Hepatitis B Vaccination Guidelines 2020

Hepatitis B vaccine is recommended for all people who are not infected with hepatitis B virus and do not have sufficient protective antibodies in their bodies.； Newborns are given free priority vaccination, and high-risk exposed groups need to be monitored regularly for booster shots. The protection rate of full-course standardized vaccination exceeds 90%, which is currently the most economical and effective means of preventing hepatitis B.

Having just received the physical examination report, the first reaction of friends who saw two pairs of patients who were half and fully negative for hepatitis B must be, "Do I have to take a shot?" ”, there were indeed two completely different opinions in the industry: one group believed that adults with normal immune function, even if they are accidentally exposed to hepatitis B virus, more than 95% of them can be cleared by themselves and antibodies will be produced by the way, so there is no need to take three injections. ； The other group believes that as long as there are no antibodies, you should get vaccinated, and there is no harm in having an extra layer of protection. The 2020 version of the guidelines is equivalent to balancing these two views: if you are an adult with normal immune function and no high-risk exposure risk, you can choose according to your own wishes, and you do not need to be kidnapped by morality and say, "If you don't fight, you will be irresponsible to yourself."” ； However, if you are medical staff, family members of hepatitis B patients, staff who often come into contact with blood products, or people with multiple sexual partners, it is still strongly recommended to get vaccinated, and don’t take any chances. I used to help at the vaccination post at a community health service center for half a year. I met a young man who was doing business and often socialized with clients. Sometimes he had oral ulcers and accidentally used a male cup used by the client. The antibody titer was found to be only 6mIU/ml. I was still debating whether to take the injection. After reading the guide, I made an appointment for three injections without saying a word. I said that buying it for a few hundred yuan would be more practical than worrying about it every day.

The requirements for mother-to-child transmission in the 2020 version are much stricter than before. In the past, many places required babies born to mothers who were positive for hepatitis B surface antigen to receive immune globulin within 24 hours. The new version directly stuck the time to 12 hours. Even premature babies weighing less than 2kg cannot wait. They will receive a dose of immune globulin after birth, and then follow the procedure of 0, 1, and 6 to receive 4 additional doses of vaccine, which is one more shot than ordinary babies. I was particularly impressed by a pregnant mother with a miscarriage syndrome who gave birth prematurely last year. The baby was only 1.8kg after birth. The community doctor previously said that the baby should wait until the weight increased to 2.5kg before taking the vaccine. Later, the family looked through the 2020 version of the guide and found it. They gave the protein and the first dose of the vaccine that day. Later, when the baby was six months old, the antibody titer was over 300, and the blockade was successful. The family had been hanging on for more than half a year before the decision was made.

Many people have a headache: "What should I do if I don't have antibodies after three injections?" This issue has been debated for many years. Some doctors ask you to continue taking injections, imported ones, and increase the amount of injections. Some say that you are born without antibodies, and the injections are in vain. The 2020 version of the guide gives a clear statement: If the antibody titer is still lower than 10 mIU/ml 1-2 months after the three injections, you can get another injection of 60 μg high-dose vaccine, or re-vaccination with three injections of 20 μg vaccine. If you still have no antibodies after this round, you don’t need to take another injection. This type of people belongs to a group with a weak immune response. The probability of developing chronic hepatitis after being infected with hepatitis B is very low, and there is no need to get repeated injections. There was a young girl who had just graduated. She had two courses of three injections in a row, but her antibodies were always negative. She was so scared that she couldn't eat or sleep well every day, fearing that she would be easily infected. I read the original text of the guide to her, broke it into pieces and explained it clearly. Then she finally breathed a sigh of relief and said that she no longer had to go to the vaccination site every week.

Oh, and there is another widely circulated misunderstanding. Many people think that if the antibody titer drops below 10, a booster shot must be taken immediately, otherwise there will be no protection. In fact, the 2020 version of the guide has long said that as long as the general population has been vaccinated and has produced enough antibodies, even if the titer drops later, the immune memory in the body is still there. Once exposed to the hepatitis B virus, the immune system will quickly wake up and produce antibodies, and chronic infection will not occur at all. There is no need to check twice a year and a half, and there is no need to rush to re-injection as soon as the titer drops. Only the high-risk groups we just mentioned need to check for antibodies every 3-5 years. If it is lower than 10, just take a booster shot. There used to be an aunt who came here every year to prescribe two and a half hepatitis B test sheets. As long as the antibody dropped below 20, she had to get a booster shot. She refused to listen to her advice several times. Later, I printed out the 2020 version of the guide and showed it to her, and then she said with a smile, "I've received several shots in vain in the past few years."

As for the side effects that everyone is concerned about, the data in the guide is also very clear: more than 90% of people will not feel any discomfort after vaccination. A few people will have redness and swelling at the vaccination site, low-grade fever, and fatigue, which will subside on their own in two or three days. The probability of severe allergies is less than one in a million, which is lower than the probability of winning the jackpot when you go out and buy a lottery ticket. There is absolutely no need to stop eating due to choking.

In fact, to put it bluntly, the most user-friendly part of the 2020 version of the guide is that it does not apply to one-size-fits-all, and everyone does not need to rush to the vaccination site, and do not take it lightly just because you are young and in good health. You can choose based on your own living situation - after all, although hepatitis B can be controlled now, if you really want to get it, you need long-term medication and follow-up. Spending hundreds of dollars on a vaccine in exchange for decades of stability is a good deal no matter how you calculate it.