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Hepatitis B virus vaccination

Eng-Kiong Teo, MD
Anna SF Lok, MD
Section Editor
Rafael Esteban, MD
Deputy Editor
Jennifer Mitty, MD, MPH


There are more than two billion individuals with serological evidence of hepatitis B virus (HBV) infection worldwide [1]. Of these, 240 million are chronic carriers and approximately 686,000 hepatitis B related deaths occur annually [2-4]. Despite advances in antiviral therapy, only a minority of patients with chronic hepatitis B will have a sustained response. Thus, primary prevention by vaccination to increase herd immunity remains the main focus in controlling HBV infection.

The commonly used hepatitis B vaccines are extremely safe and have an efficacy of >90 percent against all HBV serotypes and genotypes. Thus, HBV infection can potentially be eradicated through global vaccination. Globally, vaccine coverage based upon completion of the third dose of vaccine (HepB3) has increased from 3 percent in 1992 to 84 percent in 2015 [5-7]. However, even in countries that actively advocate universal vaccination, coverage is less than 100 percent. As an example, the vaccine coverage in Taiwan for birth cohorts from 1984 to 2010 was 88.8 to 96.9 percent [8,9].

In the United States, vaccine coverage among adults is low, and the overall prevalence of hepatitis B vaccine-induced immunity was 25 percent during the period from 2007 to 2012 [10]. In 2010, vaccine coverage ranged from 58 percent for those between 18 and 20 years old to 26 percent for those between 41 and 49 years old [11]. In high-risk adults, vaccine coverage for those between 19 and 49 years was 42 percent, while the coverage rate for low-risk adults in the same age range was 33 percent. Despite this suboptimal vaccine coverage, the incidence of acute hepatitis B has decreased by 90 percent in the United States (from 8.5/100,000 in 1990 to 0.9/100,000 in 2012) [12]. However, new infections continue to be seen, especially among young adults who use injection drugs [10]. (See "Epidemiology, transmission, and prevention of hepatitis B virus infection", section on 'Epidemiology of chronic HBV'.)

While vaccination represents the cornerstone of public health measures to eradicate HBV, 5 to 10 percent of individuals do not respond to currently available vaccines. Thus, other public health measures, including health education and infection control measures, remain important. (See "Epidemiology, transmission, and prevention of hepatitis B virus infection".)


The development of hepatitis B vaccine is considered to be one of the major achievements of modern medicine. This section will review available vaccines. A discussion of novel approaches to vaccination is found below. (See 'New developments' below.)

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