Hepatitis B vaccine is delivered on the immunisation schedule as part of Infanrix-hexa vaccine delivered at 6 weeks, 3 months and 5 months. No further doses are required.
Engerix-B 10 mcg and Engerix-B 20 mcg are the funded hepatitis B vaccines for:
Engerix-B 20 mcg is also the vaccine available for purchase by adults who are not eligible for funded hepatitis B vaccine but for whom hepatitis B vaccine is recommended. For example, adults who have an occupational risk of being infected with hepatitis B through contact with blood or bodily fluids. Hepatitis B vaccine may also be recommended but not funded for adults with a medical condition or lifestyle that increases their risk of being exposed to hepatitis B virus.
Engerix-B 10 mcg and Engerix-B 20 mcg are the funded hepatitis B vaccines for:
Infants born to mothers who are hepatitis B positive are at a very high risk of developing chronic hepatitis B infection, which can result in liver failure and cancer later in life as well as infecting others. Therefore, hepatitis B vaccine is given to newborn babies whose mothers are hepatitis B-positive, at the same time as hepatitis B immunoglobulin (HBIG), to reduce the risk of having been infected with hepatitis B virus during the birth process. Hepatitis B vaccination plus HBIG protects infants from hepatitis B infection significantly better than immunoglobulin alone.
Engerix-B dose options from the data sheet and Immunisation Handbook 2020
Infants born to mothers who are hepatitis B positive
*Not in Engerix-B data sheet, but is advised in Handbook based on interchangeability of hepatitis B vaccines and the adolescent hepatitis B vaccination for those aged 11-15 years of two adult hepatitis B vaccine doses (a minimum of four months apart; but preferably six).
Dialysis and liver/kidney transplant patients
See Appendix 2 in the current Immunisation Handbook for further details on catch-up schedules and doses.
Generally a serology result of ≥10 IU/L (or ≥20 IU/L for high risk individuals, depending on laboratory used) is considered immunity to hepatitis B. Vaccinated individuals who have laboratory confirmation of anti-HBs ≥10 IU/L are considered to have lifetime immunity to hepatitis B even if antibody levels wane to undetectable levels in subsequent serology. This is because an anamnestic immune response will be protective against future hepatitis B exposure.
Refer to the current Immunisation Handbook for information on post-vaccination serology testing and management of non-responders. Non-responders require case-by-case consideration.
Adults aged 18 years or older who meet the 'special groups' eligibility criteria:
Those with bleeding disorders, such as haemophilia. The vaccine should be administered in accordance with the haematologist’s instructions. It may, in this situation only, be given subcutaneously. An increased incidence of local reactions including subcutaneous nodules has been observed with this method.
It is safe to give during pregnancy if the woman is non-immune to hepatitis B and has had sexual or household contact with a hepatitis B infected person. Engerix-B can safely be given when breastfeeding.
The response to Engerix-B varies with age. After a course of three Engerix-B vaccine doses 89-96% of healthy individuals were protected from hepatitis B.
Immune memory from recombinant hepatitis B vaccines against clinical disease and chronic hepatitis B infection remains for at least 15-20 years when given to health individuals fully immunised as infants. Cellular immunity appears to remain even when antibody levels decline below detectable levels.
A study of recombinant hepatitis B vaccine recipients 15-16 years earlier, including several whose antibody levels were <10 mIU/mL, demonstrated an anamnestic antibody response to a booster/challenge dose of hepatitis B vaccine. Routine measurement of hepatitis B antibodies post-vaccination is not recommended. The exception would be when the vaccinee may be at increased risk and evidence of seroconversion is required. Serology should be done four weeks after the third vaccine dose