Hepatitis B vaccination: how to protect yourself and your family from a dangerous disease

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— Hepatitis — Vaccination against hepatitis B
Vaccination against hepatitis B is an effective way to protect not only from the disease itself, but also from its severe consequences. The most significant are cirrhosis and primary liver cancer. The annual mortality rate from them is about 800,000 people, “second only” to such an infectious disease as tuberculosis.

According to WHO experts, in 2021, about 325 million people were registered in the world infected with hepatitis B or C. Unfortunately, a vaccine against hepatitis C has not yet been created, but vaccination against hepatitis B can prevent infection in 98-100% . cases.

Is it worth getting vaccinated against hepatitis?

To understand how the hepatitis B vaccine works, it is important to understand what the virus is, how long it can remain viable in the environment, and who is at risk for developing the chronic disease.

Information about the hepatitis B virus

The cause of hepatitis B is a DNA-containing virus, “packaged” in a regular protein shell (capsid) and a lipid membrane – supercapsid. The membranes contain specific proteins HBcAg and HBsAg. Scientists have identified 10 genotypes of the virus, representatives of which are unevenly distributed in different countries of the world.

Penetrating into liver cells, the virus is partially integrated into human DNA. Its fragments remain in hepatocytes for a long time. In most patients, primary infection results in an asymptomatic course (persistence of the virus), and hepatitis can be detected incidentally during a routine blood test.

Prolonged existence of the virus in liver cells can cause primary cancer. Currently, there are 2 hypotheses for its development:

• modification of the cell genome by viral DNA fragments;
• the action of protein X, which triggers the synthesis of virions using host hepatocytes.

In an infected person, the virus can be detected in almost all biological fluids: saliva, tears, blood, as well as in urine and feces. Virions do not penetrate intact skin and mucous membranes.

The virus is highly resistant to the adverse effects of environmental factors: high and low temperatures, freezing and thawing, ultraviolet irradiation, and acids. Outside the human body, it remains viable for 7 days. Inactivation is possible due to boiling, autoclaving, dry heat sterilization in compliance with the temperature and time characteristics of the process.

For whom is the virus most dangerous?

Discussion of the possibility of potential infection, even among people who care about their health, is often negative. Hepatitis B, along with other severe, socially significant infections (HIV, tuberculosis), is one of those diseases that “is not customary to talk about.” The fact of infection stigmatizes patients as individuals who lead an unhealthy lifestyle and are somehow “to blame” for their illness. But is it?

First of all, children are at risk for developing chronic infection. In infants, 70 to 80% of infections are associated with transfusions of blood and its components. WHO statistics are as follows: chronic infection develops in 85-90% of children who become ill within 1 year of life, and in 30-50% of children who become ill between 1 and 6 years. What’s interesting is that an adult who does not have other concomitant pathologies is in a more advantageous position. The probability of developing a chronic infection is no more than 5%.

In areas with a high spread of the virus, a child can be infected from the mother during childbirth, in the family through contact with blood, or through communication among preschool children.

Also at risk for hepatitis B infection are the following categories of people:

• patients with chronic liver diseases (including chronic viral hepatitis C);
• HIV-infected;
• partners of persons infected with hepatitis;
• sexually active people who prefer polygamous relationships;
• patients with diseases that are predominantly sexually transmitted;
• medical personnel working with blood and having contact with biological fluids;
• patients suffering from end-stage kidney disease and receiving hemodialysis;
• social workers involved in caring for patients;
• personnel and persons living in boarding houses, boarding houses;
• men having homosexual contacts;
• people traveling to regions where there is a high incidence of viral hepatitis.
• persons who use injecting drugs.

Features of national vaccination

Each WHO member country has its own National Preventive Vaccination Calendar. The NCPP may differ in comparison with the universal vaccination programs of other countries, but the basic set of vaccinations is approximately the same for all. However, the Russian NKPP lacks several vaccinations. For example, vaccines against hepatitis A, meningococcal infection, human papillomavirus, chickenpox, rotavirus infection, vaccinations against which are included in the calendars in some countries.

On the other hand, many national preventive vaccination calendars do not include the anti-tuberculosis vaccine (BCG), which is carried out in our country. In addition to Russia, people are vaccinated against tuberculosis in about 60 countries where the risk of contracting this disease is considered high. In other countries, this vaccination is simply recommended, such as in Italy, the Netherlands and Belgium, and some have refused vaccination altogether. For example, the United States has never used the tuberculosis vaccine on a large scale. By the way, this very fact is today used in the theory about the connection between BCG vaccination and coronavirus - in countries where the population is not vaccinated against tuberculosis, COVID-19 is more rampant.

Another disease that the EU and US states have “forgotten” about is polio. Since 2002, not a single case of this terrible infection has been recorded there, so these countries now use exclusively inactivated (not live) polio vaccine. Russia is not abandoning the live polio vaccine not only for economic reasons, but also due to the existing risk of introducing the wild polio pathogen. Today, the Russian NKPP combines two types of polio vaccine: inactivated for infants and live for older children.

Russia is one of the few European countries where the NKPP includes influenza vaccination. In most EU countries, they either do not vaccinate against flu free of charge at all, or only those who are in high-risk groups. For example, in Great Britain, France, Germany, and the Netherlands, elderly people over 60-65 years of age are vaccinated against influenza vaccine. In the United States, on the contrary, since 2010, influenza immunization has been available to all categories of the population, starting from 6 months of age.

Anti-influenza vaccines for the Russian National Calendar of Preventive Vaccinations are supplied by Nacimbio. Last year, the well-known drugs “Sovigripp”, “Flu-M”, “Ultrix” on the market were joined by a new product – the first Russian quadrivalent vaccine “Ultrix Quadri”. It contains four (and not three, as in the more common trivalent vaccines of the previous generation) strains of the influenza virus, which since 2021 has been the standard for influenza vaccine prevention in accordance with WHO recommendations. In addition to Russia, quadrivalent influenza vaccines are produced in six countries around the world.

Prevention of hepatitis B

In reality, it is very easy to get infected with this virus. And if for HIV infection the minimum dangerous dose of blood is 0.1 ml, then for hepatitis it is 1 million times less. There are many situations in life in which infection is potentially possible.

There are specific and non-specific measures to prevent infection.

Nonspecific prophylaxis is aimed at preventing the virus from entering the body. It includes the following activities:

• using condoms during sexual intercourse;
• refusal to use other people's hygiene and care items (for example, razors, manicure accessories);
• use of disposable consumables when working with blood and biological fluids;
• protection of the skin of the hands and face when performing medical and cosmetic procedures (disposable gloves, mask, protective screen);
• refusal to use drugs, casual relationships;
• control over the processing of reusable surgical, dental, manicure instruments.

Specific prevention of viral hepatitis consists of timely vaccination. Since the likelihood of the process becoming chronic is highest when infected at an early age, it is important to vaccinate the child within the first months and even days of life.

The hepatitis B vaccine is included in the National Vaccination Schedule. Free administration is provided in the compulsory health insurance system for children and adults under 55 years of age. Persons over 55 years of age who do not have epidemiological indications are vaccinated at their own expense. There are no age restrictions for hepatitis vaccination for patients.

Prevention measures

The infection is transmitted sexually and hematogenously (with blood). The hepatitis B virus can persist for quite a long time (up to several weeks) in particles of dried blood - on a razor blade, needle point, etc. The virus is not killed by boiling and can withstand repeated freezing and thawing.

• The most effective preventive measure against hepatitis B is vaccination. Vaccination prevents both types of infection and creates a lasting immune response.
• To prevent infection from mother to child during childbirth and pregnancy, women are prescribed a course of tenofovir, an antiviral drug that reduces the risk of transmission of infection during childbirth.
• To prevent infection through blood in the home, it is recommended to use only personal hygiene products, razors, and manicure tools. Scratches and cuts on the skin must be immediately treated with an antiseptic and covered with a band-aid. When performing manipulations where contact with an infected person is possible, rubber gloves are used.
• Using condoms reduces the risk of sexual transmission of the virus.

Vaccination schedule

The first vaccination is usually given in the maternity hospital with an interval of 1 day from the anti-tuberculosis vaccine (BCG). If there are contraindications, the neonatologist will give recommendations on a later start of vaccination.

When answering the question of how many times a hepatitis vaccine is given, it should be explained that, according to epidemiological indications, all patients are divided into 2 groups: standard and risk group. Representatives of the first group have no risk of infection at home. The second has close contact with an infected person, information about the mother’s health is unknown or unreliable.

For children at risk, the vaccine is administered four times (the so-called accelerated immunization) according to the following scheme: the first vaccination within 24 hours of birth, the second vaccination in the 1st month, the third vaccination in the 2nd month. Revaccination is planned for 12 months. (together with routine vaccination against measles, rubella and mumps).

This scheme is shown for the following categories of children:

• those born to mothers who are carriers of the virus, have hepatitis or have had it in the 3rd trimester of pregnancy;
• from mothers who have not been tested for HbsAg carriage;
• from mothers living with drug addicts and people suffering from chronic viral hepatitis.

For newborns who are not at risk, the vaccine is administered three times. Typically, the 0-1-6 scheme is used for this: within 24 hours after birth, at 1 month and at six months. If the vaccination schedule is not shifted, at 6 months the hepatitis vaccine can be given along with a vaccine that protects against whooping cough, diphtheria and tetanus.

Children and adults who were not vaccinated in the maternity hospital are immunized according to the same schedule:

• persons at risk who have close contacts with carriers of the virus receive the vaccine according to the 0-1-2-12 scheme, where 0 is the date of the first administration of the drug;
• standard scheme (for all others): 0-1-6 (months).

For persons who have not previously been vaccinated against hepatitis, a regimen aimed at the rapid formation of immunity is possible. It is indicated for patients before planned operations or travel to a region where viral hepatitis is extremely common. How many vaccinations are given in this case? The schedule includes 4 injections of the vaccine according to the scheme: 0 day - 7 day - 21 days and revaccination 1 year from the date of administration of the first vaccination.

These regimens do not require revaccination after some time, with the exception of medical workers (every 7 years) and persons with immunodeficiency conditions (according to clinical indications).

If the interval between vaccinations is observed, a person develops lasting immunity. If the regimen has been violated, infectious disease specialists do not consider it to be completely and correctly completed and recommend ending it as follows: the date of the last vaccine administration (if it was no more than 1 month ago) is considered day zero and vaccinations are continued according to the 0-1-6 month schedule.

Who is recommended for vaccination?

• All newborns within the first 24 hours of birth.
• Doctors, beauty salon workers.
• Employees of food production, catering establishments, retail outlets.
• People who have frequent contact with infected people.
• Those who are preparing for planned operations (according to indications based on antibody testing).

For those who received a timely vaccination against hepatitis B in childhood, repeated vaccination is recommended after 18 years of age.

Contraindications to vaccination and undesirable effects from administration

Immunologists call the hepatitis B vaccine one of the safest. Adverse reactions are rare and usually do not require medical attention. The most common include:

• soreness, redness and thickening of the skin at the injection site;
• mild malaise, weakness, flu-like symptoms.

The only absolute contraindication to the administration of the drug is intolerance to yeast and other components or a registered exacerbation of chronic diseases due to previous administration.

Temporary contraindications are:

• acute infectious and other diseases;
• exacerbation of chronic (including skin) diseases;
• pregnancy.

For children with frequent acute respiratory viral infections, according to the order of the Ministry of Health, the drug is administered after 5-10 days from the relief of acute symptoms of infection. Residual effects (runny nose, cough) are not classified as contraindications.

Clinical studies confirm that the incidence of adverse events such as muscle pain and fever in the group of patients receiving vaccination did not differ from those receiving placebo. Data on allergic reactions are rare. In addition, studies deny the connection between vaccination and the subsequent development of systemic diseases, diabetes, and arthritis.

Some pediatricians do not recommend vaccinating a newborn baby with signs of physiological jaundice and postpone the first vaccination until the age of 1 or 2 months. However, it has been proven that vaccination against hepatitis B does not affect the duration or severity of the syndrome and does not have a toxic effect on the liver. Therefore, physiological jaundice is not considered a contraindication for child immunization.

Due to the impossibility of conducting clinical studies among pregnant women, this category of people is vaccinated only in special cases - for example, if it is necessary to travel to a region unfavorable for hepatitis B. Formally, before pregnancy, a woman must already be vaccinated three times according to the standard regimen. If she did not have time to complete the vaccination as scheduled, the last portion of the vaccine can be administered after birth. The exception is situations in which there is a high probability of infection. Breastfeeding is not a contraindication to the administration of the drug.

Hepatitis Vaccine Information

Vaccinations against the virus have been available since 1981. The first vaccines were made from donor plasma; during their use, cases of damage to the nervous system in patients were recorded, but assessment of the level of antibodies even 15 years after administration showed quite high results. The next generations of the vaccine were produced using genetic technologies with cultivation in yeast culture.

Composition of hepatitis vaccine

Modern drugs contain the surface antigen of the virus HBsAg. After vaccination, it can be detected in a person’s blood for several days, then the body begins to produce antibodies that protect against infection.

The general composition of the vaccines is as follows:

• HBsAg antigen,
• adjuvant (aluminum hydroxide),
• mercury-containing preservative (synonyms “thiomersal”, “thimerosal”);
• traces of yeast proteins.

Some series of vaccines do not contain a preservative.

The table below shows the main drugs available for purchase and used in the Russian Federation.

Table: Hepatitis B vaccines

Introduction Features

The hepatitis vaccine belongs to the inactivated group - it does not contain a live pathogen. Therefore, its simultaneous administration along with other agents is allowed. Injections are performed in different parts of the body, using a separate syringe for each vaccine.

The only drug that requires separation at an interval of at least 1 day is BCG (tuberculosis vaccination).

Where is the hepatitis vaccine given? According to the instructions, for children under 2 years old it is injected into the front of the thigh, for children over 2 years old and adults - into the deltoid muscle (outer surface of the shoulder, upper third). Other injection sites (subscapular, gluteal region) should not be chosen. If the vaccination was done incorrectly, it does not count; To form antibodies, the injection should be repeated soon.

Hepatitis B is a serious disease that often leads patients to death from cirrhosis or primary liver cancer. Children under one year of age are the population among whom the infection more often becomes chronic. Timely administration of the vaccine protects in 98-100% of cases. The hepatitis vaccine is well tolerated and has no age restrictions.