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Hepatitis B

 Hepatitis B Vaccine

Hepatitis B is a virus that causes an infection of the liver, leading to inflammation and swelling.

The disease

  • 1-2% develop fulminant hepatitis, often causing death (93%).  Many develop chronic hepatitis, which leads to liver cirrhosis and hepatocellular (liver cancer) later in life.  90+% of infected infants will become chronic carriers.
  • Is spread through blood and bodily fluids..
  • ~100,000 cases per year in the U.S. Very high numbers worldwide (7% or more of the population in some areas).  15 million people worldwide are infected.

The vaccine

  • CDC recommended schedule: birth, 1-2 months, 6-18 months.
  • Who should not get the vaccine?
  • Ingredients: 250 mcg aluminum, yeast protein, sodium chloride, phosphate buffers.

Special topics

  • What is the relationship between the Hepatitis B vaccine and Multiple Sclerosis?
  • What is the relationship between the Hepatitis B vaccine and risk of developing autism?
  • Is there any thimerosal in the currently used Hepatitis B vaccine?

Research citations for Hepatitis B

Carey, William MD, et al. “Hepatitis B” First Consult. 13 February 2012. Web. 12 May 2023.

Broderick, A MB BCh, MMedSc, FRCPI, et al. “Clinical manifestations and diagnosis of hepatitis B virus infection in children and adolescents” UpToDate. April 2023. Web. 13 May 2023. 

Hamborsky J, Kroger A, Wolfe S. “Epidemiology and Prevention of Vaccine-Preventable Diseases: Hepatitis B” Centers for Disease Control and Prevention. 13th ed. Washington D.C

Hepatitis B “Engerix vaccine package insert”. GlaxoSmithKline. Accessed 13 May 2023

Ozakbas S, et al. “Development of multiple sclerosis after vaccination against hepatitis B: a study based on human leucocyte antigen haplotypes.” Tissue Antigens. 2006 Sep;68(3):235-8.

Karussis D, Petrou P. The spectrum of post-vaccination inflammatory CNS demyelinating syndromes. Autoimmun Rev. 2014 Mar;13(3):215-24.

Mikaeloff Y, et al. Hepatitis B vaccine and risk of relapse after a first childhood episode of CNS inflammatory demyelination. Brain. 2007 Apr;130(Pt 4):1105-10. Epub 2007 Feb 1.

Mikaeloff Y, Caridade G, Suissa S, Tardieu M. Hepatitis B vaccine and the risk of CNS inflammatory demyelination in childhood. Neurology. 2009 Mar 10;72(10):873-80. doi: 10.1212/01.wnl.0000335762.42177.07. Epub 2008 Oct 8.

Mikaeloff Y, Caridade G, Rossier M, Suissa S, Tardieu M. Hepatitis B vaccination and the risk of childhood-onset multiple sclerosis. S, TAr ch Pediatr Adolesc Med. 2007 Dec;161(12):1176-82.

Bogdanos DP, et al. “A study of molecular mimicry and immunological cross-reactivity between hepatitis B surface antigen and myelin mimics.” Clin Dev Immunol. 2005 Sep;12(3):217-24.

Dominique Le Houezec “Evolution of multiple sclerosis in France since the beginning of hepatitis B vaccination” Immunol Res. 2014; 60: 219–225.

DeStefano F., et al. Hepatitis B vaccine and risk of multiple sclerosis. Expert Rev Vaccines. 2002 Dec;1(4):461-6.

Langer-Gould A1, et al. Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating diseases. JAMA Neurol. 2014 Dec;71(12):1506-13. doi: 10.1001/jamaneurol.2014.2633.

Gallagher CM, Godman M. Hepatitis B triple series vaccine and developmental disability in US children aged 1-9 years. Toxicology and Environmental Chemistry 2008;90(5):997-1008.

Gallagher CM, Goodman MS. Hepatitis B vaccination of male neonates and autism diagnosis, NHIS 1997-2002. J.Toxicol.Environ.Health A 2010;73(24):1665-77.

Michael E. Pichichero, MD. United Nations Environmental Program (UNEP)-convened Intergovernmental Negotiating Committee Meeting 4 (INC4), 3 to 4 April 2012, Salle D, WHO headquarters, Geneva, Switzerland.  Web. 28 January 2016.

Langer-Gould A1, et al. Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating diseases. JAMA Neurol. 2014 Dec;71(12):1506-13. doi: 10.1001/jamaneurol.2014.2633.

Roush, S. MT, MPH, et al. “Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States.”  JAMA. 2007;298(18):2155-2163. doi:10.1001/jama.298.18.2155.

Aghakhani A, et al. Persistence of antibody to hepatitis B surface antigen among vaccinated children in a low hepatitis B virus endemic area. World J Pediatr. 2011 Nov;7(4):358-60. doi: 10.1007/s12519-011-0286-4. Epub 2011 Aug 27.

Rezaei M, et al. Seroprotection after hepatitis B vaccination in children aged 1 to 15 years in central province of Iran, Semnan.J Prev Med Hyg. 2014 Mar;55(1):1-3.

McMahon BJ, et al. Antibody levels and protection after hepatitis B vaccination: results of a 15-year follow-up.Ann Intern Med. 2005 Mar 1;142(5):333-41.

McMahon BJ, et al. Antibody levels and protection after hepatitis B vaccine: results of a 22-year follow-up study and response to a booster dose. J Infect Dis. 2009 Nov 1;200(9):1390-6. doi: 10.1086/606119

Bialek SR, et al. Persistence of protection against hepatitis B virus infection among adolescents vaccinated with recombinant hepatitis B vaccine beginning at birth: a 15-year follow-up study. Pediatr Infect Dis J. 2008 Oct;27(10):881-5. doi: 10.1097/INF.0b013e31817702ba.

Banatvala JE, et al. Hepatitis B vaccine — do we need boosters? J Viral Hepat. 2003 Jan;10(1):1-6.

Madaliński K, et al. Current views on the persistence of immunity following hepatitis B vaccination. Przegl Epidemiol. 2015;69(1):47-51, 147-50.

Travers CP, et al. Follow up of infants born to women with hepatitis B in the National Maternity Hospital. Ir Med J. 2015 May;108(5):147-9.

Pan CQ, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol. 2012 May;10(5):452-9. doi: 10.1016/j.cgh.2011.10.041. Epub 2011 Nov 9.

Bhattacharya H., et al. Status of hepatitis B infection – a decade after hepatitis B vaccination of susceptible Nicobarese, an indigenous tribe of Andaman & Nicobar (A&N) islands with high hepatitis B endemicity. Indian J Med Res. 2015 May;141(5):653-61.

Hsu HY, et al. Universal infant immunization and occult hepatitis B virus infection in children and adolescents: a population-based study. Hepatology. 2015 Apr;61(4):1183-91. doi: 10.1002/hep.27650. Epub 2015 Feb 10.

Salama II, et al. Persistence of protection to hepatitis B vaccine and response to booster dose among children and adolescents in Dakahleya- Egypt.Egypt J Immunol. 2014;21(1):13-26.

Saffar H., et al. Prevalence of hepatitis B virus seromarkers in young adults vaccinated at birth; impact on the epidemiology of hepatitis B infection in iran. Hepat Mon. 2014 May 1;14(5):e17263. doi: 10.5812/hepatmon.17263. eCollection 2014.

Bae SK, et al. Sequential occurrence of acute hepatitis B among members of a high school Sumo wrestling club. Hepatol Res. 2014 Oct;44(10):E267-72. doi: 10.1111/hepr.12237. Epub 2013 Nov 7.

Tobe K., et al. Horizontal transmission of hepatitis B virus among players of an American football team. Arch Intern Med. 2000 Sep 11;160(16):2541-5.

Stacey A, Atkins B. Infectious diseases in rugby players: incidence, treatment and prevention. Sports Med. 2000 Mar;29(3):211-20.

Boyce DE, et al. Viral hepatitis in a homeless shelter in Hawai’i. Hawaii Med J. 2009 Jun;68(5):113-5.

Lesson tags: hepatitis b, immunization, vaccines
Back to: Vaccines Demystified

Comments:

  • Michelle L Tribble
    May 30, 2023 at 4:24 pm

    MS runs in our family, but we also want our child protected in case he wants to play contact sports someday. How do I resolve this dilemma?

    Reply
    • Erika Krumbeck, ND
      May 31, 2023 at 4:25 pm

      Hi Michelle,

      This is definitely more challenging.

      First, remember that the risk of MS in childhood is still very, very low. I strongly recommend listening to the full office hours on this subject if you haven’t already. You could also delay the Hep B vaccine until he is older, just prior to doing contact sports.

      By the way, milk protein can also be a trigger for MS, so you may want to consider reducing or eliminating cow’s dairy.

      Reply
  • Darko Dodig
    December 12, 2022 at 4:33 pm

    Hi, I have two questions:

    1. What does chronic infection mean? Does this mean your immune system was not able to resolve the infection and so if you take a blood test you show up HEP B +? Or is chronic infection used to describe having symptoms of Hepatitis B?

    2. What is the infant HEP B infection rate? Do you have a statistic on that?

    Thank you

    Reply
    • Erika Krumbeck, ND
      December 14, 2022 at 10:40 am

      Hi Darko,

      Yes, chronic infection means your immune system was not able to clear the infection. 95% of adults clear a Hep B infection on their own. But 90% of infants will NOT clear the infection. These children will become chronic Hep B carriers. Chronic Hep B leads to liver cancer, liver cirrhosis or liver failure later in life (10-20 years later, typically.)

      The Hep B infection rate in the US and Canada is pretty low. The statistics vary widely by specific area. Areas with increased use of opiates (needle-sharing adults) have much higher rates of Hep B than elsewhere.

      ***It is very, very unlikely that an infant will contract Hepatitis B if their primary caregivers are Hep B negative*** This changes later in childhood, (e.g., kids who are wrestling with open wounds or biting each other, or play contact sports, or get an accidental needlestick, etc, could potentially get Hep B).

      Does this answer your question?

      ~Dr. Erika

      Reply
  • Jenny Hennig
    September 15, 2022 at 3:40 pm

    Hi,
    I am wondering what the % of people who have contracted hepatitis are actually vaccinated and if you can still get hepatitis if vaccinated?

    Question #2, is there any information sharing what the hepatitis B numbers are in areas like in areas like United States and Canada.

    Thanks 🙂
    -jenn

    Reply
    • Erika Krumbeck, ND
      September 22, 2022 at 1:18 pm

      Hi Jenn,

      The vaccine is effective in about 95-98% of patients. (So about 2-5% could possibly get the disease even while vaccinated). It is always possible to still get the disease, since there are always a small percentage of people who do not develop antibodies. It just isn’t common!

      Some studies also show that the vaccine appears to be effective for about 20 years after vaccination.

      There are an estimated 850,000 people in the US that are currently infected with Hepatitis B. 67% of them have NO symptoms. Asian Americans and Pacific Islanders are twice as likely to have a Hepatitis B infection.

      Hep B rates are growing in areas affected by high opioid use. Kentucky, Tennessee and West Virginia are having very high rates of Hep B increase (114% increase in the last few years).

      Canada has much lower rates, though they are noting some increase in cases in New Brunswick and Nova Scotia.

      In general, our rates are much lower than in Southeast Asia and the Pacific Islands.

      Hope this helps!

      Reply
  • Tiffany Garber
    September 5, 2021 at 8:30 pm

    I live in Hawaii. You mentioned the Pacific Islands being more risky, is Hawaii included? Also, I declined when she was a baby, she is now almost 3 years old. Would you recommend it now or just want until she is closer to the teenage years?

    Reply
  • Jaclyn Hagel
    January 13, 2021 at 10:51 pm

    Hi Dr. K,

    How much time would you recommend between doses? We are wanting to wait until our baby is 1 year old for the first dose as we live fairly remote in the Northwest Territories, with much less risk on contracting the virus.

    Thank you,

    Jaclyn

    Reply
    • Erika Krumbeck, ND
      January 20, 2021 at 3:11 pm

      Is this for Hepatitis B in particular, or for all vaccines? For Hepatitis B you can give the 2nd dose a minimum of 4 weeks later, and the 3rd dose a minimum of 8 weeks after the 2nd shot. I typically recommend every 2 months, unless the child is at risk of contracting Hep B.

      ~Dr. K

      Reply
  • tiffanybloomingdale
    February 4, 2020 at 7:29 am

    Hi Dr. K,

    Are the “office hours” something you’ve recorded? If so, where do I find them?

    Thanks,
    Tiffany

    Reply
    • Erika Krumbeck, ND
      February 13, 2020 at 1:06 pm

      I have two – they are the last 2 lessons! Let me know if you can’t find them.

      Reply
  • THETIJUANAMAMA
    February 9, 2019 at 1:33 pm

    If we wanted to wait until our kids are older to start with the HepB vax, is there a specific age that you recommend? Neither my husband nor I are HepB carriers but we do live internationally (Mexico) and understand there may be a higher exposure risk as we work with immigrants, migrants, and poverty level communities.

    Reply
    • Erika Krumbeck, ND
      February 18, 2019 at 10:24 am

      Sorry for the delay!

      I typically have kids get the vaccine before they would be exposed. In areas with little exposure to hep B that would be before adolescence. If you are working with immigrants, migrants and poverty communities your kids would definitely be at higher risk and I would strongly consider the vaccine. Even here in the US in some areas that are considered “safer” there are many parents who are getting their kids caught up on the Hep B series because of the opioid epidemic and how that has been spreading the disease.

      I hope that helps!

      ~ Dr. Erika

      Reply
  • ashleyhmccloud
    April 10, 2018 at 6:46 pm

    Hi Dr K, thanks for this great information. Just curious, why are vaccines given in does of 3 or more? Why not just once? Thanks.

    Reply
    • Erika Krumbeck
      April 11, 2018 at 8:02 pm

      Hi Ashley,

      I’ll try to make a short answer, and then I can explain in more detail in office hours. The immune system doesn’t make enough antibodies with just one (or two) doses, EXCEPT with the MMR and Varicella vaccines, since they are live virus injected vaccines. (95% of patients get good immunity to those with only 1 dose.) Basically it takes multiple times for the immune system to “see” the antigen before it will make enough antibodies to be protective. And it varies from disease to disease – most are getting excellent tetanus protection with 2 doses, but it takes the full 5 doses to get even halfway decent protection against pertussis.

      Does this make sense?

      Reply
  • dr.mirandawiley
    October 11, 2017 at 9:22 pm

    Hi, Is there any data to indicate the risk of becoming a chronic carrier for toddlers, preschoolers, children, and adolescents? Any indication of when/how dramatically the risk of becoming a carrier drops from the 90+% of infancy down to the 5% of adulthood?

    Reply
    • Erika Krumbeck
      October 11, 2017 at 10:24 pm

      Great question! Here’s your answer from the CDC PinkBook: “Of children who become infected with HBV between 1 year and 5 years of age, 30% to 50% become chronically infected. By adulthood, the risk of acquiring chronic HBV infection is approximately 5%. Acute HBV progresses to chronic HBV in approximately 40% of hemodialysis patients and up to 20% of patients with immune deficiencies”

      Doesn’t 100% answer your question, but it gives you a good idea of how quickly the chronic infection risk drops.

      Reply

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