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Hepatitis B virus immunization in infants, children, and adolescents

Author
Jan E Drutz, MD
Section Editors
Teresa K Duryea, MD
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Hepatitis B virus (HBV) immunization before HBV exposure is the most effective means to prevent HBV transmission. Hepatitis B immunization in infants, children, and adolescents will be discussed here, focusing on immunization of infants, children, and adolescents in the United States. Our recommendations are consistent with those of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians. Hepatitis B immunization in adults and elsewhere in the world are discussed separately. (See "Hepatitis B virus vaccination".)

HEPATITIS B INFECTION

HBV is a DNA hepadnavirus. The viral particle is composed of an outer lipoprotein envelope, which contains hepatitis B surface antigen (HBsAg), and an inner nucleocapsid which consists of hepatitis B core antigen (HBcAg) [1].

HBV can be transmitted vertically from mother to infant during labor or delivery, through sexual intercourse, or by exposure to contaminated blood or body fluids. In utero transmission is uncommon. Infants born to HBsAg-positive women are at increased risk of HBV infection. Adolescents also are at increased risk as a result of sexual behavior or injection drug use. (See "Epidemiology, transmission, and prevention of hepatitis B virus infection", section on 'Transmission of HBV'.)

Each year in the United States an estimated 25,000 infants are born to women who are HBV carriers [2]. As many as 90 percent of these infants will acquire acute HBV infection if no preventive measures are taken [3,4]. Acquisition of HBV at a younger age is associated with an increased risk of developing chronic HBV infection (figure 1). Approximately 25 percent of people infected with chronic HBV during infancy infection die prematurely from cirrhosis or liver cancer [5-7]. Most people with chronic HBV infection remain asymptomatic until the onset of cirrhosis or end-stage liver disease and may be unaware of their infection, increasing the risk of transmission to household, sexual, or needle-sharing contacts. (See "Hepatitis B and pregnancy", section on 'Mother-to-child transmission' and "Clinical manifestations and natural history of hepatitis B virus infection", section on 'Sequelae and prognosis of chronic HBV infection'.)

VACCINE FORMULATIONS

Two single antigen (ie, monovalent) recombinant hepatitis B (HepB) vaccines, are available for use in the United States: Engerix-B and Recombivax HB [1,8]. These vaccines are supplied in different concentrations and have different doses (table 1). They can be used interchangeably [9], except that only Recombivax HB can be used for the two-dose series in adolescents age 11 to 15 years [1].

                          

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Literature review current through: Nov 2016. | This topic last updated: Mon Aug 01 00:00:00 GMT+00:00 2016.
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