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


  • Avatar
    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?

  • Avatar
    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

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

    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 🙂

  • Avatar
    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?

  • Avatar
    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,


  • Avatar
    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?


  • Avatar
    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.

  • Avatar
    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.

  • Avatar
    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?

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