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Hepatitis B Vaccination
Until 1982, prevention of viral hepatitis-B was based on passive immunoprophylaxis, either with standard IgG containing modest levels of anti-HBs or hepatitis B immune globulin (HBIG) containing high titre of anti-HBs. Initially the vaccine for active immunisation was prepared from the plasma of healthy HBsAg carriers. The vaccine was subjected to 3 different chemical inactivation steps which cumulatively destroy the infectivity of every known virus without harming the host. The plasma derived vaccine in 1987 was substituted by the genetically engineered vaccine derived from recombinant yeast. This genetically en gineered vaccine (Engerix B and Recombivax - HB) consists of HBsAg particles that are non- glycosylated but are otherwise indistinguishable from natural HBsAg. It is equally immunogenic, protective and safe as the first generation plasma-derived vaccine . Indications for hepatitis B vaccination include pre-exposure and post-exposure cases. Pre-exposure prophylaxis is advised in the following cases: 1. Health workers exposed to blood. 2. Haemodialysis patients and staff.
Pregnancy is not a contraindication for hepatitis B vaccination. Site of administration: The vaccination is indicated at 0, 1 and 6 months in the deltoid region or the anterolateral aspect of the thigh and not in the gluteal region as it may reduce the efficacy of the vaccine. Dosage: 1 . Engerix B. (i) 10 micog in children below 10 years; (ii) 20 micog for immunoincompetent children below 10 years; and Adults. (iii) 40 micog for patients on dialysis and other immuno- compromised persons. 2. Recombivax-HB. (i) 2.5 micog for children below 1 1 years of HBsAg-negative mothers; (ii) 5 micog for infants of HBsAg-positive mothers and children and-adolescents between 11 and 19-yrs; (iii) 10 micg for immunoincompetent adults; and 40 micog for patients on dialysis and other immunocompromised persons. 3. Heppacine-B (plasma derived): 1 ml IM at 0, 1 and 6 months. For unvaccinated persons sustaining exposure to HBV, treatment comprises: 1. HBIG for immediate action. 2. Hepatitis B vaccination for prolonged action. Special precautions: One should he careful during febrile illness infections and in patients on immunosuppressive therapy. Adverse side effects may include: tenderness and induration at the site of the injection, fatigue, fever, headache, diziness and arthralgia.
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