Hepatitis B primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2], Sara Mehrsefat, M.D. [3]


The risk of transmission of hepatitis B may be reduced by the implementation of certain measures proposed by the WHO. These include the vaccination of all infants within 24 hours of birth; vaccination of members of certain risk groups, including travelers to endemic areas and healthcare workers (if they have not been vaccinated yet); avoidance of sexual contact with a person who has acute or chronic hepatitis B; and avoiding sharing personal items such as razors or toothbrushes. The HBV vaccine is effective in preventing HBV infections when it is administered either before exposure or shortly after exposure.[1][2][3]

Primary Prevention

According to the WHO, the following measures should be implemented to prevent infection by hepatitis B virus:[1][2][3]

Primary Prevention Recommendations
Hepatitis B vaccine
  • The hepatitis B vaccine is the mainstay of hepatitis B prevention
  • The complete vaccine series induces protective antibody levels in more than 95% of infants, children, and young adults
  • Protection lasts at least 20 years and may be lifelong
  • WHO recommends vaccination for:
    • All infants receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours
      • The birth dose should be followed by 2 or 3 doses to complete the primary series. In most cases, 1 of the following 2 options is considered appropriate:
    • All children and adolescents younger than 18 years old who have not previously been vaccinated should receive the vaccine
    • People who frequently require blood or blood products, dialysis patients, recipients of solid organ transplantations
    • Incarcerated people
    • Injection drug users
    • Household and sexual contacts of people with chronic HBV infection
    • People with multiple sexual partners, as well as health-care workers and others who may be exposed to blood and blood products through their work
    • Travellers who have not completed their hepatitis B vaccination series should be offered the vaccine before leaving for endemic areas
Screening of all donated blood
Hepatitis B immune globulin
Lifestyle measures
  • Avoid sexual contact with a person who has acute or chronic hepatitis B
  • Use a condom and practice safe sex
  • Avoid sharing personal items such as razors or toothbrushes
  • Do not share drug needles or other drug equipment (such as straws used for snorting drugs)
  • Clean blood spills with a solution containing 1 part household bleach for every 10 parts water

Patients with chronic hepatitis B should be aware of the following:[1][2]

Education and Prevention of Hepatitis B
  • Importance of lifestyle modifications (e.g., reduction of alcohol consumption)
  • Risk of transmission to others:
  • Household memebers with negative test results for HBV serologic markers should be vaccinated.
  • Regular sexual partners with negative test results for HBV serologic markers should be vaccinated.
  • Casual sexual partners or unvaccinated regular sexual partners should make use of barrier protection methods.
  • Pregnant HBsAg-positive women should inform their healthcare providers so that Hepatitis B Immune Globulin and hepatitis B vaccine may be administered to the infant after delivery.
  • Healthcare workers infected with hepatitis B should consult an expert review panel.
  • In case of organ transplant in which anti-HBc-positive organ donors are used for HBV seronegative recipients, HBV infection should be prevented with the administration of antiviral therapy. 6-12 months of prophylactic therapy may be sufficient for organ transplants other than hepatic. For hepatic transplants, life-long antiviral therapy is recommended.


Hepatitis B vaccine is the most effective tool in preventing the transmission of HBV and HDV. Vaccines are composed of the surface antigen of HBV (HBsAg), and are produced by two different methods: plasma-derived and recombinant DNA. The natural reservoir for hepatitis B virus is man. Closely related hepadnaviruses have been found in woodchucks and ducks, but they are not infectious for humans.[1]

The primary hepatitis B immunization series conventionally consists of three doses of vaccine. Vaccination of infants and, in particular, delivery of hepatitis B vaccine within 24 hours of birth is 90–95% effective in preventing infection with HBV as well as decreasing HBV transmission if followed by at least two other doses. WHO recommends universal hepatitis B vaccination for all infants and specifies that the first dose should be given as soon as possible after birth.[1][4] This strategy has resulted in a dramatic decrease in the prevalence of CHB among young children in regions of the world where universal infant vaccination programs have been implemented. A small proportion of vaccinated children (5–10%) have a poor response to vaccination and remain susceptible to acquisition of HBV infection throughout their lives.[1][5]

WHO recommends that hepatitis B vaccine be included in routine immunization services in all countries. The primary objective of hepatitis B immunization is to prevent chronic HBV infections, which result in chronic liver disease later in life. By preventing chronic HBV infections, the major reservoir for transmission of new infections is also reduced.


  1. 1.0 1.1 1.2 1.3 1.4 1.5 World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016
  2. 2.0 2.1 2.2 Morbidity and Mortality Weekly Report. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. (2006). http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf Accessed on October 4th, 2016
  3. 3.0 3.1 Centers for Disease Control and Prevention. Prevention and Control of Infections with Hepatitis Viruses in Correctional Settings http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5201a1.htm Accessed on October 4th 2016
  4. Ni JD, Xiong YZ, Wang XJ, Xiu LC. Does increased hepatitis B vaccination dose lead to a better immune response in HIV- infected patients than standard dose vaccination: a meta-analysis? Int J STD AIDS. 2013;24(2):117–22.
  5. Liu CJ, Liou JM, Chen DS, Chen P J.Natural course and treatment of dual hepatitis B virus and hepatitis C virus infections. J Formos Med Assoc Taiwan. 2005;104(11):783–91.

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