The national recommendations for vaccinations are given in the latest edition of the Australian Immunisation Handbook (1). Table 5.2 summarises the vaccines available in Australia.
Table 5.2 Vaccines available in Australia
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Monovalent vaccines
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Trade name (formulation)
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Dose of HBsAg protein and volume
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Engerix-B (adult formulation ≥ 20 years old)
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20 μg in 1 mL
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Engerix-B (paediatric formulation < 20 years old)
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10 μg in 0.5 mL
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Recombivax / H-B-VAX II adult formulation ≥ 20 years old)
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10 μg in 1 mL
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Recombivax / H-B-VAX II (paediatric formulation < 20 years old)
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5 μg in 0.5 mL
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Recombivax / H-B-VAX II (dialysis formulation)
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40 μg in 1 mL
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Combinations containing hepatitis A vaccine
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Trade name (formulation)
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Type of combination
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Twinrix Junior (1 ≤ 16 years old) (360/10)
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10 μg in 0.5 mL
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Twinrix (≥ 16 years old)(720/20)
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20 in 1 mL
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Combination vaccines used in infant vaccination or catch-up schedules
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Trade name (formulation)
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Type of combination
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Infanrix Hep B (paediatric)
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diphtheria-tetanus-acellular pertussis-hepatitis B
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Infanrix Hexa (paediatric)
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diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliomyelitis vaccine-Haemophilus influenzae type b
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Infanrix Penta (paediatric)
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diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliomyelitis vaccine
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Infants
It is recommended that all newborns receive hepatitis B vaccine within 24 hours of birth, followed by three further doses in infancy, at 2, 4 and 6 months of age. The first dose can be given at 6 weeks of age. If an infant did not receive the birth dose within 7 days of birth, no catch up of that dose is necessary; these infants only require a three-dose course of a hepatitis B-containing combination vaccine, given at 2, 4 and 6 months of age. There should be an interval of at least 8 weeks between doses two and three. For infants the final dose of the primary hepatitis B vaccine course should be administered at or after 24 weeks of age. The type of hepatitis B vaccine used differs between states and territories (1).
Premature infants
Preterm babies do not respond as well as term babies to hepatitis B vaccine (11). For babies under 32 weeks gestation or less than 2000 g birth weight, it is recommended to give the vaccine at 0 (within 24 hours of birth), and 2, 4 and 6 months of age and do one of the following:
- measure anti-HBs at 7 months of age and, if antibody titre is less than 10 mIU/mL, give a booster at 12 months of age (1)
- give a booster at 12 months of age without measuring the antibody titre (19).
Infants born to mothers positive for hepatitis B surface antigen with chronic hepatitis B
Infants born to HBsAg-positive mothers should be given HBIG (100 IU) in addition to the birth dose of monovalent hepatitis B vaccine (19) (see: Managing hepatitis B virus infection in pregnancy and children). HBIG should be given within 12 hours (ideally 4 hours) and certainly within 48 hours of birth (see Consensus Recommendation 23). The birth dose of HBV vaccine should be given at the same time but in separate sites. Monovalent vaccine alone has been shown to be protective and should not be delayed; it is most effective given within 24 hours of birth (ideally within 4 hours). In all infants, HBsAg and anti-HBs should be measured at 9–12 months of age (i.e. 3–12 months after completing the course of primary vaccination). If the anti-HBs level is less than 10 mIU/mL, further testing for evidence of HBV infection is advised.
Click to open GESA recommendation
Adolescents
It is recommended that adolescents not vaccinated in childhood receive hepatitis B vaccines (1). Two regimens are available:
- Three-dose regimen for adolescents aged up to 20 years: hepatitis B (paediatric formulation) – three doses of 0.5 mL. The optimal interval is 1 month between the first and second dose, and a third dose 5 months after the second dose.
- Two-dose regimen for adolescents aged 11–15 years: H-B-Vax II 10 μg (adult formulation) or Engerix-B 20 μg (adult formulation) at 0 and 4–6 months.
State and territory health authorities can provide further information on hepatitis B vaccine for this age group.
Adults aged 20 years or over
Groups recommended for vaccination (after testing) are listed in Table 5.1.
Monovalent hepatitis B vaccine is usually given in a three-dose schedule, at 0, 1 and 6 month or 0, 2 and 4 month intervals (1). The minimum interval is 1 month between the first and second doses, 2 months between the second and third doses, and 4 months between the first and third doses. Special consideration is needed for immunocompromised individuals, who may require alternative dosing regimens including double dosing.
The standard three-dose schedule is effective in achieving protective antibody titres in over 90% of immunocompetent adults with seroconversion rates of approximately 35% after the first dose and rising thereafter.
Accelerated vaccination schedules
Two products, Engerix-B (paediatric and adult) and Twinrix (720/20), are registered for use in accelerated schedules, which consist of four doses in total. Accelerated schedules should only be used if there is limited time before departure to endemic regions, or the need to achieve urgent protection (9). Whilst accelerated schedules result in a higher proportion of individuals with protective anti-HBs titres in the early months, antibody levels are lower than the standard schedule at 7 months. Thus, the fourth booster dose should always be given in this setting. (Table 5.3).
Table 5.3 Accelerated hepatitis B vaccination schedules
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Vaccine
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Age
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Dose (HBsAg protein)
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Volume
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Schedule
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Engerix-B (paediatric)
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Up to 20 years
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10 μg
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0.5 mL
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0, 1, 2 months; booster at 12 months
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Engerix-B (adult)*
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≥ 20 years
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20 μg
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1.0 mL
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0, 7, 21 days; booster at 12 months or 0, 1, 2 months; booster at 12 months (preferred schedule)
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Twinrix (720/20)*
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> 15 years
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20 μg
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1.0 mL
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0, 7, 21 days; booster at 12 months
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*If time permits, it is recommended that the 0, 1, 2 month schedule be used, because higher seroprotective rates are observed following this schedule than with a 0, 7, 21 day schedule; a booster dose at 12 months is recommended for long-term protection.
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Booster doses
Although vaccine-induced antibody levels decline with time and may eventually become undetectable, booster doses are not recommended in immunocompetent people after a primary course, because there is good evidence that a completed primary course of hepatitis B vaccination provides long-lasting protection. This recommendation includes health-care workers. Booster doses are recommended, however, for people who are immunocompromised (e.g. those with HIV infection or renal failure) (1). The time for receipt of the boosting dose in these individuals should be determined by monitoring of anti-HBs levels.
Hepatitis B testing before vaccination
Testing before vaccination is recommended for those at increased risk of infection (see: Hepatitis B virus testing and interpreting test results, and Table 5.4), including people born overseas in high- or intermediate-prevalence countries, Aboriginal and Torres Strait Islander peoples, men who have sex with men, people who inject drugs, sex workers, immunocompromised people and people in custodial settings, or those who have ever been in such settings.
Table 5.4 Prevalence of chronic hepatitis B in Australia by risk group (10)
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Group
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HBsAg prevalence in risk group (%)
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Proportion of CHB in Australia (%)
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People born in high- or intermediate-prevalence countries
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4.4
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69.0
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Aboriginal and Torres Strait Islander peoples
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2
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7.2
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People who inject drugs
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3.7
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5.6
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Men who have sex with men
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2.8
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4.3
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Non-indigenous Australian-born individuals*
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0.2
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14.5
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Other or not stated
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1.0
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4.9
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*excluding those belonging to the other priority populations listed above
CHB: chronic hepatitis B; HBsAg: hepatitis B surface antigen
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Hepatitis B testing post vaccination
Infants born to HBsAg-positive mothers should be tested 3–12 months after the primary course of vaccination is completed. Testing for post-vaccination response 4 weeks after the primary course is also recommended for:
- health-care workers involved with exposure-prone procedures (see: Infection control and occupational health)
- those at risk of severe or complicated disease (e.g. immunosuppressed patients and patients with chronic liver disease)
- those expected to have a poor response to hepatitis B vaccine (e.g. haemodialysis patients)
- those at high risk of acquiring hepatitis B (e.g. contacts of those with CHB, people who inject drugs, sex workers, and those living in communities with high prevalence of hepatitis B).