Adult Hepatitis B Vaccine Recommendations: Identify, Strongly Recommend, Protect

This article was sponsored by Dynavax

In 2022, the Advisory Committee on Immunization Practices (ACIP) issued a universal recommendation that all previously unvaccinated adults aged 19-59 years receive hepatitis B vaccination.^1* Hepatitis B is a serious liver infection caused by the hepatitis B virus.² For most people, hepatitis B clears on its own.^2,3 For those who don’t clear the virus, the resulting health complications can lead to liver cirrhosis, cancer, or even death.^2,3 It can be difficult to predict who will clear the virus and who will not.^2,3 Therefore, vaccination is critical for protection.¹ In fact, per the Centers for Disease Control and Prevention (CDC), the best way to prevent hepatitis B is by being vaccinated.¹

Approximately 2.4 million Americans are living with chronic hepatitis B infections.² And unfortunately, many people are unaware they are infected, increasing the risk of unknowingly spreading it to others.² From 2016-2020, more than 75% of acute infections occurred among people aged 30-59 years.⁴ And 67% of reported acute hepatitis B cases in 2019 occurred in people with no identified risk factors or in people with missing risk data.⁴ This demonstrates how an age-based recommendation can simplify the process for healthcare professionals to identify and protect patients, helping to eliminate hepatitis B in the US.^1,4,5

Institution Check-In

Now, more than a year after the recommendations were introduced, how is your institution implementing? Do you have strategies and tools in place at an institutional level to proactively identify eligible patients, strongly recommend vaccination and protect with a vaccine that can provide series completion with only two doses in one month?^1,5,6,7

“It is critical that institutions and their healthcare staff not only educate themselves but create a plan to implement the 2022 ACIP adult hepatitis B vaccination recommendation,” said Dr. Arun B. Jesudian, Associate Professor of Clinical Medicine, Director of Liver Quality and Director of Inpatient Liver Services, Weil Cornell Medicine. “Beginning in 1991, hep-b vaccination became the standard of care for infants as part of a routine vaccination series, making it the first shot they likely received before leaving the hospital. However, we know that many adults are still unprotected. In fact, 80% of adults born before 1991 may not have vaccine-induced immunity.”^5,8

The time is now to take stock of your current efforts to increase hepatitis B vaccination rates in accordance to the updated ACIP recommendation.

Identify Adult Patients Based on Date of Birth or Age

Ensure the healthcare professionals in your institution are aware of the recommendations and are equipped to proactively identify eligible patients. With the shift from risk-based to age-based it is easier to routinely identify patients each day within healthcare institutions and pharmacies who may be eligible for hepatitis B vaccination.^1,5

Four out of five adults born before 1991 do not have vaccine-induced immunity.⁸ Although the 1991 universal pediatric recommendation dramatically decreased rates of hepatitis B in children, adults born before 1991 may still be vulnerable to hepatitis B infection and are recommended to be protected.^5,6,8 With access to your patients’ date of birth, your healthcare professionals have the ability to identify eligible patients for vaccination opportunities and help protect against vaccine preventable diseases, like hepatitis B.^1,2,5,6,8 In order to help healthcare professionals identify eligible patients, many institutions are choosing to implement new internal tools or create communications channels or EHR alerts as well as utilize care gap reporting.

Strongly Recommend Hepatitis B Vaccination to Eligible Adults You Interact with Daily

Now that the ACIP recommends universal hepatitis B vaccination for all eligible adults aged 19-59* years, your healthcare professionals, especially pharmacists and many pharmacy technicians, have the ability to routinely make a strong recommendation for hepatitis B vaccination to adult patients.^1,5,6,8

To start the conversation with patients your healthcare professionals can say something like, “Based on your date of birth, you likely did not receive the hepatitis B vaccine series as a child. The CDC now recommends that previously unvaccinated adults aged 19-59* get caught up on their hepatitis B vaccination status, and I strongly recommend that you get started today.”^1,5,6,8

There are tools and resources available to help facilitate adult hepatitis B vaccination rates in health systems and drive effective implementation at HeplisavBresources.com.

Protect More Adult Patients Against the Hepatitis B Virus

The hepatitis B vaccine could become one of the most widely used non-flu vaccines for adults you see daily in your pharmacy in the United States.^9** In fact, excluding the flu vaccine, the number of adults eligible for hepatitis B vaccination far surpasses that of other adult vaccines, including shingles and pneumonia, with an estimated 133 million adults currently eligible.^9**

Therefore, many institutions are choosing a two-dose hepatitis B vaccine to help vaccinate adults.⁷ HEPLISAV-B [Hepatitis B Vaccine (Recombinant), Adjuvanted] is the only 2-dose adult hepatitis B vaccine that provides series completion in just one month.⁷

INDICATION

HEPLISAV-B is indicated for prevention of infection caused by all known subtypes of hepatitis B virus in adults age 18 years and older.

If you or your institution has not yet created an implementation plan for the ACIP adult universal hepatitis B vaccination recommendation, the time is now and effective implementation starts with you and your teams to protect all eligible adult patients from hepatitis B!

*The ACIP recommends hepatitis B vaccination for all previously unvaccinated adults aged 19–59 years and adults aged ≥60 years with hepatitis B risk factors. Adults aged ≥60 years without risk factors may receive hepatitis B vaccination.

**Adults eligible for influenza vaccines calculated from population aged 18+ in 2022; adults eligible for shingles vaccines calculated using adults turning 50 years old in 2022, adults aged >50 who are unvaccinated based on CDC coverage rates, and immunocompromised adults aged 19-49; adults eligible for pneumonia vaccines included adults aged 65+ and at-risk adults aged 18-64 excluding smokers, patients with chronic heart disease, and patients who are immunocompromised; adults eligible for hepatitis B vaccination calculated using US census data published in 2018, CDC coverage data, and risk factor analyses. COVID vaccines were not part of this analyses.

IMPORTANT SAFETY INFORMATION

Do not administer HEPLISAV-B to individuals with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any hepatitis B vaccine or to any component of HEPLISAV-B, including yeast.

Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of HEPLISAV-B.

Immunocompromised persons, including individuals receiving immunosuppressant therapy, may have a diminished immune response to HEPLISAV-B.

Hepatitis B has a long incubation period. HEPLISAV-B may not prevent hepatitis B infection in individuals who have an unrecognized hepatitis B infection at the time of vaccine administration.

The most common patient-reported adverse reactions reported within 7 days of vaccination were injection site pain (23%-39%), fatigue (11%-17%), and headache (8%-17%).

Please see Full Prescribing Information at HEPLISAVBHCP.com, click here.

References:

¹Centers for Disease Control and Prevention. Recommended adult immunization schedule for ages 19 years or older, United States, 2022. Accessed July 20, 2023. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf.

²Hepatitis B Foundation: Hepatitis B Facts and Figures. Accessed August 1, 2023. https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/facts-and-figures.

³Centers for Disease Control and Prevention. Hepatitis B Frequently Asked Questions. Accessed August 23, 2023. https://www.cdc.gov/hepatitis/hbv/bfaq.htm.

⁴CDC. Viral hepatitis surveillance report 2020. Accessed July 21, 2023. https://www.cdc.gov/hepatitis/statistics/2020surveillance/hepatitis-b/table-2.2.htm.

⁵Immunization Practices Advisory Committee. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep. 1991;40(RR-13):1-19.

⁶Bjork A, Morelli V. Immunization strategies for healthcare practices and providers. In: Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th ed. Public Health Foundation; 2021:29-42.

⁷HEPLISAV-B. Package insert. Dynavax Technologies Corporation; 2023 for dosing see section 2.1.

⁸He WQ, Guo GN, Li C. The impact of hepatitis B vaccination in the United States, 1999-2018. Hepatology. 2022;75(6):1566-1578. doi:10.1002/hep.32265.

⁹Data on file. Dynavax Technologies Corporation; 2022.