Hepatitis B: Should I have the vaccine?
In most adults, an acute hepatitis B infection will usually clear up on its own, without treatment. If it becomes chronic, though, it can have serious consequences. There is a vaccine to prevent hepatitis B. It is recommended for all babies and toddlers, as well as for adults who have a high risk of becoming infected.
The hepatitis B virus is mainly spread through blood, but also through other body fluids. This usually happens during unprotected sex – most commonly between men who have sex with other men. Having several sexual partners and recurring sexual STIs (sexually transmitted infections) can increase the risk of getting hepatitis B too. Other routes of infection include using non-sterile syringes when injecting drugs or having a tattoo done with non-sterile needles.
If a pregnant woman has hepatitis B, she might pass it on to her baby while giving birth. In Germany and other countries, pregnant women are offered a hepatitis B test to see whether they are infected.
The likelihood of becoming infected is generally quite low in countries like Germany, where less than 1 out of 100 people have hepatitis B.
In adults, the body usually fights off the virus successfully
In more than 95 out of 100 adults who are infected with hepatitis B, the immune system can effectively fight the virus. If the infection clears up on its own, the virus can no longer be detected in the blood after six months. Sometimes small amounts of the virus remain in liver cells but they don’t cause any problems.
Acute hepatitis B infections only very rarely lead to long-term health issues. If someone has had hepatitis B in the past and recovered from it, it means that their immune system has made antibodies that will most likely keep the virus under control. A hepatitis B infection that lasts longer than six months is considered to be chronic. Over time, chronic hepatitis B can lead to liver damage (liver cirrhosis) and liver cancer. These serious liver diseases don’t necessarily cause noticeable symptoms, or the symptoms may be non-specific.
Babies and children have a lower risk of infection. But if they’re infected, they react more sensitively to the hepatitis B virus and the infection is more likely to become chronic: Only about 10 out of 100 babies and children who are infected with hepatitis B are able to successfully fight the virus. In other words, the infection becomes chronic in about 90 out of 100 babies and children who have it.
Vaccine recommended for high-risk groups and young children
In Germany, the Standing Committee on Vaccination (Ständige Impfkommission, STIKO) at the Robert Koch Institute is responsible for issuing recommendations about vaccines. They recommend that adults have the hepatitis B vaccine if they have certain risk factors – for instance, if they
- are more likely to come into contact with the hepatitis B virus due to their job or voluntary work (for instance, medical staff, police or first aiders),
- are in close contact with someone who has a chronic hepatitis B infection (such as a relative),
- have an illness that means that a hepatitis B infection could have more serious consequences (for instance, people who have HIV or a chronic liver disease, or people who need dialysis or regular blood transfusions),
- use syringes to inject drugs,
- have many different sexual partners and are a man who has sex with other men,
- travel to a country where hepatitis B is very common.
STIKO also recommends that all babies and toddlers be vaccinated against hepatitis B. For this purpose, there is a combination vaccine that also offers protection against other diseases such as diphtheria, tetanus, polio, whooping cough and haemophilus influenzae type b. Depending on the exact type of vaccine, 3 or 4 injections are needed to achieve enough protection. Teenagers who haven’t yet been vaccinated are advised to have the vaccine.
In Germany, statutory health insurers pay for all people under the age of 18 to have the vaccines recommended by STIKO. Coverage of high-risk groups or travel vaccinations varies from insurer to insurer, but most statutory health insurers pay for them. If someone would like to be vaccinated against hepatitis because they are traveling to a high-risk area, they are usually given a combination vaccine against both hepatitis A and hepatitis B. You will find more information about travel vaccinations on the website of the World Health Organization.
How well is the hepatitis B vaccine tolerated?
The hepatitis B vaccine is well tolerated. There are no known severe side effects in healthy people.
But the vaccine isn’t suitable for people
- who have an acute illness that is associated with a high fever or needs to be treated. For instance, people shouldn’t be vaccinated if they have the flu. They can have the vaccine later instead.
- who had an overly sensitive reaction to a previous hepatitis B vaccination.
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Gemeinsamer Bundesausschuss (G-BA). Richtlinien des Gemeinsamen Bundesausschusses über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung („Mutterschafts-Richtlinien“). April 21, 2016.
Institute for Quality and Efficiecy in Healthcare (IQWiG, Germany). Screening for hepatitis B: Final report; Commission S16-03. November 14, 2018.
McDonald JW, Burroughs AK, Feagan BG, Fennerty MB (Ed). Evidence-Based Gastroenterology and Hepatology. Hoboken: Wiley-Blackwell; 2010.
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Robert Koch-Institut (RKI). Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut – 2017/2018. August 24, 2017. (Epidemiologisches Bulletin; Volume 34).
Robert Koch-Institut (RKI). RKI-Ratgeber: Hepatitis B und D. May 20, 2016.
Trepo C, Chan HL, Lok A. Hepatitis B virus infection. Lancet 2014; 384(9959): 2053-2063.
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