections may be needed. A panel of US academic hepatologists with expertise and experience in preventing and managing HBV infection have collaborated to write this practical clinical paper intended to guide clinicians in vaccinating for HBV and address questions that regularly arise in the clinic.

Response to Intradermal Route of Hepatitis B Vaccination in Children on Maintenance Hemodialysis: A Single Center Experience

“…7 Measures including intradermal (ID) route, use of third generation vaccines with newer adjuvants or immunostimulants have reported better response rates. 8 Administration of ID HBV in healthy children 9 and in those with conditions like celiac disease 10 has shown comparable seroprotection rates of more than 90% similar to that of the primary Hep B vaccination. While, multiple studies in adults 11 have shown better efficacy of ID HBV route in non-responders to the IM route; no study to the best of our knowledge has been conducted in pediatric hemodialysis patients.…”