Thursday 13 July 2017

Hepatitis B - New Green Book chapter

A new Green Book chapter (18) was posted online on 6th July 2017.  This new version includes information about the introduction of hepatitis B into the childhood immunisation programme in the hexavalent combination vaccine which will be given to babies born on or after 1st August 2017.  For this reason there are currently two versions of chapter 18 as the information for babies born up to and including 31st July remains current.   However on this holding page the information 'For indications other than babies, we recommend that you consult the new chapter that contains the most recent advice', is relevant so here is a short summary of some of the changes I've noticed with an emphasis on travel health.

The new chapter has been reordered is some places, but the new type font makes it easier to read and I liked the layout.  The pages have been re numbered and at the bottom of each page it has the chapter number then the page number e.g. Chapter 18 -1 and it ends at Chapter 18 - 24.  Terminology for intravenous drug users (IDU) has been changed to people who inject drugs (PWID).

What is different for travel?
The change is found on page 13 under the heading Reinforcing doses for those who have received pre-exposure immunisation.  An increased number of references have been given and the text includes information from the World Health Organization.   The conclusion in this section is that the current UK recommendation is that those who have received a primary course of immunisation, including children vaccinated according to the routine childhood schedule and individuals at high risk of exposure, do not require a reinforcing dose of HepB-containing vaccine, except in the following categories:
  • healthcare workers (including students and trainees), who should be offered a single booster dose of vaccine, once only, around five years after primary immunisation
  • patients with renal failure 
  • at the time of a significant exposure (see the chapter, but this group would include babies born to hepatitis B positive mothers )
Basically we would no longer give a booster to a traveller at 5 years under normal circumstances and whereas the previous chapter was more difficult to clarify, this is now a lot clearer.  

OTHER ITEMS OF INTEREST but NOT TRAVEL RELATED (but please ensure you read further)

Babies born to hepatitis B infected mothers management which is named the selective neonatal immunisation programme as follows:
  • A monovalent hepatitis B vaccine given at birth (within 24 hours of delivery as already actioned currently) 
  • A monovalent hepatitis B vaccine given at 4 weeks
  • A hexavalent hepatitis B-containing vaccine at 8 weeks, then at 12 weeks and at 16 weeks
  • A monovalent hepatitis B vaccine at one year, alongside a test for HBsAg.
A further dose at 3 years 4 months is NO LONGER recommended but this pre-school booster check should be used to check the child has been fully immunised against hepatitis B and tested for infection.  

A newborn infant born to a hepatitis B negative woman but known to be going home to a household with another hepatitis B infected person should be offered a monovalent dose of hepatitis B vaccine before discharge from hospital and then continue to routine schedule at 8 weeks.  

If you are involved in this type of management please make sure you read the chapter (page 13 - 15)


  • Blood testing - information remains the same that we would not blood test a traveller but for those at occupational exposure the chapter now says anti-HBs titres should be checked ONE TO TWO MONTHS after the completion of a primary course (rather than 1 - 4 months as in the previous chapter.  See page 18
  • A new heading: neurological conditions has been added on page 20
  • A new short paragraph added under adverse reactions says: Confirmed anaphylaxis occurs extremely rarely. Data from the UK, Canada and the US point to rates of 0.65 to 3 anaphylaxis events per million doses (Bohlke et al., 2003; Canadian Medical Association, 2002).  See page 21
  • Under 'supplies' details are included for Scotland and Northern Ireland.

PLEASE REMEMBER - this is a short resume of items I thought may be useful to know from this new chapter, but please make sure you go to the publication and read for further information.

Please note my disclaimer

Further resources 
Green Book chapter 18 - Hepatitis B 
Hexavalent combination vaccine: programme guidance from Public Health England
NaTHNaC factsheet Hepatitis B  
A previous blog about Hepatitis B re 0, 1 and 2 month schedule (please note this was written in July 2016 so some of the links may not be working now)

but look out for possible news items updating on this chapter on both NaTHNaC and TRAVAX 

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