Hepatitis B (Hep B) is a liver infection against which vaccination was previously recommended for certain eligible risk groups. However, in 2022, the Centers for Disease Control and Prevention (CDC) switched from recommending vaccination for at-risk persons to recommending universal vaccination for children and adults.
That includes infants, children 18 years of age and younger, adults aged 19-59, and people aged 60 and up with risk factors for this viral infection. Even those aged 60 and older without known risk factors for hepatitis B may receive Hep B vaccines.
Risk factors under prior recommendations included potential criminal or stigmatizing behaviors such as injection-drug use, incarceration, or multiple sex partners, which limited risk assessment by providers. The CDC points out that universal adult Hep B vaccination through age 59 obviates the need for the previous approach of risk-factor screening and sensitive disclosures to determine eligibility and could increase vaccination coverage and reduce cases.
“A universal recommendation for Hep B vaccination could increase the number of persons who receive vaccination before the onset of chronic liver disease and other comorbidities (e.g., obesity or diabetes) that might make vaccination less effective,” the CDC stated, noting that patients with chronic liver disease have a reduced immune response to Hep B vaccination. Hep B vaccination also protects against hepatitis D.
“Most people born in the US are vaccinated during infancy, beginning on the first day of life,” Lauren D. Block, MD, an internist at Northwell Health and an assistant professor in the Institute of Health System Science at the Feinstein Institutes for Medical Research at sites in metropolitan New York City, said in an interview.
Feinstein Institute for Medical Research
Dr. Lauren D. Block
Typically, Dr. Block added, at-risk persons will have titers drawn to make sure they are immune to Hep B. “Titers can wane over the decades in healthy people, in which case a booster shot may be needed, or a restart of the three-part vaccination series if a person is not sure if they were vaccinated previously.” Those at greater risk include people with weakened immune systems, people with diabetes or on immunosuppressives, healthcare workers, travelers to higher-risk countries, people with multiple sexual partners, and IV drug users.
Although Hep B vaccines have demonstrated safety, immunogenicity, and efficacy during the past four decades, coverage among US adults has been suboptimal, limiting further reduction in infections, the CDC noted.
Hepatitis A
Though not widely endemic to North America, Hep A can be acquired during travel abroad, particularly to developing countries, or through exposure to unsanitary conditions and contaminated food or water.
The CDC recommends routine Hep A vaccination for all children aged 12-23 months, all unvaccinated children and adolescents 2-18 years, and all persons, including those who are pregnant, with increased risk factors for this orally and fecally transmitted infection or at risk for severe disease from it. At-risk groups include international travelers to affected regions, men who have sex with men, incarcerated individuals or group-home residents, injection and non-injection drug users, and homeless persons.
Hepatitis C and E
There is no vaccine for Hep C, and no FDA-approved vaccine in the United States for hepatitis E, although a vaccine for the latter was approved in China in 2012.
As with Hep A, observing strict water, food, and sanitation standards is essential for preventing infection with hepatitis E.
Dr. Block disclosed no competing interests relevant to her comments.