HEPATITIS B

ADMINISTRATION

Professor Mary Grace L. Araullo RN MSCPD

Professor Lizcir T. Panelo RN MAN
 • Epidemic jaundice
HEPATITIS B described by
Hippocrates in 5th
century BCE.
• Jaundice reported
among recipients
of human serum
and yellow fever
vaccines in 1930s
and 1940s
• Serogenic tests
developed in 1970s
 HEPATITIS B CLINICAL FEATURES
• Incubation period 6 weeks to
6 months (average of 120
days)
• Nonspecific prodrome of
fever, malaise, headache,
myalgia
• Illness not specific for
Hepatitis B
• At least 50% of infectious
asymptomatic
 MODE OF
TRANSMISSI
ON

• VERTICAL TRANSMISSION from infected mother to infant

• HORIZONTAL TRANSMISSION from infected household
contact to child
 Both modes of transmission can be prevented by
vaccination of newborns!
 DIFFERENCE of HBsAG and HBeAg

• HBsAg (Hepatitis B surface antigen) - A "positive" or

"reactive" HBsAg test result means that the person is infected with
hepatitis B. This test can detect the actual presence of the hepatitis B
virus (called the “surface antigen”) in your blood.
• Hepatitis B e-antigen (HBeAg) is a small polypeptide that exists in
a free form in the serum of individuals during the early phase of
hepatitis B infection, soon after hepatitis B surface antigen (HBsAg)
becomes detectable. Serum levels of both HBeAg and HBsAg rise
rapidly during the period of viral replication.
 VERTICAL TRANSMISSION

• If the mother positive for

HBsAg and HBeAg
70%-90% of infants infected
90% of infected infants
become chronic carriers
• If positive for HBsAg only
20% of infants infected
90% of infected infants
become chronic carriers
• IMMUNOPROPHYLAXIS
is highly effective in
preventing vertical HBV
transmission: Hepatitis B
vaccine alone prevents
vertical transmission in
up to 95% of infants
when given soon after
birth
 • Transmission occurring during
HORIZONTAL early childhood is a result of
horizontal transmission of HBV
TRANSMISSION within household
To young children from family
members: usually infected
parents, older siblings, and
household members
• May be associated with breaks
in skin barrier common in
tropical areas – e.g scabies,
dermatitis

 Hepatitis B vaccination will

prevent horizontal
transmission in early
childhood.
HEPATITIS B
BEST PREVENTIVE METHOD IS VACCINATION
 • Universal vaccination of infants beginning at
birth
STRATEGIES • Prevention of perinatal HBV infection through
TO Routine screening of all pregnant women for
Hepatitis B surface antigen (HBsAg), and
ELIMINATE Immunoprophylaxis of infants born to HBsAg-
HBV positive women or to women with unknown
HBsAg status
TRANSMISSI • Routine vaccination of previously
ON unvaccinated children and adolescents
• Vaccination of previously unvaccinated adults
at risk for HBV infection
 HEPATITIS B VACCINE

* Booster doses not routinely recommended

COMPOSITION Recombinant HBsAg

EFFICACY 95% (Range, 80%-100%)

DURATION OF IMMUNITY > 15 years

SCHEDULE 3 doses
HEPATITIS B VACCINE
FORMULATIONS • Recombivax HB
(Merck)
5.0mcg/0.5ml
(pediatric)
10mcg/1ml (adult)

• Engerix –B (GSK)
10mcg/0.5ml
(pediatric)
20mcg/1ml (adult)
 COMVAX

• Hepatitis B-Hib combination

• Use when either antigen is
indicated
• Can not use < 6 weeks of age
• May be used in infants whose
mother are HBsAg positive or
status is not known
PEDIARIX • DTaP – Hep B – IPV
Combination
• Approved for 3
doses at 2, 4, and 6
months
• Not approved for
booster doses
• Licensed for
children 6 weeks to
7 years of age.
 RECOMMENDED DOSE OF
HEPATITIS B VACCINE
Recombivax HB Engerix – B
Dose (mcg) Dose (mcg)

INFANTS AND CHILDREN 0.5ml (5) 0.5ml (5)

< 11 years of age

ADOLESCENTS 0.5 ml (5) 0.5ml (10)

11-19 years old

ADULTS > 20 years 1.0 ml (10) 1.0 ml (20)

 HEPATITIS B VACCINE ROUTINE INFANT
SCHEDULE
( at least 16 weeks after the first dose)
DOSE USUAL AGE MINIMUM
INTERVAL
PRIMARY 1 0-2 months ----

PRIMARY 2 1-4 months 4 weeks

PRIMARY 3 6-18 months 8 weeks

 THIRD DOSE OF HEPATITIS B
VACCINE

• Minimum of 8 weeks after second dose, and

• At least 16 weeks after first dose, and
• For infants, at least 24 weeks of age
VERY LOW BIRTHWEIGHT INFANTS

• Infants < 2000 grams respond

poorly to vaccine
• Delay first dose until
chronological age 1 month if
mother HBsAg NEGATIVE
• Birth dose and HBIg if mother
HBsAg POSITIVE
BIRTH DOSE
AND not only for the robustness of
the immune response, but
INTERVAL
As well for the prevention of
BETWEEN vertical and horizontal
THE DOSES transmission and
ARE The long term protection post-
EXTREMELY vaccination
IMPORTANT:
 THE RATIONALE
• 1ST DOSE – At birth > Prevents vertical transmission
• 2ND DOSE – Minimum 4 weeks later > Limited number of
seroconversion (a change from a seronegative to a seropositive
condition)
• After the 1ST dose, hence closely spaced second dose > Prevents
immediate horizontal transmission
• 3RD DOSE – Minimum 8 weeks after 2ND dose,
-- Minimum 16 weeks after 1ST dose,
-- After 24 weeks age,
• Leads to increased antibody titres > BETTER LONG TERM PROTECTION