Hepatitis b vaccine recommended after exposure

The Centers for Disease Control and Prevention (CDC) currently recommends universal hepatitis B (HepB) vaccination for any individual from infancy through 59 years. 1 The new recommendation follows the Advisory Committee on Immunization Practices (ACIP) guidance, as they expanded their recommendations for HepB vaccination in April 2022 to include universal HepB vaccination for all adults 19–59 years.

• Persons at risk for infection by sexual exposure: – Sex partners of persons testing positive for HBsAg – Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous six months) – Persons seeking evaluation or treatment for a sexually transmitted infection – Men who have sex with men
• Persons at risk for infection by percutaneous or mucosal exposure to blood: – Persons with current or recent injection drug use – Household contacts of persons testing positive for HBsAg – Residents and staff members of facilities for persons with developmental disabilities – Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids – Persons on maintenance dialysis, including incenter or home hemodialysis and peritoneal dialysis, and persons who are predialysis – Persons with diabetes at the discretion of the treating clinician
• Others: – International travelers to countries with high or intermediate levels of endemic HepB virus infection (HBsAg prevalence of ≥2%) – Persons with hepatitis C virus infection – Persons with chronic liver disease (including, but not limited to, persons with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase or aspartate aminotransferase level greater than twice the upper limit of normal) – Persons with HIV infection – Persons who are incarcerated

The recent expansion of the HepB vaccine recommendations is an important public health intervention since “Hepatitis B vaccination is the most effective measure to prevent HBV [hepatitis B virus] infection and its consequences.” 2 These effects can include chronic liver disease, liver cancer, and even death. 3

There are currently an estimated 2.4 million individuals in the United States living with HepB and an estimated 20,000 new infections every year. 4 Offering universal HepB vaccination for adults 19–59 years is significant, as less than one-third of the U.S. adult population is currently vaccinated against HepB, 1 and individuals 30–59 years are the highest-risk age range for new HepB infections. 5

There is an underestimation of adult patients who would benefit from immunizations for several reasons, including their vaccination status not being validated by medical records, demographic and other characteristics (e.g., insurance status, access to health care, patient unwillingness to disclose behaviors increasing the risk for HepB), and adults not accurately recalling or having records of receiving vaccines as children. 6 Therefore, it is imperative to universally target patients in the age range with the greatest risk of contracting HepB. The CDC's updated HepB vaccination guidelines seek to do just that, thereby reducing new cases of HepB and subsequent morbidity and mortality from chronic HepB.