Should you get the hepatitis B vaccine?

Hepatitis B is an infection that can cause serious damage to the liver, including permanent scarring (cirrhosis), liver cancer, liver failure, chronic liver disease, and even death. It’s caused by the hepatitis B virus (HBV), which can be found in blood, semen, and other body fluids. 

According to the Centers for Disease Control and Prevention (CDC), about 22,000 people in this country are living with an acute HBV infection (a short-term illness), while close to 1 million have chronic hepatitis B. Infection—which can produce vague symptoms like fatigue, fever, and stomach upset—can be prevented with a vaccine, but not everyone gets immunized. The hepatitis B vaccine is generally recommended for babies/children and adults in certain high-risk groups. But since hepatitis B is an infection that’s asymptomatic in up to one third of cases and spread via fluids that can be hard to completely avoid, you might wonder whether everyone should get immunized. Here, what you need to know.

Who needs a hepatitis B vaccine?

According to the Hepatitis B Foundation, 80,000 Americans develop hepatitis B each year. Worldwide, two people die from the infection every minute.

Since 1991, it’s been recommended that all healthy newborns receive a hepatitis B vaccination starting shortly after birth. The American Academy of Pediatrics (AAP) says healthy newborns should receive their first dose of the vaccine within 24 hours of birth, with the second dose at 1 to 2 months of age, and the third and final dose between 6 and 18 months. If a birth mothera mom tests positive for hepatitis B during pregnancy (and pregnant women are routinely tested), those timetables may be moved up, as hepatitis B can be transmitted during the birth process.

Why do babies need a hep B vaccine, especially if they’re living among adults who aren’t in a high-risk group? Because many people with hepatitis B virus infection are asymptomatic, and the infection can be spread via something as innocuous as the toothbrush or shaving razor of an infected person. According to Children’s Hospital of Philadelphia (CHOP), hepatitis B is 100 times more infectious than HIV. Ninety-five percent of children receiving all three doses of hep B vaccine will be protected from the complications the infection causes, says the AAP.

Another reason to vaccinate young? The AAP also notes that more than half of the 5,000 adults who die from hepatitis B in this country each year acquired the infection as children. If you’re an adult who’s not sure whether or not you were ever immunized, you can get a blood test that will check for immunity—but it’s not right for everyone; you should check with your provider to determine if testing is appropriate.

“If you’re already immune, you can avoid getting extra shots and making unneeded clinic visits, especially in this era of COVID,” notes Amon Asgharpour, MD, an assistant professor in the Division of Liver Diseases at Icahn School of Medicine at Mount Sinai in New York City. However, administering extra doses of single-antigen hepatitis B vaccine is not harmful.

Others who should be vaccinated, say the CDC, include:

• Men who have sex or sexual contact with other men.
• People who are not in a mutually monogamous sexual relationship.
• People being treated or evaluated for sexually transmitted diseases (STDs).
• Injection drug users or others who share or use needles.
• Healthcare workers, public safety workers, incarcerated individuals, and those who work or live in facilities for intellectually disabled people.
• People who are household contacts of those who test positive for hepatitis B.
• Those traveling to areas of the world (for example, certain parts of Eastern and Central Europe, Africa, and South and Central America) with high hepatitis B rates.
• People with certain chronic diseases, such as liver disease (including hepatitis C), diabetes, kidney disease, and HIV infection.
• Hemodialysis patients (hemodialysis is a procedure in which waste products from the blood are filtered; it’s used by people whose kidneys don’t function properly).
• Pregnant women who have multiple sex partners, are intravenous drug users, have or are being evaluated for an STD, or have a hepatitis B positive partner. According to the CDC, pregnant women can safely receive the vaccine without any harm to their unborn babies.

What if you fall outside all these categories—should you still get vaccinated? “While the actual risk of getting the infection varies greatly across the population, the vaccine is so safe and easy to get that all adults should get it, regardless of their personal risk,” says Christine Traxler, MD, retired family practice physician, author of I’m having a baby: What now?

Vaccine safety and efficacy

Thanks to the widespread immunization of infants since the early 1990s, the overall spread of hepatitis B has significantly declined in this country. However, infection with HBV has been on the rise in the past few years among certain groups, particularly those 30 to 49 years of age, reports the United States Department of Health and Human Services (HHS). The agency points to incomplete vaccination coverage (the hepatitis B vaccine is generally given in a vaccine series of shots) among this age group as well as an increase in drug use, especially opioid drugs. In 2015, acute hepatitis B infection rates increased 20.7%, the first increase in nearly 10 years says the HHS.

Many hep B vaccines are given on a vaccination schedule that includes three doses, spaced a few months apart. In 2017, the Food and Drug Administration (FDA) approved a two-dose vaccine (called Heplisav-B) given 30 days apart for use in adults. “You get high immune system response and better compliance with a two-dose program,” notes Robert G. Gish, MD, medical director of the Hepatitis B Foundation. 

The hep B vaccine (in addition to Heplisav-B, other brand names include Engerix-B and Recombivax HB) has been around for decades. While no one knows for sure exactly how long the vaccine provides immunity, at least one study from 2016 shows that it can be at least 30 years. Booster shots are generally not recommended for healthy people who’ve been vaccinated. 

The Hep B vaccine is not a live vaccine, so it is safe for newborns, infants, pregnant or lactating women, and immunocompromised individuals.

Hep B vaccine side effects

The vaccine does not use blood or blood products and has been shown to be safe. The most common side effect is soreness at the injection site. “Otherwise, 1 to 3% [of those being vaccinated] report headache, joint pain, low-grade fever, myalgia, or malaise,” Dr. Asgharpour says. “With a low risk of side effects, it definitely makes vaccination more attractive to physicians and patients.”

Severe allergic reactions are rare, but definitely get immediate medical help from a healthcare professional if you experience any of the following side effects:

• Hives
• Facial swelling
• Problems breathing
• Fast heartbeat
• Dizziness

They could be signs of a dangerous reaction.

Insurance coverage and cost

According to the CDC, all health insurance marketplace plans and most private insurers will cover the cost of a hepatitis B vaccine if you use an in-network provider. Medicare Part B will cover the hepB vaccine if you’re in a high-risk group. Price will vary by a number of factors, including the brand of vaccine used and whether it is for pediatric or adult use, but in general the vaccine can range in price from less than $13 to upward of $150. You can receive the vaccine at your healthcare provider’s office or through some local health departments. Your area pharmacy may also be able to administer it. For greater savings on the hepatitis B and other vaccines available at your pharmacy, use your SingleCare card.

How to protect yourself against hepatitis B

While there are antiviral drugs that can help slow and limit the liver damage hepatitis B causes, there is no cure. Prevention is key. In addition to getting vaccinated, you can help protect yourself from the infection with these tips from the Hepatitis B Foundation:

• Wash your hands thoroughly with soap and water after coming into contact with blood or other body fluids.
• Use barrier protection (condoms) when having sex.
• Don’t share toothbrushes, razors, earrings, or nail clippers.
• Avoid intravenous drug use.
• Clean up blood droplets on surfaces after an injury with a solution of one part bleach to nine parts water.
• Make sure new, sterile needles and inks are used whenever you get a piercing, tattoo, or acupuncture and receive these services only from licensed shops.
• Stay up to date on all vaccines, especially hepatitis A.
• If you are trying to become pregnant or are pregnant, talk with your healthcare provider about early hepatitis B testing and vaccination.
• If you are a healthcare provider or exposed worker, always use recommended universal precautions.
• If you think you have hepatitis B, are at risk for hepatitis B, or were exposed, contact your provider as soon as possible.

When in doubt, talk to your healthcare provider for professional medical advice to find out more preventive measures.