Friday, 8 July 2016

Hepatitis B vaccine

PLEASE NOTE the following blog is related to the 
PROVISION OF HEPATITIS B VACCINE FOR TRAVELLERS only 

A few people have mentioned to me of late about the rapid schedule of hepatitis B vaccine just now being 0, 1 and 2 months.  I previously thought one gave a 4th reinforcing dose at 12 months. This remains most certainly the case for infants at continued risk and is the schedule used for babies born to hepatitis B positive mothers.  (see page 174 of the Green Book).

However reviewing all the information, the evidence remains confusing. Wherever the text is in lime green, it will take you to the relevant link online - current at the time of posting this blog today !  Sorry this is such a long posting.

The Green Book on page 175 states for pre-exposure prophylaxis in most adult and childhood risk groups, an accelerated schedule should be used with vaccine given at zero, one and two months.  Only for those infants who are at continued risk, a fourth dose is recommended at 12 months.  An alternative schedule at zero one and six months should only be used where rapid protection is not required and there is a high likelihood of compliance.

The TRAVAX information summary chart for hepatitis B vaccine for adults concurs with this information.

The NaTHNaC summary chart for hepatitis B vaccine states the accelerated schedule of 0, 1 and 2 months and a fourth dose at 12 months for Engerix B (20mcg/1ml) but for HBVAXPRO Adult states the accelerated schedule of 0, 1 and 2 months.

The SPC for Engerix B 20mcg (updated 24.11.15) and HBVAXPRO 10mcg (updated 05.06.14) at both state a fourth dose should be administered at 12 months if using a 0, 1 and 2 month schedule.

So I’m confused!  However, remember the Green Book chapter 4, page 25, first paragraph states ...Recommendations on immunisation procedures are based on currently available evidence and experience of best practice. In some circumstances, this advice may differ from that in vaccine manufacturers’ Summaries of Product Characteristics (SPCs). When this occurs, the recommendations in this book (which are based on current expert advice received from the Joint Committee on Vaccination and Immunisation (JCVI) should be followed.

Therefore I conclude I will go with a 0, 1 and 2 month schedule with usually NO 4th reinforcing dose at 12 months when appropriate!

The booster at 5 years of course is another debate!



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