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20-September-2008 09:55:51 - B vaccine Hepatitis B vaccine is a vaccine developed for the prevention of hepatitis B virus infection. The vaccine contains one of the viral envelope proteins, hepatitis B surface antigen HBsAg. After a course of three 3 vaccine injections, an immune system antibody to HBsAg is established in the bloodstream. The antibody is known as anti-HBsAg. This antibody and immune system memory then provide immunity to hepatitis B infection.1 Contents 1 History 2 Recommended populations 3 Response to vaccination 4 Duration of protection 5 See also 6 References History The vaccine was originally prepared from plasma obtained from patients who had long-standing hepatitis B infections. However, vaccines currently used in the United States are made using recombinant DNA technology.2 The two types of vaccines are considered equally effective. In the United States, two of the newer recombinant vaccines are Engerix-B made by GlaxoSmithKline,3 and Recombivax HB4 made by Merck. The recombinant vaccines consist of proteins produced in modified yeast cultures. Unlike plasma-derived vaccines, these recombinant vaccines are not produced using human cell lines or human tissue material.34 Infection with hepatitis B may lead to hepatocellular carcinoma, a type of liver cancer. Therefore, the hepatitis-B vaccines are cancer-preventing vaccines. According to the Centers for Disease Control and Prevention CDC, the hepatitis B vaccine was the first anti-cancer vaccine.5 Recommended populations Babies born to mothers with active hepatitis B infections are recommended to receive treatment reducing the risk of mother-to-child transmission of the hepatitis B infection. As soon as possible and within 48 hours of birth, newborns are vaccinated with hepatitis B surface antigen HBsAg and injected with hepatitis B immune globulin HBIG.6 Many countries now routinely vaccinate infants against hepatitis B. In countries with high rates of hepatitis B infection, vaccination of newborns has not only reduced the risk of infection, but has also led to marked reduction in liver cancer. This was reported in Taiwan where the implementation of a nationwide hepatitis B vaccination program in 1984 was associated with a decline in the incidence of childhood hepatocellular carcinoma.7 In many areas, vaccination against hepatitis B is also required for all health-care and laboratory staff.8 Some college campus housing units now require proof of vaccination as a prerequisite.citation needed Response to vaccination Following the primary course of 3 vaccinations, a blood test may be taken after an interval of 1-4 months to establish if there has been an adequate response, which is defined as an anti-hepatitis B surface antigen anti-Hbs antibody level above 100 mIU/ml. Such a full response occurs in about 85-90% of individuals.9 An antibody level between 10 and 100 mIU/ml is considered a poor response, and these people should receive a single booster vaccination at this time, but do not need further restesting.9 People who fail to respond anti-Hbs antibody level below 10 mIU/ml should be tested to exclude current or past Hepatitis B infection, and given a repeat course of 3 vaccinations, followed by further retesting 1-4 months after the second course. Those who still do not respond to a second course of vaccination may respond to a high dose of vaccine or to intradermal administration.101112 Those who still fail to respond will require hepatitis B immunoglobulin HBIG if later exposed to the hepatitis B virus.9 Poor responses are mostly associated with being over the age of 40 years, obesity and smoking,13 and also in alcoholics, especially if with advanced liver disease.14 Patients who are immunosuppressed or on renal dialysis may respond less well and require larger or more frequent doses of vaccine.9 At least one study suggests that hepatitis B vaccination is less effective in patients with HIV.15 Duration of protection Although initially it was thought that the hepatitis B vaccine did not provide indefinite protection, this is no longer considered the case. Previous reports had suggested vaccination would provide effective cover of between five and seven years,1617 but subsequently it has been appreciated that long-term immunity derives from immunological memory which outlasts the loss of antibody levels and hence subsequent testing and administration of booster doses is not required in successfully vaccinated immunocompetent individuals.1819 Hence with the passage of time and longer experience, protection has been shown for at least 25 years in those who showed an adequate initial response to the primary course of vaccinations,20 and UK guidelines now suggest that for initial responders who require ongoing protection, such as for healthcare workers, only a single booster is advocated at 5 years.9 See also Twinrix References ^ Centers for Disease Control, USA December 8, 2006. Hepatitis B Vaccine: Fact Sheet. ^ Immunization Action Coalition September 2007. Hepatitis A B Vaccines Be sure your patient gets the correct dose!. ^ a b GalxoSmithKline December 2006. Engerix-B Prescribing Information. ^ a b Merck October 2006. Recombivax HB Hepatitis B Vaccine Recombinant. ^ Centers for Disease Control and Prevention CDC, Department of Health and Human Services February 23, 1999. http://frwebgate6.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=364662410388+1+0+0WAISaction=retrieve 64 35: 9042-9048. ^ A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: Recommendations of the ACIP, Part 1: Immunization of Infants, Children and Adolescents December 23, 2005. MMWR 54 RR-16: 12. ^ Chang MH, Chen CJ, Lai MS, Hsu HM, Wu TC, Kong MS, Liang DC, Chau WY, Chen DS 1997. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med 336 26: 1855-9. doi:10.1056/NEJM199706263362602. PMID 9197213. ^ Joint Committee on Vaccination and Immunisation 2006. Chapter 12 Immunisation of healthcare and laboratory staff -- Hepatitis B, Immunisation Against Infectious Disease 2006 The Green Book PDF, 3rd ion, Edinburgh: Stationery Office, 468. ISBN 0113225288. ^ a b c d e Joint Committee on Vaccination and Immunisation 2006. Chapter 18 Hepatitis B, Immunisation Against Infectious Disease 2006 The Green Book PDF, 3rd ion Chapter 18 revised 10 October 2007, Edinburgh: Stationery Office, 468. ISBN 0113225288. ^ King JW, Taylor EM, Crow SD, et al. 1990. Comparison of the immunogenicity of hepatitis B vaccine administered intradermally and intramuscularly. Rev Infect Dis 12 6: 1035-43. PMID 2148433. ^ Levitz RE, Cooper BW, Regan HC 1995. Immunization with high-dose intradermal recombinant hepatitis B vaccine in healthcare workers who failed to respond to intramuscular vaccination. Infect Control Hosp Epidemiol 16 2: 88-91. ^ Cardell K, Ã…kerlind B, Sällberg M, Frydén A 2008. Excellent response rate to a double dose of the combined Hepatitis A and B vaccine in previous nonresponders to Hepatitis B vaccine. J Infect Dis 198 3: 299-304. doi:10.1086/589722. ^ Roome AJ, Walsh SJ, Cartter ML, Hadler JL 1993. Hepatitis B vaccine responsiveness in Connecticut public safety personnel. JAMA 270 24: 2931-4. PMID 8254852. ^ Rosman AS, Basu P, Galvin K, Lieber CS 1997. Efficacy of a high and accelerated dose of hepatitis B vaccine in alcoholic patients: a randomized clinical trial. Am. J. Med. 103 3: 217-22. PMID 9316554. ^ Pasricha N, Datta U, Chawla Y, Singh S, Arora S, Sud A, Minz R, Saikia B, Singh H, James I, Sehgal S 2006. Immune responses in patients with HIV infection after vaccination with recombinant Hepatitis B virus vaccine. BMC Infect Dis 6: 65. doi:10.1186/1471-2334-6-65. PMID 16571140. ^ Krugman S, Davidson M 1987. Hepatitis B vaccine: prospects for duration of immunity.. Yale J Biol Med 60 4: 333-339. ^ Petersen K, Bulkow L, McMahon B,Zanis C, Getty M, Peters H, Parkinson A 2004. Duration of Hepatitis B Immunity in Low Risk Children Receiving Hepatitis B Vaccinations from Birth. Pediatric Infectious Disease Journal 23 7: 650-655. doi:10.1097/01.inf.0000130952.96259.fd. ^ Gabbuti A, Romanò L, Blanc P, et al 2007. Long-term immunogenicity of hepatitis B vaccination in a cohort of Italian healthy adolescents. Vaccine 25 16: 3129-32. doi:10.1016/j.vaccine.2007.01.045. PMID 17291637. ^ European Consensus Group on Hepatitis B Immunity 2000. Are booster immunisations needed for lifelong hepatitis B immunity?. Lancet 355 9203: 561-5. PMID 10683019. ^ Van Damme P, Van Herck K 2007. A review of the long-term protection after hepatitis A and B vaccination. Travel Med Infect Dis 5 2: 79-84. doi:10.1016/j.tmaid.2006.04.004. PMID 17298912. v d e Vaccines, Vaccination, Immunization, and Inoculation see also artificial induction of immunity Development Adjuvants Cancer vaccines DNA vaccination HIV Live vector vaccine Models Timeline Trial Administration Global: GAVI Policy Schedule Vaccine injury USA: ACIP VAERS VSD Vaccine court Vaccines live Anthrax BCG tuberculosis Flu MMR MMRV PolioOPV Rotavirus Smallpox Varicella Yellow fever Inactivated/toxoid inactivated virus: Flu HAV PolioIPV inactivated bacteria/toxoid: DTwP conjugate: Hib PCV Other subunit: Anthrax DTaP HPV recombinant DNA: HBV other: Anthrax PPV Controversy General A-CHAMP MMR NCVIA Pox party Safe Minds Thiomersal See also List of vaccine topics Epidemiology Eradication of infectious diseases Retrieved from http://en..org/wiki/Hepatitis_B_vaccine Categories: VaccinesHidden categories: All articles with statements | Articles with statements since October 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages БългарÑ?ки Español Français This page was last modified on 16 July 2008, at 09:38
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