Hepatitis B Vaccination Guidelines 2023

Except for those who are positive for hepatitis B surface antigen (i.e., have been infected with hepatitis B virus) and those who are severely allergic to vaccine components, as long as the hepatitis B surface antibody (anti-HBs) titer is less than 10mIU/ml, they can choose to be vaccinated based on their own risk of exposure.； Healthy people do not need to retest antibodies every year after completing 3 doses of basic immunization. High-risk groups are recommended to monitor titers every 3-5 years and revacculate if they are insufficient.

Last week, I helped my cousin's child who had just entered kindergarten to get a physical examination. After looking through the vaccine book, I discovered that she had missed the third dose of hepatitis B vaccine because she had a fever when she was a child. When she was taken to the community health service, she thought she would have to take three injections all over again. However, the nurse asked her to check two and a half pairs first. When she saw that the antibody titer was only 6mIU/ml, she directly prescribed a shot of 20μg recombinant yeast vaccine. After a month of follow-up, it rose to 128mIU/ml, which saved a lot of trouble.

You must have come across two completely opposite opinions: one group says that "hepatitis B antibodies only last for 5 years, and you must re-vacculate at that point, otherwise it will be a waste." The other group says that "as long as you have received three injections as a child, you will still have immune memory even if the antibodies are not detectable, and you don't need to make up for it blindly." In fact, these two statements are supported by their own research. In the 2023 Guidelines of the Hepatology Branch of the Chinese Medical Association, it is directly stated Let’s put it bluntly: If you are a healthy adult with normal immune function, who is not at high risk of exposure to hepatitis B virus, and has indeed completed 3 basic immunization shots as a child, even if the antibody test is negative now, there is no need for routine re-vaccination, because the body’s memory B cells still remember the appearance of the hepatitis B virus, and will quickly awaken and produce antibodies when exposed to the virus, and will almost never develop into a chronic infection. However, if you are medical staff, test personnel who often come into contact with blood, or have family members with high-risk groups such as hepatitis B patients, men who have sex with men, and intravenous drug addicts, even if you have received three injections before, it is still recommended to check the titer every 3-5 years. If the titer is lower than 10, replenish it. After all, you are exposed to the virus every day, and an extra layer of protection is more secure.

Many people ask me what should I do if I can’t remember whether I got the hepatitis B vaccine when I was a child? In fact, you can just go to the social welfare department to get vaccinated without having to check the two and a half first - of course you can check if you want to. If it is found that you are infected, the vaccination is really useless. If you are not infected, it does not hurt whether you have been vaccinated before or not. I have a friend who was born in 1992. When he was a child, the hepatitis B vaccine was not widely available in his hometown in the countryside. Last year, the physical examination at work was negative for antibodies. He went directly to the social welfare department and received three injections of 20 μg. Now the titer is almost 300, which makes him feel relieved.

There are also cases where people still have no antibodies after three injections. This situation accounts for about 5-10% of the population. Don’t panic. You can try a different vaccine process. For example, if you used recombinant yeast, you can switch to CHO cell vaccine, or you can directly take a high-dose vaccine of 60 μg. Instead of three injections, just one injection will do. More than 80% of people will develop antibodies after the injection. There are really a very small number of people who don’t develop antibodies despite being vaccinated. As long as they are not in a high-risk group, there is no need to worry. You will not be infected with hepatitis B through ordinary daily contact, so there is no need to scare yourself.

Vaccination precautions for special groups are not as complicated as everyone thinks. For example, can pregnant women be vaccinated? Absolutely, the vaccines currently used are genetically recombinant inactivated vaccines, which do not contain live viruses and will not affect the fetus. If there is a pregnant woman with hepatitis B in the family and the antibodies are not enough, it is recommended to take it to give the baby an extra layer of protection. There are also people with immune function problems, such as HIV-infected people, people who take immunosuppressants after organ transplantation, and people who undergo radiotherapy and chemotherapy for malignant tumors. These people are prone to develop chronic hepatitis B infection. It is recommended to get a high-dose vaccine. After 1-2 months, the antibody should be checked. If it is not enough, continue to take supplements. It is safer to maintain the titer above 100mIU/ml.

Let me talk about some practical details that I learned while accompanying my family to get the vaccine. There are currently three kinds of hepatitis B vaccines in social health: ordinary doses of 10 μg, 20 μg, and high dose of 60 μg. For ordinary healthy people, just choose the 20 μg vaccine. Three injections only cost tens of dollars. If you don’t want to bother with three trips, one injection of the 60 μg vaccine is enough. It costs about more than 100 yuan, and it is very cost-effective. There are still people who are confused about whether to import or domestically produced. There is really no need. There is no statistical difference in the protection rate between domestically produced recombinant vaccines and imported ones. My parents took the domestically produced vaccine last year, and the titer after the injection was 200, which is completely sufficient.

In fact, hepatitis B is the main cause of liver cancer in our country, and the hepatitis B vaccine is currently the only vaccine that can effectively prevent liver cancer. Don’t worry too much about whether to take it. When you pass by the community health service, ask by the way, and take a shot every 5 minutes. It is better than anything else. If you are really unsure, take a look at your physical examination report to a social welfare doctor, and they will give you an accurate answer in two minutes. There is no need to read all kinds of contradictory information online and get confused.