Hepatitis B vaccine

The vaccine gives protection against hepatitis (inflammation of the liver) caused by the hepatitis B virus (HBV). It is also used to prevent infection after exposure. 

When a person has been exposed to infection, their need for both the vaccine and hepatitis B antibodies, or HB immunoglobulin, must always be assessed.

Hepatitis B spreads in blood-to-blood and sexual contact.
Vaccine-preventable diseases

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To whom is the hepatitis B vaccine administered?

A free vaccine is offered as part of the national programme to 

  • haemophiliacs receiving regular treatment
  • intravenous drug users 
  • persons close to intravenous drug users, including family members, housemates and sexual partners
  • men who have sex with men

In case of persons belonging to one of these groups, also check their protection against hepatitis A. If the person has not received either vaccine previously, you can administer a free hepatitis A and B combination vaccine.

Due to increased infection risk, a free hepatitis B vaccine is also offered to

  • newborn children and sexual partners of, and those living in the same household with, persons with a hepatitis B infection and asymptomatic HBsAg positive persons
  • sex workers
  • students exposed to infection risk during internships
  • persons at risk of hepatitis B infection resulting from a needlestick injury or other blood exposure and who have been exposed in environments other than the workplace
  • children aged under 5 years at a day care centre when a child in the group is known to be HBsAg positive
  • newborn infants when at least one of the parents comes from a country where hepatitis B is common
  • newborn infants of mothers with a hepatitis C infection.

Which vaccine is used and what does it contain?

The products used in the national programme are called Engerix-B and HBVAXPRO. There are different vaccine products for children and adults:

Engerix-B vaccine in a 0,5 ml single-dose syringe is intended for children aged from 0 to 15 years.

HBVAXPRO 10 micrograms vaccine in a 1 ml single-dose syringe is intended for adolescents over 16 years of age and adults.

Vaccine composition:

  • The vaccines do not contain live pathogens.
  • The active substance is surface structures from hepatitis B viruses.
  • The adjuvant is an aluminium compound.
  • The excipients are salts and purified water.
  • The vaccines contain no preservatives.

Dosage and schedule

The hepatitis B vaccine dose is 0.5 ml for children aged from 0 to 15 years and 1 ml for anyone aged 16 and over.

The primary vaccination series consists of three doses administered in months 0, 1 and 6.

This schedule is also followed in cases of suspected or verified exposure to HBsAg positive blood, for example in connection with a needlestick injury. HB immunoglobulin and the first vaccine dose should be administered as soon as possible, preferably within 24 hours of exposure.

A vaccination series of four doses is used when protection is needed quickly and the infection risk is assessed to be high, for example when a patient has been exposed to a large volume of HBsAg positive blood. In this case, the vaccinations are administered in months 0, 1, 2 and 12. A fourth dose is needed to guarantee long-term protection.

The HB immunoglobulin is administered together with the first vaccine dose.

A series of four vaccinations with the intervals given above should also be administered to a newborn infant whose mother is a hepatitis B virus carrier. 

In exceptional situations and based on a risk assessment, the vaccinations can be given to an adult on days 0, 7 and 21. In this case, a fourth dose should be given one year after the first vaccination. An example of an exceptional situation is a person who is travelling to an area where hepatitis B occurs for nursing work and who does not have time to get the vaccine on the normal schedule.

After a full series of vaccinations, it is currently believed that nine people out of ten have life-long protection.

Persons with immunodeficiencies may need additional doses.

Should I test for antibodies?

There is no need for a routine check of vaccination protection with every client. In vaccine studies, hepatitis B vaccines have afforded a protective level of antibodies to over 95% of vaccination recipients.

Checking the protection achieved by the vaccination series is particularly important in cases of continuous significant exposure. These cases include the child of a mother who is a hepatitis B carrier, or the partner of a hepatitis B carrier. 

A physician makes the decision on testing for antibodies in situations where it is suspected that protection is insufficiently established and the person’s exposure risk is significant and continuous. 

Protection may not be established if the vaccine recipient

  • is aged over 50
  • smokes
  • is severely overweight, or
  • has a chronic illness that reduces their resistance.

If a person has a repeated exposure risk at work, the occupational healthcare services will assess if their protection should be checked.

This is done by testing for antibodies (S-HbsAb) 6 to 8 weeks after the last dose. Protection is sufficient if S-HBsAb is 10 IU/l or higher after a series of three or four doses.

If a person has not developed sufficient protection following the primary vaccination series and repeated exposure is obvious, additional vaccinations should be administered in months 0, 2 and 4. Test for antibodies again 6 to 8 weeks after the final dose. If sufficient protection has still not been established, the infection risk must be reduced by other means.

What are the contraindications and precautions associated with the vaccine?

The vaccine may not be administered to a person who has had a confirmed anaphylactic reaction following a previous dose of a hepatitis B vaccine or a vaccine containing similar components.

The vaccination should be postponed if the person has a fever or febrile infection.

What are the benefits of the hepatitis B vaccine?

 By vaccinating persons who have an increased infection risk, we can prevent infections, acute and chronic hepatitis caused by the virus, and virus carriage.

Young children, in particular, may become life-long virus carriers if they contract the infection. This is why vaccinating newborn infants and young children at risk of an infection is particularly useful. By vaccinating them, the consequences of a chronic hepatitis B infection can also be prevented, including liver cirrhosis and cancer.

Vaccinating persons close to a hepatitis B carrier is important to prevent infections in daily life.

Vaccinating a person in an at-risk group protects the vaccine recipient and persons close to them as well as prevents the spread of the virus in the population.

After a situation involving a blood-to-blood infection risk, a potential infection can usually be prevented by administering the vaccine and HB immunoglobulin.

What are the potential adverse effects of the hepatitis B vaccine? 

The most common adverse effects are local symptoms at the injection site, including pain, redness and swelling.

Transient generalised symptoms are also common, including

  • fever
  • feeling ill
  • headaches
  • nausea
  • gastrointestinal symptoms
  • irritability
  • tiredness.

Skin symptoms or actual hypersensitivity reactions are rare.

Local and generalised symptoms usually begin within a few days of the vaccination and go on for some days. They may be treated with fever and pain medications.

Local and generalised symptoms are not a contraindication for further vaccinations.

History of the hepatitis B vaccine in the national vaccination programme 

Hepatitis B vaccinations for the first at-risk groups were started in the national vaccination programme in 1993. Since then, more at-risk groups have been added gradually. 

Recommendations and reports 

Should the hepatitis B vaccine be offered to all children in the national vaccination programme?
Report of the working group on hepatitis B vaccinations