An update to
Hepatitis B: the green book, chapter 18 was posted on the website on 9th April 2024 and the
update information posted and copied below says that in this new chapter they have
Updated to remove the single booster dose in healthy immunocompetent adults who have completed a primary course, advice for pre-exposure vaccination of recipients of solid organ transplants, more detail on assessing occupational risk and inclusion of 2 new adult vaccines. Signposting to clinical guidance on management of the pregnant woman, including use of antiviral treatment in third trimester.
That's quite a lot of detail and in this blog I only intend to refer to the updated news I've read in the current chapter in relation to travel health. Therefore please look at the chapter if you use hepatitis B vaccine for indications other than travel. This is my interpretation in brief -
Three new vaccines added
- Vaxelis® which is used as a 6 in 1 vaccine in the childhood programme given at 8, 12 and 16 weeks. This is just of interest to be aware of in the programme, because you need to know about this to provide any general vaccines within your pre travel health consultation.
- Heplisav B® Use from the age of 18, dose of 20 micrograms - 0.5ml of two doses on a 0 and 1 month.
- PreHevbri® Use from the age of 18, dose of 10 micrograms – 1.0ml of three doses on a 0, 1 and 6 month schedule
Note: Heplisav B® and PreHevbri® both have a black triangle status. The Green Book says on page 16/17 that both these vaccines may be preferred in those who are likely to have a poorer response to vaccine, or have not responded to other monovalent vaccines. I would advise you to read the full details in the Green Book about these new vaccines. They are included in the National PGD template for hepatitis B, but this document specifically states it cannot be used if a hepatitis B vaccine is being given solely for the purpose of overseas travel. If you were using them for travel purposes you would need to be a prescriber, give under a PSD or develop your own private PGD as hepatitis B vaccines are now a private provision for travel.
The main update for travel is the preferred schedule of 0, 1 and 2 months which in the previous February 2022 edition of the Green Book chapter said '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’.
The rational was that completion rates were achieved with the accelerated schedule in groups where compliance is difficult. It was thought this was likely to offset the slightly reduced immunogenicity when compared with the zero, one and six month schedule.
It stated ‘An alternative schedule at zero, one and six months should only be used where rapid protection is not required and there is high likelihood of compliance.
However in the April 2024 edition of the Green Book chapter, Page 16 stated ‘For pre-exposure prophylaxis in most adult and childhood risk groups, an accelerated schedule should be used (some exceptions discussed below), with vaccine given at 0, 1, 2 and 12 months.
And then on page 17 when going on to discuss boosters, it says ‘the current UK recommendation is that immunocompetent children and adults who have received a complete primary course of immunisation (either 8, 12 and 16 weeks old in babies or the standard 0,1,6 months or accelerated 0,1,2,12 months schedules for children and adults) do not require a reinforcing dose of hepatitis B-containing vaccine’.
SO MY CONCLUSION WOULD BE
- If giving hepatitis B vaccine for travel, give a schedule of 0, 1, 2 and 12 months now in preference to a 0,1 and 6 month schedule
- Advise the traveller they would not need a further booster
- Take note that from the statement at the current time, once children have had the three doses of hep B in the combined 6 in 1 vaccine at 8, 12 and 16 weeks, there is no recommendation for a follow up booster).
Hepatitis B resources related to this posting
Hepatitis B vaccinations (bma.org.uk)
See my travel vaccine guide chart in Tools - item no. 3 here. Below is an extract on the hep B vaccines we could use in a travel context.
