Hepatitis B vaccine shortage
Read our clinical update on new guidance from Public Health England in light of a hepatitis B vaccine shortage.
Read our clinical update on new guidance from Public Health England in light of a hepatitis B vaccine shortage
The hepatitis B vaccine is highly effective in preventing infection if given prior to exposure and is also effective post-exposure. Post-exposure vaccination should start immediately, ideally within 24 hours of exposure.
Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). The virus is transmitted by parenteral exposure to infected blood or body fluids.
The World Health Organization has estimated that around 250 million people worldwide are chronically infected with HBV.
Temporary recommendations on hepatitis B immunisation have been developed in light of recent global shortages of hepatitis B vaccine, including combination hepatitis A/B vaccine, which have severely impacted UK supply.
Public Health England (PHE) has published recommendations including advice on prioritisation of vaccine for specific groups to preserve adult and paediatric hepatitis B vaccine stock for those at highest, immediate need and with the greatest ability to benefit.
Signs and symptoms
The acute illness can start with nausea and vomiting and an ache in the right upper abdomen. Fever, when present, is usually mild. Malaise may be profound. As jaundice develops, there is progressive darkening of the urine and lightening of the faeces. In patients who do not develop symptoms suggestive of hepatitis, the illness will only be detected by abnormal liver function tests and/or the presence of serological markers of hepatitis B infection such as hepatitis B surface antigen (HBsAg), hepatitis B core IgM antibody (anti-HBc IgM).
Causes and risk factors
According to PHE, transmission mostly occurs through:
- Vaginal or anal intercourse.
- As a result of blood-to-blood contact through percutaneous exposure, for example sharing of needles and other equipment by people who inject drugs.
- Through perinatal transmission from mother to child.
How you can help your patient
PHE has set out prioritisation of certain groups and says that for all pre- and post-exposure indications an individual risk assessment is required.
Infants born to mothers infected with hepatitis B are the highest priority for post-exposure vaccination as they are at greatest individual risk of infection.
Prioritisation for pre-exposure vaccination includes groups such as clinical health workers with regular blood exposure and sex workers.
Those considered at lowest risk are people seeking booster jabs, having already completed a primary course of immunisation.
RCN professional lead for public health nursing Helen Donovan
‘The PHE guidance is intended to make sure the supplies of vaccine remain available for those at greatest risk of infection and to support clinical staff when advising and recommending the vaccine. This will depend on the individual and the circumstances and require a specific risk assessment.
‘Those who are at greatest risk will be individuals who are exposed to the infection from a known source, for example neonates born to mothers infected with hepatitis B or the sexual partners of someone infected.
‘Pre-exposure vaccination for those at occupational risk such as nurses are also a priority. The vaccine itself is actually very effective, so if people have had one dose they will already have some protection, and boosters are not such a high priority. Waiting between doses will not affect the efficacy of the vaccine at all.'
Find out more
- Hepatitis B vaccination in adults and children: temporary recommendations from 4 August 2017
- Information on the vaccine shortage on the RCN immunisation page
- Hepatitis B (Nursing Standard, 2014)
- UK supply of hepatitis B vaccine ‘severely affected’ by global shortages (Nursing Standard, 2017)
- New 'six in one' vaccine to be offered for babies (Nursing Standard, 2017)