Universal Recommendation for Hepatitis B Vaccination for Adults 19-59 Years

ByJoshua Foust
A partner post from our friends at the Colorado Department of Public Health & Environment.

On April 1, 2022, Centers for Disease Control and Prevention published updated recommendations for universal hepatitis B vaccination in adults aged 19-59 years. The updated recommendation removes the risk factor assessment previously in place for adults in this age group. A universal recommendation will simplify the hepatitis B recommendation for both vaccine recipients and clinicians with the hope to increase hepatitis B vaccination coverage and decrease hepatitis B infection.

Hepatitis B vaccines should now routinely be recommended for:

  • Infants (with the first dose given at birth).
  • Persons aged <19 years.
  • Adults aged 19-59 years New Universal Recommendation.
  • Adults aged ≥ 60 years with risk factors for hepatitis B (see below for risk factors).
    • Persons at risk for infection by percutaneous or mucosal exposure to blood, including:
      • 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 in-center or home hemodialysis and peritoneal dialysis, and persons who are predialysis.
      • Persons with diabetes at the discretion of the treating clinician.
    • Persons at risk for infection by sexual exposure, including:
      • 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.
    • Others, including:
  • Adults aged ≥ 60 years without known risk factors for hepatitis B may receive hepatitis B
    vaccines.

Despite demonstration of safety, immunogenicity, and efficacy of hepatitis B vaccination over the past four decades, the number of acute hepatitis B cases among adults are on the rise, and hepatitis B vaccination coverage among adults aged 19 years and older is low. Risk-factor based approaches to vaccine administration can lead to missed opportunities due to several reasons; nondisclosure of risk factors from patients and inadequate time to routinely assess patients for risk factors are two common reasons. A universal vaccination recommendation eliminates the need for risk assessment before vaccination for adults aged 19-59 years.

Additional clinical guidance:

  • No additional hepatitis B vaccine doses should be administered to persons who have previously completed a hepatitis B vaccination series or who have a history of hepatitis B virus infection (with the exception of specific cases where revaccination might be indicated – see 2018 ACIP recommendation).
  • Providers should only accept records with dates of vaccination as evidence of previous hepatitis B vaccination. Self-reported previous hepatitis B vaccination is not acceptable as proof of vaccination.
  • In community settings in which there is a high rate of previous hepatitis B virus infection, pre-vaccination testing performed simultaneously with administration of the first dose of vaccine might reduce overall costs. However, serological testing should not be a barrier to vaccination.
  • Due to lack of safety data, Heplisav-B and PreHevbrio should be avoided during pregnancy. Providers should vaccinate pregnant people needing hepatitis B vaccination with Engerix-B, Recombivax HB, or Twinrix.

Resources:
Hepatitis B Vaccination of Adults | CDC
Hepatitis B Questions and Answers for Health Professionals | CDC
Adult Immunization Schedule by Age Group | CDC
Universal Hepatitis B Vaccination | Morbidity and Mortality Weekly Report (MMWR)
Strategies for Increasing Adult Vaccination Rates | CDC
ACIP Presentation Slides Nov 2-3, 2021 | Universal Adult Hepatitis B Vaccination | CDC
Universal Adult Hepatitis B Vaccination: Introduction | CDC
Viral hepatitis surveillance reports | CDPHE