What is hepatitis B?

Hepatitis B is a viral infection of the liver spread by direct contact with the blood or body fluids of an infected person. It occurs worldwide with highest rates reported in parts of East Asia and Sub Saharan Africa. Higher rates of infection are also found in the Amazon, southern parts of Eastern and Central Europe, the Middle East and the Indian subcontinent. The rates of infection in Western Europe and North America are low.

Possible hepatitis B symptoms are feeling or being sick, rash, joint pain, loss of appetite, tiredness and headache as well as flu-like symptoms. Some patients also develop a yellowing of skin and eyes, which is called jaundice. The infection can persist for a long time and become chronic hepatitis B, resulting in liver cancer, damage and failure.

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If you are travelling to an area where hepatitis B is a common illness, you may require a hepatitis B vaccine. The same goes for healthcare workers and medical professionals, who are more likely to be exposed to the infection.

Risk for travellers is low although certain behaviours or activities put individuals at higher risk, particularly when these occur in areas where hepatitis B is more common. These behaviours and activities include:

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• unprotected sex.

• exposure to blood or blood products through occupation, such as healthcare work.

• exposure to contaminated needles through injecting drug use, or as a result of accessing medical or dental care, because of needing emergency treatment or those travelling specifically for medical treatment.

• participation in contact sports.

• adoption of children from risk countries.

• long stay travel.

 

Blood test?

A blood test to check immunity (hepatitis B surface antibody levels) is only recommended for people with kidney failure or those at risk of occupational exposure particularly healthcare and laboratory workers. Travellers are at a lower risk of contracting hepatitis B and do not require a blood test.

Those thought to have a continued high risk of infection should consider having a booster after 5 years. Boosters may be needed after exposure to the infection. If you think you have been exposed to hepatitis B please seek medical attention urgently.

 

Prevention

All travellers should avoid contact with blood and bodily fluids by:

• avoiding unprotected sexual intercourse.

• using appropriate protective precautions where contact is unavoidable e.g. due to occupation

• avoiding tattooing, piercing and acupuncture (unless sterile equipment is used)

• not sharing needles or other injection equipment.

• not sharing shaving equipment

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Any traveller can be at risk of an accident or require emergency treatment. Travellers should be aware that using precautions will also help protect against other blood and body fluid-borne viruses, such as HIV and hepatitis C, for which there are currently no vaccines. A sterile medical equipment kit may be helpful when travelling to resource poor areas.

 

Length of Protection

The WHO has concluded that although knowledge about the duration of protection against infection and disease is still incomplete, studies demonstrate that, among successfully vaccinated immunocompetent individuals, protection against chronic infection persists for 20-30 years or more. Therefore there is no compelling evidence for recommending a booster dose of hepatitis B vaccine in routine immunisation programmes (WHO 2017).

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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 hepatitis B-containing vaccine, except:

• 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. Antibody levels should be monitored annually and a booster given to those who have responded to vaccine previously and whose antibody levels fall below 10mlU/ml. A booster dose should be offered to any haemodialysis patients who are intending to visit high risk countries and who have previously responded to the vaccine, particularly if they are to receive haemodialysis and have not received a booster in the last 12 months.

• at the time of a significant exposure

 

Side effects

The hepatitis B vaccine can cause mild side effects, such as redness and soreness at the injection site. Occasionally, patients feel tired within the first few days after the injection.

Common and very common side effects include:

• temporary soreness

• redness or hardening of the skin around the injection site

• fatigue

• fever

• gastro-intestinal disturbances

• headache

• loss of appetite

• lymphangitis

• malaise

• muscle pain

• irritability

 

Who needs the Hepatitis B vaccine?

Hepatitis B occurs in all parts of the world. In some areas, however, there is an increased risk due to the infection being widespread. Hepatitis B risk areas include parts of eastern Europe, Africa, South and Central America, South East Asia, Russia, India, China as well as some South Pacific Islands. If you are planning to travel to any of these destinations, our pharmacists can advise on whether you require a hepatitis B vaccine. We also provide a combined hepatitis A and B vaccine for travellers who require immunisations against both infections.

 

Vaccination Schedule 

Engerix B (20mcg/ml) 16 years +

• 3 doses: 0, 1 and 6 months

• Accelerated regime: 0, 1 and 2 months. A 4th dose at 12 months can be considered for those in certain risk categories (Please complete the assessment form for more information)

• Very Rapid Schedule of 4 doses (ADULTS ONLY): 0, 7 and 21 days: 4th dose at 12 months.

Engerix B (10mcg/ml) below 15 years:

• 3 doses: 0, 1 and 6 months

• Accelerated schedule: 0, 1 and 2 months; a 4th dose at 12 months can be considered for those in certain risk categories

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Prices 

Engerix B Adults - £65/dose

Engerix B children - £60/dose

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Combination Vaccines

Hepatitis A and Hepatitis B adults, 3 course vaccination £99/dose

Hepatitis A and Hepatitis B children, 3 course vaccination £75/dose

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Additional information

For more information, click here