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Hepatitis B: Questions and Answers Information about the disease and…
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Hepatitis B: Questions and Answers
Information about the disease and vaccines
What causes hepatitis B? spread of HBV occurs during early childhood in-
Hepatitis B is a liver disease caused by the hepatitis volves contact between an infected person's body
B virus (HBV). fluids (e.g., their blood or drainage from their
wounds or skin lesions) and breaks in the child's
How does HBV spread? skin. HBV can be spread also when an HBV-infected
The spread of HBV occurs when blood from an HBV- person bites another person who is not infected.
infected person enters the body of a person who is HBV can be spread also by an infected person pre-
not infected. This can occur through having sex with chewing food for babies, and through contact with
an HBV-infected person without using a condom HBV from sharing personal-care items, such as ra-
(the efficacy of latex condoms in preventing infec- zors or toothbrushes. The virus remains infectious
tion with HBV is unknown, but their proper use may and capable of spreading infection for at least seven
reduce spread of HBV). days outside the body. Virus can be found on objects,
Sex contact is the most common reason for the even in the absence of visible blood.
spread of HBV infection in the United States. The HBV is not spread through food or water, sharing
spread of HBV from male to female or female to eating utensils, hugging, kissing, coughing, and
male accounts for about 1 out of 3 acute (recently sneezing or by casual contact, such as in an office or
acquired) HBV infections in adults. The risk of factory setting. People with chronic HBV infection
spreading HBV increases if the male or female has should not be excluded from work, school, play,
multiple sex partners, a history of a sexually trans-
childcare, or other settings.
mitted disease, or has sex with an HBV-infected per-
son. About 1 out of 4 acute HBV infections occur How long does it take to show signs of illness after
among men who have sex with men. coming in close contact with a person who has HBV
HBV is also easily spread by sharing drugs, needles, infection?
or "works" when "shooting" drugs. The risk of HBV The incubation period ranges from 45 to 160 days
infection from HBV-contaminated needlesticks is (average 120).
much greater than the risk of spreading HIV by this
What are the signs and symptoms of hepatitis B?
method. In the United States, illegal drug use injec-
About 7 out of 10 adults with acute hepatitis B have
tion accounts for about 16 out of 100 acute HBV
signs or symptoms when infected with HBV Children
.
infections. Other types of percutaneous (through the
under age 5 years who become infected rarely show
skin) exposures, including tattooing and body pierc-
any symptoms. Signs and symptoms of hepatitis B
ing, have also been reported to result in the spread
might include nausea, lack of appetite, tiredness,
of HBV when good infection control practices have
muscle, joint, or stomach pain, fever, diarrhea or
not been used. Unsafe injections in medical settings
vomiting, headache, dark urine, light-colored stools,
are a major source of HBV spread in many develop-
and yellowing of the skin and whites of the eyes
ing countries and might be a risk for United States
(jaundice). People who have such signs or symptoms
residents traveling abroad, if medical care is re-
generally feel quite ill and might need to be
quired in settings that have poor infection control
hospitalized. In 2006, 4,713 cases of hepatitis B were
practices.
reported to the CDC and 8% of these cases died from
HBV is also spread through needlesticks or sharps their infection.
exposures on the job and from an infected mother
to her baby during birth. Breastfeeding has not been How serious is hepatitis B?
associated with the spread of HBV . Hepatitis B is very serious. About 9 out of 10 infants
(who do not receive appropriate prophylaxis at
HBV can also be spread during childhood. Most
birth), 30 out of 100 children younger than age 5,
early childhood spread occurs in households of
and about 2 of 100 adults who are infected with
people with chronic (life-long) HBV infection, but
HBV are unable to clear HBV from their bodies and
the spread of HBV has also been seen in daycare
become chronically infected. This serious condition
centers and schools. The most likely way that the
Page 1 of 7
www.vaccineinformation.org/catg.d/p4205.pdf · Item #P4205 (5/08)
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Page 2 of 7
is discussed below. Even though people might even- people have chronic HBV infection at the present
tually recover from their acute infection, a feeling of time. Most of these people do not know they are
tiredness and poor health might last for months. infected.
During 1990-2005, the overall occurrence of re-
What does it mean to have chronic HBV infection?
ported cases of acute hepatitis B declined to a great
People with chronic HBV infection are infectious and
extent. In 2006, the estimated number of new HBV
can transmit HBV to others. Usually, chronically in-
infections was about 46,000--a decrease from an
fected people do not feel sick and do not realize they
estimated 232,000 new infections in 1990. Racial
are infected. They generally have HBV infection for
and ethnic disparities for acute HBV infection were
their entire lives. They are also at high risk of devel-
nearly eliminated for Asian/Pacific Islanders, Ameri-
oping chronic liver disease, including cirrhosis (scar-
can Indians/Alaska Natives, and Hispanics. How-
ring of the liver), liver failure, and liver cancer.
ever, racial disparities for acute (recently acquired)
What are the complications of chronic HBV infec- hepatitis B still remain among blacks. The highest
tion? occurrence of acute hepatitis B occurred among
An estimated 15-25 people out of 100 with chronic people ages 25-44 despite their race or ethnicity.
HBV infection eventually develop serious liver dis- The overall decrease in the occurrence of acute
ease. Chronic HBV infection is responsible for most hepatitis B in the United States is most likely due to
HBV-related sickness and death, including cirrhosis, the increased use of hepatitis B vaccine and changes
liver failure, and liver cancer. When people are in- in risk-reduction behaviors among at-risk popula-
fected at a very young age, these forms of liver dis- tions in response to the HIV/AIDS epidemic. During
ease do not appear usually until young adulthood or 1990-2006, the greatest decline in cases was among
middle age. children and adolescents, the group with the largest
increase in hepatitis B vaccination coverage. Report-
Is HBV infection a serious problem in the world?
ing of hepatitis B still remains a problem as many
In the United States, an estimated 3,000-4,000 people do not exhibit symptoms recognized as hepa-
people die each year of HBV-related cirrhosis, and titis B and many cases/infections are missed and
another 1,000-1,500 die each year of HBV-related therefore not reported to health authorities.
liver cancer. Worldwide, the medical consequences
of chronic HBV infections are a huge problem. Ap- Despite the dramatic decrease in the number of new
proximately 350 million people around the world HBV infections in the United States, chronic HBV in-
are chronically infected with HBV and approxi- fection remains a major problem. As stated above,
mately 1 million of these people die each year from about 1 million people have chronic HBV infection
cirrhosis leading to liver failure or liver cancer. The currently and most of these people do not know they
medical literature states that hepatitis B is the 10th are infected because they haven't been tested. Most
leading cause of death worldwide. cases of chronic HBV infection in the U.S. are found
in immigrants or refugees from areas of the world
What is the risk of getting HBV infection while trav- with moderate or high rates of hepatitis B. Some of
eling in other countries? these areas of the world include Asia, Africa, the
Short-term travelers to regions (Asia, Sub-Saharan Pacific Islands, and Eastern Europe. People from
Africa, Amazon Basin, Eastern Europe, and the these areas of the world should be tested to find out
Middle East) in which there are moderate to high if they are chronically infected.
rates of HBV infection are typically at risk for infec-
tion only through exposure to blood in medical, How does a person know if s/he has HBV infection?
healthcare or disaster-relief activities; receipt of A blood test called IgM anti-HBc is needed to diag-
medical care that involves blood exposures; or nose acute hepatitis B. There are additional blood
sexual activity or drug use. The Centers for Disease tests for hepatitis B that determine other aspects of
Control and Prevention recommends hepatitis B HBV infection. These other blood tests can tell
vaccination for travel to any of these places, regard- whether or not a person is currently infected and
less of the length of stay. whether or not a person has been infected in the
past. If the tests indicate a person has been infected
How common is hepatitis B in the United States? in the past, testing will also determine whether the
About 5 out of 100 people in the United States will person has developed protective antibodies to the
contract HBV infection sometime in their lifetime, if virus (i.e., they have gotten over the infection and
not vaccinated. Approximately 0.8 to 1 million will not get infected with HBV again [this is called
Immunization Action Coalition · St. Paul, MN 55104 · (651) 647-9009 · www.vaccineinformation.org · www.immunize.org
Page 3 of 7
immunity]) or whether they still have vi- What hepatitis B blood tests are available
rus in their blood, indicating they might and what do they mean?
have chronic HBV infection. Hepatitis B surface A positive test means that you have hepati-
antigen tis B virus in your blood and can pass the
Is there a medication to treat hepatitis B? (HBsAg) virus to others. You could be recently in-
There are several Food and Drug Admin- fected or you could have chronic (life-long)
istration (FDA)-approved medications infection. A negative test means that you do
that might help a person who has not have the virus in your blood.
chronic HBV infection. These medica-
Antibody to hepatitis B A positive test means that you are immune
tions don't usually get rid of the virus, surface antigen (cannot get hepatitis B). This positive test
but they might decrease the chance of (anti-HBs) occurs when you were either vaccinated
the infected person developing severe with hepatitis B vaccine successfully, had a
liver disease. Not everyone is a candidate recent dose of hepatitis B immune globulin
for these medications. Researchers con- (HBIG), or you had the actual infection.
tinue to seek additional cures for hepa- Only vaccination or actual infection
titis B. There is no treatment (other than provide long-lasting and usually permanent
supportive care) for people with acute immunity (means you will not get hepatitis
B again). Anti-HBs produced by HBIG
hepatitis B.
lasts only a short time (about 3 months).
How long can a person with HBV Antibody to hepatitis B A positive test means you currently have or
infection spread HBV? core antigen have had infection with hepatitis B virus at
A person with acute or chronic HBV in- (total anti-HBc) some undefined time period. The positive
fection is contagious as long as they have test has no relationship to having received
the virus in their blood, which can only hepatitis B vaccine; however, the test might
be determined by blood testing. In gen- be used prior to vaccination to see if you
eral, a person with acute hepatitis B gets had already been infected.
rid of the virus in their blood in six IgM antibody subclass of A positive test means that you were
months. If this does not happen, it is anti-HBc recently (within 6 months) infected with
(IgM anti-HBc)
likely the person will become chronically hepatitis B virus.
infected with HBV for life. Hepatitis B "e" antigen If this test is positive, you are infected with
(HBeAg) hepatitis B virus and have a large amount
What are some important Do's and of hepatitis B virus in your blood. You are
Don'ts for people with chronic HBV at increased risk of serious liver problems
infection? due to your chronic hepatitis B virus
DO's infection.
· Cover all cuts and open sores with a Antibody to hepatitis B This blood test might be positive if you
bandage. "e" antigen have chronic hepatitis B virus infection or
· Discard used items such as bandages (Anti-HBe) if you have already recovered from your
and menstrual pads carefully so no one infection. If have chronic hepatitis B virus
is accidentally exposed to your blood. infection and this test is positive, this
means that you have low levels of hepatitis
· Wash hands well after touching your B virus circulating in your blood and are at
blood or infectious body fluids. lower risk of liver problems due to your
· Clean up blood spills; then clean the chronic hepatitis B virus infection.
area again with a bleach solution (one HBV Deoxyribonucleic When this test is positive, it means you are
part household chlorine bleach to 10 acid infectious to others and the hepatitis B
parts of water). (HBV-DNA) virus is active in your body, possibly
· Tell your sex partner(s) you have hepa- causing liver damage. The test is often used
titis B so they can be tested and vacci- to determine success or failure of drug
nated (if not already infected or vacci- therapy if given for chronic hepatitis B
virus infection.
nated). Partners should have their
blood tested 1-2 months after three
doses of vaccine are completed to be sure the vac- · Use condoms (rubbers) during sex unless your sex
cine worked. partner has had hepatitis B or has been immu-
Immunization Action Coalition · St. Paul, MN 55104 · (651) 647-9009 · www.vaccineinformation.org · www.immunize.org
Page 4 of 7
nized and has had a blood test (as described blood contaminated body fluids enter another
above) demonstrating immunity to HBV infection. person's bloodstream. HBV and HCV infections can
(Condoms might also protect you from other sexu- cause chronic liver problems. HAV does not. There
ally transmitted diseases). are vaccines that will protect people from HAV infec-
· Tell household members to see their doctors for tion and HBV infection. Currently, there is no vaccine
testing and vaccination for hepatitis B. to protect people from HCV infection. There are
· Tell your doctors that you are chronically infected medications that are approved by the FDA for treat-
with HBV . ment of chronic HBV and HCV infections. If a per-
son has had one type of viral hepatitis in the past, it
· See your doctor every 6-12 months to check your
is still possible to get the other types.
liver for abnormalities, including cancer.
· If you are pregnant, tell your doctor that you have When did hepatitis B vaccine become available?
HBV infection. It is critical that your baby is started The first hepatitis B vaccine became commercially
on hepatitis B shots within a few hours of birth. available in the United States in 1982. In 1986, a
DON'Ts
DON'Ts hepatitis B vaccine produced by recombinant DNA
· Don't share chewing gum, toothbrushes, razors, technology was licensed, and a second recombinant-
washcloths, needles for ear or body piercing, or type hepatitis B vaccine was licensed in 1989.
anything that might have come in contact with
What are the names of the hepatitis B vaccines
your blood or infectious body fluids.
available in the United States?
· Don't pre-chew food for babies. The two recombinant vaccines (Recombivax HB®
· Don't share syringes and needles. and Engerix-B®) are the only hepatitis B vaccine
· Don't donate blood, plasma, body organs, tissue, preparations currently used in the United States.
or sperm. (There are additional products licensed in the U.S.
that contain these vaccines in combination with
What should you do if you have been exposed to other vaccines.)
HBV?
If you think you've been exposed to HBV don't de-
, What kind of vaccines are they?
lay. Contact your doctor or clinic. If you have not The hepatitis B vaccines used in the United States
been vaccinated, it is recommended that you receive are recombinant DNA vaccines, which means they
treatment with hepatitis B immune globulin (HBIG). are produced by inserting the gene for HBV into
This is a blood product containing protective HBV common baker's yeast where it is grown, harvested,
antibodies. You should also get the first dose of and purified. HBV infection cannot occur from re-
hepatitis B vaccine as soon as possible, preferably at ceiving hepatitis B vaccine.
the same time as the HBIG is given, but at a differ-
ent site on your body. Following this, you will need How is this vaccine given?
to complete the full hepatitis B vaccine series (usu- Hepatitis B vaccine should be given to infants (12
ally a total of three doses over a six-month period). months of age and younger) in the thigh muscle.
Either the thigh or the upper arm muscle may be
Can you get hepatitis B more than once? used for young children. The upper arm muscle is
No. If you get an acute case of hepatitis B and re- the preferred site of administration for adolescents
cover, you should have protective antibodies in your and adults. Hepatitis B vaccine should always be
blood that will prevent any further infection with given into the muscle despite the age of the patient.
HBV The medical literature does report possible
.
mutant strains of HBV infection, but these are rare Who should get this vaccine?
and would be highly unlikely to occur. Hepatitis B vaccine, usually a three-dose series, is
recommended for all children 0-18 years of age. It
How does HBV differ from hepatitis A virus (HAV) is recommended for infants beginning at birth in the
and hepatitis C virus (HCV)? hospital. All older children who did not get all the
HBV HCV and HAV are different viruses that attack
, , recommended doses of hepatitis B vaccine as an in-
and injure the liver, and can cause similar symptoms. fant should complete their vaccine series as soon as
Usually people get HAV infection from close per- possible. Most states require hepatitis B vaccine for
sonal contact with an infected person or from ingest- school entry. Adolescents who are just starting their
ing fecally-contaminated food or water. HBV and series will need two or three doses, depending on
HCV are spread when an infected person's blood or their age and the brand of vaccine used. Adults at
Immunization Action Coalition · St. Paul, MN 55104 · (651) 647-9009 · www.vaccineinformation.org · www.immunize.org
Page 5 of 7
increased risk of acquiring HBV infection should also · Healthcare settings targeting services to men who
be vaccinated. In addition, the vaccine can be given have sex with men
to any person who desires protection from hepatitis B. · Chronic-hemodialysis facilities and end-stage re-
nal disease programs
What groups of adults are at increased risk of HBV
infection? · Institutions and nonresidential day care facilities
for developmentally challenged people
· Healthcare workers and public safety workers
with reasonably anticipated risk for exposure to Who recommends this vaccine?
blood or blood-contaminated body fluids The Centers for Disease Control and Prevention
· Men who have sex with men (CDC), the American Academy of Pediatrics (AAP),
· Sexually active people who are not in long-term, the American Academy of Family Physicians (AAFP),
mutually monogamous relationships the American College of Physicians (ACP), and
· People seeking evaluation or treatment for a sexu- American College of Obstetricians and Gynecologists
ally transmitted disease (ACOG) recommend this vaccine.
· Current or recent injection drug users Is hepatitis B vaccine safe?
· Inmates of long-term correctional facilities Yes. Hepatitis B vaccines have been demonstrated to
· People with end-stage kidney disease, including be safe when administered to infants, children, ado-
predialysis, hemodialysis, peritoneal dialysis, and lescents, and adults. Since 1982, more than an esti-
home dialysis patients mated 70 million adolescents and adults and more
· Staff and residents of institutions or group homes than 50 million infants and children have received
for the developmentally challenged at least one dose of hepatitis B vaccine in the United
· Household members and sex partners of people States. The majority of children who receive this
with chronic HBV infection vaccine have no side effects. Serious reactions are
rare.
· Susceptible (non-infected) people from United
States populations known to previously or cur- What side effects have been reported with this vaccine?
rently have high rates of childhood HBV infection, Of those children experiencing a side effect, most
including Alaska Natives, Pacific Islanders, and will have only a very mild reaction, such as soreness
immigrants or refugees from countries with inter- at the injection site (fewer than one out of three
mediate or high rates of chronic HBV infection. To children) or low-grade fever. Adults are slightly
see a list of these countries, go to http:// more likely to experience such mild symptoms. Se-
www.cdc.gov/ncidod/diseases/hepatitis/b/ rious allergic reactions following hepatitis B vacci-
country_listing.htm nation are rare.
· International travelers to regions with high or in-
termediate rates of HBV infection. To see a list of How effective is this vaccine?
these countries, go to http://www.cdc.gov/ After three properly administered doses of vaccine,
ncidod/diseases/hepatitis/b/country_listing.htm at least 9 out of 10 healthy young adults and more
than 9 out of 10 infants, children, and adolescents
In addition, any adult who wishes to be protected
develop protective antibodies and subsequent immu-
from HBV infection should be vaccinated without
nity to HBV infection.
having to acknowledge a specific risk factor.
If you have not been fully vaccinated with hepatitis Why is this vaccine recommended for all babies
B vaccine and you are cared for in any of the follow- when most of them won't be exposed to HBV for
ing settings, you should ask the setting's healthcare many years, if then?
provider to fully vaccinate you with hepatitis B vac- There are three basic reasons for recommending
cine. These setting include: that all infants receive hepatitis B vaccine, starting
· Sexually transmitted disease treatment facilities at birth.
· HIV testing and treatment facilities First, babies and young children have a very high
· Facilities providing drug-abuse treatment and pre- risk for developing chronic HBV infection if they
vention services become infected at a young age.
· Healthcare settings targeting services to injection It is estimated that about 1 out of 3 of the nearly 1
drug users million Americans with chronic HBV infection ac-
· Correctional facilities (page 5 of 7)
Immunization Action Coalition · St. Paul, MN 55104 · (651) 647-9009 · www.vaccineinformation.org · www.immunize.org
Page 6 of 7
quired their infection as infants or young children. out of 100 chances of developing HBV infection
Those with chronic HBV infection are most likely to sometime during his or her lifetime. By avoiding
spread the infection to others. Infants and children obvious means of exposure, people can reduce their
who become chronically infected have an increased odds of becoming infected. But while there are de-
risk of dying prematurely from liver cancer or grees of risk involved in contracting HBV infection,
cirrhosis. there is no such thing as "no risk." Moreover, hepa-
In contrast to other vaccine-preventable diseases of titis B vaccine is the first vaccine to prevent cancer--
childhood, HBV infection in infants and young chil- HBV-related liver cancer.
dren usually produces no symptoms. Thus, the small Read "Unusual Cases of Hepatitis B Virus Transmis-
number of reported cases of hepatitis B among chil- sion (Spread)" for examples of the spread of HBV in
dren represents the tip of the iceberg of all HBV in- a variety of settings.
fections in children. For every child with symptoms
of hepatitis B, there are at least 100 HBV-infected Will your child need a booster shot later in life?
children with no symptoms--hence the increased At the present time, booster doses are not recom-
risk to spread the infection to others without mended routinely for people with normal immune
knowing it. systems. Although the level of protective antibodies
in the blood of a vaccinated person seems to decline
Second, early childhood infection occurs. About
with time, the immune system retains an immuniza-
16,000 children under 10 years of age were infected
tion "memory" and if the person is exposed to HBV ,
with HBV every year in the United States before rou-
the system "kicks in" and provides the needed pro-
tine infant hepatitis B vaccination was recom-
tection.
mended. Although these infections represented few
of all HBV infections in the United States, it is esti- Experts are continuing to monitor the long-term ef-
mated that 18 out of 100 people with chronic HBV fectiveness of hepatitis B vaccine and will issue rec-
infection in the United States acquired their infec- ommendations on the need for booster doses if evi-
tion during early childhood. Clearly, infections occur dence shows that booster doses are necessary.
among unvaccinated infants born to mothers who
are not HBV-infected. In addition, unvaccinated for- Should I be tested before I get the vaccine to see if
I'm already infected or immune?
eign-born children account for a high proportion of
Blood testing before vaccination is not recom-
infections. More effort needs to be placed on vacci-
mended for the routine vaccination of infants, chil-
nating these unprotected children.
dren, and adolescents. However, certain children,
Most early childhood spread of HBV occurs in house- such as those born in countries where HBV is mod-
holds where a person has chronic HBV infection, but erate or highly endemic (see http://www.cdc.gov/
the spread of HBV has also been recognized in ncidod/diseases/hepatitis/b/country_listing.htm for
daycare centers and schools. The most probable a list of these countries), should be tested to be sure
ways children become infected with HBV are from they are not already infected. Testing can be done at
skin puncture (e.g., biting) or from having their the same visit when the first dose of hepatitis B vac-
mucous membranes or cuts and scratches come in cine is given. Vaccinating a person already immune
contact with infectious body fluids from an HBV-in- to or infected with HBV will not help or harm the
fected person. HBV remains infectious for at least person.
seven days outside the body and can be found on
The main reason for testing people at increased risk
and spread through sharing of inanimate objects
for HBV is to determine if they are infected. If after
such as washcloths or toothbrushes.
testing they are found to be infected, they must be
Third, long-term protection following infant vacci- referred to a health professional for ongoing medi-
nation is expected to last for decades and will ulti- cal care for chronic HBV infection.
mately protect against acquiring infection at any
age. Should I get my blood tested after getting the vac-
cine series to make sure it worked?
Why should your child be protected against hepati- Testing after vaccination is not recommended rou-
tis B if h/she won't ever inject drugs or be sexually tinely. Testing after vaccination is recommended
promiscuous? only for people whose medical care depends on
HBV can be transmitted in many ways in addition to knowledge of their response to the vaccine. This
sex contact and injection drug use. On average, an includes infants born to HBV-infected mothers;
unvaccinated baby born in the United States has 5 healthcare and public safety workers at risk of con-
Immunization Action Coalition · St. Paul, MN 55104 · (651) 647-9009 · www.vaccineinformation.org · www.immunize.org
Page 7 of 7
tinued exposure to blood on the job; immune com- dose of hepatitis B vaccine. People with a history of
promised people (e.g., people with AIDS or on he- hypersensitivity to yeast should not receive this vac-
modialysis); and sex and needle-sharing partners of cine. People with a moderate or severe acute illness
people with chronic HBV infection. Testing for ba- should postpone receiving the vaccine until their
bies born to HBV-infected mothers should be done condition is improved.
after completion of at least 3 doses of a licensed
hepatitis B vaccine series, at age 9-18 months (gen- Can I get this vaccine when I am pregnant?
erally at the next well-child visit). Testing for other Yes.
persons should be performed 1-2 months after the
last dose of vaccine. I'm an adult who wants hepatitis B vaccination. How
can I pay for the shots?
What should be done if a person gets the first two If you have insurance, the cost of hepatitis B vacci-
doses of hepatitis B vaccine but never goes back for nation might be covered. If not, these shots are of-
the final dose? Should the series be restarted? ten available at low cost through special programs
No, the series does not need to be restarted. If the or from health departments. Call your local health
series is interrupted after the first dose, the second department for details.
dose should be given as soon as possible; the second
and third doses should be separated by an interval Will hepatitis B vaccination protect me from hepati-
of at least 8 weeks. If only the third dose is delayed, tis A or hepatitis C?
it should be administered as soon as possible. No. Hepatitis A and hepatitis C are different diseases
caused by different viruses. There is a vaccine for
The minimum recommended dosing intervals are 4 hepatitis A, but there is no vaccine for hepatitis C at
weeks between the first and second doses and 8 this time. For information on hepatitis A and hepa-
weeks between the second and third doses. The titis C, talk to your healthcare professional, call your
minimum interval between the first and third doses local health department, or visit www.immunize.org
is 16 weeks. and www.cdc.gov/hepatitis
Who should NOT receive hepatitis B vaccine?
People who had a serious allergic reaction to one
dose of hepatitis B vaccine should not have another
Immunization Action Coalition · St. Paul, MN 55104 · (651) 647-9009 · www.vaccineinformation.org · www.immunize.org