Hepatitis B – immunisation

About hepatitis B

Hepatitis B is a virus which may cause liver disease.

Most adults who contract hepatitis B recover completely and do not require ongoing treatment. Children with hepatitis B are more likely to develop chronic hepatitis B (defined as infection that persists for at least 6 months) causing liver disease or cancer in later life.

All children should be vaccinated against hepatitis B. Adults at increased risk should be vaccinated against hepatitis B.

Serious side effects or allergic reactions to the vaccines are very rare. If you are concerned about your or your child's reaction to any vaccine, see your doctor immediately.

Complications of hepatitis B infection in infants and children

Mothers who are living with hepatitis B can pass the virus to their baby at the time of birth if no precautions are taken. Hepatitis B virus can also be spread through exposure of broken skin or mucous membranes to the blood or other body fluids of an infected person.

Babies born to mothers with hepatitis B are recommended a dose of hepatitis B vaccine within 12 hours of birth as well as another medicine called ‘hepatitis B immunoglobulin.’ These 2 injections provide extra protection for babies born to women living with hepatitis B.

Many people living with hepatitis B have no symptoms. Babies and children who are infected with hepatitis B are less likely than adults to have symptoms, but are more likely to develop chronic hepatitis B.

Symptoms of hepatitis B may include:

• fever
• tiredness
• loss of appetite
• nausea
• vomiting
• yellow skin and eyes
• aching muscles, abdominal pain or joints arthritis.

A child who contracts chronic hepatitis B has an increased risk of developing chronic (long-term) liver disease and cancer later in life. A small proportion of adults who contract the hepatitis B virus develop chronic hepatitis B infection.

Immunisation against hepatitis B

Immunisation is the best protection against hepatitis B infection. A course of hepatitis B containing vaccine is recommended for all babies and for people in high-risk groups.

Immunisation can be with a vaccine against hepatitis B alone or with a combination vaccine. To be immunised, contact your doctor or local council.

National Immunisation Program

Free hepatitis B vaccine is available for eligible people under the National Immunisation Program Schedule for:

• babies at birth – vaccinate with hepatitis B vaccine as soon as possible after birth
• babies at 2, 4 and 6 months – immunisation in the form of a diphtheria, tetanus, whooping cough, hepatitis B, polio and Haemophilus influenzae type b (Hib) vaccine (six-in-one vaccine)
• people up to 20 years of age - for catch up immunisation
• refugees and humanitarian entrants aged 20 years and above.

Immunisation for people at risk

Free hepatitis B vaccine is provided for people at increased risk of hepatitis B infection, as follows:

• all Aboriginal and Torres Strait Islander people - hepatitis B non-immune, no restrictions.
• household contacts and sexual partners of people living with hepatitis B
• people who inject drugs or are on opioid substitution therapy
• people living with Hepatitis C
• men who have sex with men
• people living with HIV
• people no longer in a custodial setting who commenced but did not complete a free vaccine course while in custody
• people born in priority hepatitis B endemic countries and arrived in Australia in the last 10 years (priority countries include China, Philippines, Malaysia, Vietnam, Afghanistan, Thailand, South Korea, Myanmar (Burma) Indonesia, Singapore, Hong Kong, Taiwan and Cambodia)
• vulnerable citizens - a person who has experienced socioeconomic disadvantage that compromised their equitable access to the NIP-funded vaccine during their period of eligibility. Vulnerable citizens are vaccinated based on an individual assessment by an immunisation provider.

Immunisation is also recommended, but not necessarily free, for people who are at increased risk of infection, including:

• people whose occupation increases their risk of acquiring hepatitis B, including:
  • healthcare workers
  • police, members of the armed forces, emergency services staff and staff of correctional facilities
  • staff of facilities caring for people with developmental disabilities
  • funeral worker and embalmers
  • tattooists and body-piercers
• travellers to hepatitis B–endemic areas who may be at increased risk
• and people whose circumstances increase their risk of acquiring hepatitis B, including:
  • inmates of correctional facilities
  • sex industry workers

If you think you have been exposed to hepatitis B, see a doctor immediately. Your doctor can give you treatment that, in some instances, can greatly reduce your risk of infection with hepatitis B.

Remember that being immunised against hepatitis B does not protect you against HIV, hepatitis C or other diseases spread by blood or bodily fluids. It is important that you take precautions to make sure you are not exposed to these diseases.

Pregnancy and hepatitis B immunisation

Hepatitis B vaccine is not usually recommended for women who are pregnant. Speak with your doctor about protecting yourself from hepatitis B if you are not immune to hepatitis B and you are at increased risk.

Pre-immunisation checklist

Before immunisation, it is important that you tell your immunisation provider if you (or your child):

• are unwell (have a temperature over 38.5 °C)
• have had a serious reaction to any vaccine
• have had a serious reaction to any component of the vaccine
• have had a severe allergy to anything
• are pregnant or intend to become pregnant.

Side effects of hepatitis B vaccines

Immunisations containing components to protect against hepatitis B (including the six-in-one vaccine) are effective and safe, although all medication can have unwanted side effects.

Side effects from the vaccine are uncommon and usually mild, but may include:

• localised pain, redness and swelling at the injection site
• low-grade temperature (fever)
• in children – being unsettled, irritable, tearful, generally unhappy, drowsy and tired
• occasionally, an injection-site lump (nodule) that may last many weeks, but for which treatment is not needed.

Managing fever after immunisation

Common side effects following immunisation are usually mild and temporary (occurring in the first few days after vaccination). Specific treatment is not usually required.

There are a few treatment options that can reduce the side effects of the vaccine such as having extra fluids to drink and not overdressing if you have a fever.

Although routine use of paracetamol after vaccination is not recommended, if fever is present, paracetamol can be taken – check the label for the correct dose or speak with your pharmacist, especially when giving paracetamol to children.

Managing injection site discomfort

Many vaccine injections may result in soreness, redness, itching, swelling or burning at the injection site for one to 2 days. Paracetamol might be required to ease the discomfort.

Concerns about immunisation side effects

If the side effect following immunisation is unexpected, persistent or severe, or if you are worried about yourself or your child's condition after a vaccination, see your doctor or immunisation nurse as soon as possible or go directly to a hospital.

It is important to seek medical advice if you (or your child) are unwell, as this may be due to other illness, rather than because of the vaccination.

Immunisation side effects may be reported to SAEFVIC, the Victorian vaccine safety and reporting service. Discuss with your immunisation provider how to report adverse events in other states or territories.

Rare side effects after immunisation

There is a very rare risk of a serious allergic reaction (anaphylaxis) to any vaccine. This is why you are advised to stay at the clinic or medical surgery for at least 15 minutes following immunisation, in case further treatment is required.

If you think your child may be having a serious allergic reaction and you are no longer at the clinic where they were immunised, take them immediately to your doctor or to the nearest hospital, or call 000 for an ambulance.

Another rare side effect is the hypotonic-hyporesponsive episode (HHE). If they are experiencing HHE, a baby may be:

• pale
• limp
• unresponsive.

This may occur from one to 48 hours following vaccination. The whole episode may last from a few minutes to 36 hours.

If you think your child may be having an HHE episode, take them immediately to your doctor or to the nearest hospital.

Follow-up of children with HHE shows no long-term neurological or other side effects.

Immunisation and HALO

The immunisations you may need are decided by your health, age, lifestyle and occupation. Together, these factors are referred to as HALO. Check your immunisation HALO.

Talk to your doctor or immunisation provider if you think you or someone in your care has health, age, lifestyle or occupation factors that could mean immunisation is necessary.

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor)
• Pharmacist
• Community Pharmacist Program – receive some treatments at a local pharmacy without needing to see a doctor for a prescription in Victoria
• LiverWELL Tel. 1800 703 003
• Local government immunisation service
• Maternal and Child Health Line Tel. 13 22 29 (24 hours, 7 days)
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Immunisation Unit, Department of Health, Victorian Government Email: immunisation@health.vic.gov.au
• National Immunisation Information Line Tel. 1800 671 811
• SAEFVIC Tel. 1300 882 924