Hepatitis vaccination

What is the hepatitis vaccine?

There are several forms of viral hepatitis: hepatitis A, B, C, D and E. At present, only hepatitis vaccinations are available against hepatitis A and B to disposal. There are single vaccines (hepatitis A vaccine, hepatitis B vaccine) and a combined hepatitis A and B vaccine.

There is no compulsory vaccination in Germany – neither for the hepatitis vaccine nor for other vaccinations. However, hepatitis vaccination is sometimes recommended by the Standing Vaccination Commission (STIKO) at the Robert Koch Institute (RKI).

Depending on the principle of action, experts distinguish active and passive hepatitis vaccine:

Active hepatitis vaccine

In active hepatitis vaccination, the body is injected with components of hepatitis A or B viruses, in the upper arm muscle. This stimulates the immune system to produce specific antibodies against the respective pathogen. If it later comes to a “real” infection with the virus, the antibodies catch it. This can prevent a disease outbreak.

The vaccine used in active hepatitis vaccination is a so-called dead vaccine. The contained virus components can not trigger a disease, but only call the immune system on the plan.

After administration of the active hepatitis vaccine, it takes some time for the immune system to produce the specific antibodies. The vaccine protection is not given immediately. For this he stays for years.

Passive hepatitis vaccine

The passive hepatitis vaccine consists of already finished antibodies against the hepatitis virus in question. They are usually obtained from the blood of infected patients and processed highly purified to a hepatitis vaccine.

The passive hepatitis vaccine gives an immediate vaccine protection. But this only lasts for a few weeks – until the body has degraded the administered (foreign) antibodies. For example, the passive hepatitis vaccine is suitable for people who have recently had contact with patients and may have become infected (post-exposure prophylaxis). At the same time they are given the first dose of active hepatitis vaccine (a single vaccine, not the combined hepatitis A and B vaccine). Until it becomes effective, the vaccine is largely protected from infection by passive immunization.

Even before traveling to countries with a high incidence of hepatitis, passive hepatitis vaccination may be useful if the time for active immunization is insufficient.

Hepatitis A vaccination

Hepatitis A vaccine is administered intramuscularly, ie injected into a muscle. Usually the doctor chooses the upper arm muscle for it.

Hepatitis A vaccine: Who should get vaccinated?

The Standing Vaccination Commission (STIKO) recommends the hepatitis A vaccine only as Indication vaccination for certain risk groups, This includes:

• People who have an increased risk of infection due to their sexual behavior (such as homosexual men)
• Patients who frequently receive blood components due to certain diseases (such as haemophilia in hemophilia)
• Patients with behavioral disorders or brain damage (such as stroke patients) living in mental health institutions or similar care facilities
• Healthcare workers exposed to increased risk of infection (laboratory workers, etc.)
• People who come into contact with sewage (such as sewerage workers, sewage treatment workers)
• Employees in day-care centers, children’s homes, workshops for the disabled, asylum-seeker homes, etc. (including kitchen and cleaning staff)
• People who want to travel to regions where hepatitis A is more prevalent (such as the Mediterranean, Eastern Europe, many tropical regions)

Hepatitis A vaccine: How often do you need to vaccinate?

Two injections are required for the primary vaccination with the active hepatitis A vaccine: after the first vaccination, vaccination should take place a second time every six to twelve months.

Attention: The combined hepatitis A and B vaccine requires three doses of vaccine (see below)!

Hepatitis A vaccination: refresher

Long-term protection is achieved with the two vaccine doses of the hepatitis A primary vaccine. He holds at least 12 years in adults, possibly even 20 to 25 years. In any case, experts assume that in people with a healthy immune system, no hepatitis A refresher after a completed primary vaccination is necessary.

Only in certain cases, such as in immunocompromised individuals, should a titre control be carried out by means of a blood test – ie a measurement of the specific antibodies formed in response to the hepatitis vaccine. Refreshing may be necessary if the antibody level is too low.

Passive hepatitis A vaccine

Hepatitis A virus can also be passively vaccinated. The finished antibodies administered provide protection against hepatitis A infection for about three months.

During this time, vaccinations with live vaccines (such as measles, mumps and rubella vaccine = MMR vaccine) should not be performed. Their efficacy can be attenuated by the administered hepatitis antibodies.

Hepatitis B vaccination

The active hepatitis B vaccine was the world’s first recombinant vaccine. “Recombinantly produced” means that the constituents of hepatitis B virus (HBV) contained therein are produced artificially with the aid of genetically modified organisms. The Hepatitis B vaccine, like the Hepatitis A vaccine, is injected into the muscle (intramuscular, i.m.), most preferably in the humerus. Then, according to studies, this hepatitis vaccine is the most effective. A vaccination in the butt does not work so well.

Hepatitis B vaccine: Who should get vaccinated?

This hepatitis vaccine has been used by the STIKO since 1995 Standard vaccination for all infants and toddlers recommended. While hepatitis B disease is rare in these age groups, it carries a high risk of becoming chronic: acute hepatitis B becomes chronic in about 10 percent of adults, but up to 90 percent in infants and toddlers Cases.

In adulthood, the STIKO recommends the hepatitis B vaccine as Indication vaccination for certain risk groups, These include, for example:

• People who are likely to have severe hepatitis B disease (including patients with existing or expected immunodeficiency or pre-existing disease, such as hepatitis C patients, HIV-infected, dialysis patients)
• People who live in the family or in shared apartments together with people infected with hepatitis B
• People whose sexual behavior carries an increased risk of infection (eg because the sexual partner is changed frequently)
• Drug addict who inject the addictive substance
• People who are exposed to an increased risk of infection with hepatitis B in their profession (such as medical personnel, company first responders, police officers, social workers, etc.)
• Travelers who spend extended periods of time in countries with high levels of hepatitis B virus infection or who have close contact with the native population

Note: Anyone who has already undergone a hepatitis B infection can not, according to the current state of knowledge, re-infect with hepatitis B viruses. A hepatitis vaccine against this virus type is then not necessary.

Hepatitis B vaccine: How often do you need to vaccinate?

The hepatitis B vaccine can be given to infants and toddlers in the context of the sixfold vaccination together with the vaccines against diphtheria, tetanus (tetanus), polio (polio), whooping cough (pertussis) and Haemophilus influenzae type b (Hib). For the primary immunization are four vaccination dates between the ages of two and 14 months.

The hepatitis B vaccine can also be given as a single vaccine. Then only three vaccine doses necessary.

If the primary vaccination was missed in infancy, this hepatitis vaccine should be made up before the 18th birthday.

For the Indication vaccination for certain risk groups in adulthood are also three vaccine doses The second and third dose of HBV hepatitis vaccine are given one month and six months after the first.

For exceptional cases (when it must go fast, such as unplanned travel) is accelerated vaccination schedule The three vaccine doses are given at shorter intervals, for example within 21 days. The exact time intervals between the individual vaccine doses depend on the respective preparation. This accelerated vaccination schedule is not as good and long-acting as the normal vaccination schedule. For long-term protection, therefore, an additional 4th vaccine dose after six to 12 months is recommended.

Hepatitis B vaccine: refresher

According to the Robert Koch Institute, hepatitis B refresher is not necessary if a complete basic immunization was carried out in childhood. It is believed that the protection of this hepatitis vaccine at least ten to 15 years, possibly even lifelong persists.

Even after a hepatitis B vaccine in adulthood, booster vaccinations are usually not necessary. In people with weakened immune systems (such as dialysis patients), it may be useful to regularly monitor the level of hepatitis B antibodies in the blood (titer control). If the antibody count drops below 100 IU / L (International Units per liter), a booster dose is advised.

Also for people at high risk of infection (such as certain health professionals) who have received the full basic immunization as a child, vaccination coverage should be monitored and, where appropriate, refreshed.

Hepatitis B vaccine: protection of newborns

Women who are infected with the hepatitis B virus (HBV) can transmit the pathogen to the child during pregnancy, childbirth or breastfeeding. Therefore, the babies of such mothers receive the first dose of active hepatitis vaccine and passive hepatitis vaccination against HBV (simultaneous vaccination) within 12 hours after birth. Later follow the other vaccine doses of the active vaccine.

Even in mothers with unknown hepatitis B vaccine status, the newborn receives this simultaneous vaccination. An infection in the child is thereby prevented with high probability.

Hepatitis A and B vaccine in combination

Hepatitis A vaccine and hepatitis B vaccine can be given as a combined vaccine. For the combination vaccine, three injections are provided: the first two are given at intervals of four weeks. The third vaccination was scheduled six months later. This is followed by a vaccination protection lasting about ten years. The combined hepatitis A & B vaccine can be injected from the age of two.

Caution: The combination vaccine Hepatitis A & B is not suitable for people who may have been infected by contact with hepatitis A / B patients and now want to protect themselves by vaccination. For this post-exposure prophylaxis, a single hepatitis vaccine (plus a passive hepatitis vaccine) is used.

No hepatitis C vaccine yet

Hepatitis C (such as hepatitis B) can be chronic and lead to cirrhosis and liver cancer. Because the hepatitis C virus can change very quickly, science has not yet succeeded in getting a vaccine on the market. Also against other forms of viral hepatitis there is no vaccine. The hepatitis E vaccine available in China is not approved in Europe.

Hepatitis vaccination: side effects

All medications can cause side effects, including vaccinations like the hepatitis vaccine. Side effects in this case usually consist of harmless and transient reactions in the area of ​​the injection site, such as:

• reddening
• swelling
• Pain
• Hardening of the puncture site
• Swelling of the adjacent lymph nodes

Furthermore, after a hepatitis vaccine, you may experience side effects that affect the whole body:

• fatigue
• Gastrointestinal complaints
• fever
• Headache and body aches
• allergic reaction

In detail, the following possible side effects of the hepatitis A and hepatitis B vaccine are shown:

Hepatitis A vaccination: side effects

Hepatitis A vaccination causes redness and painful swelling around the puncture site in about 10 to 20 percent of cases. In addition, the general condition may be impaired for a short time. Sometimes the vaccine also causes fever, fatigue, head and body aches. Allergic reactions are rare.

Hepatitis B vaccine: side effects

Mild vaccination reactions such as redness, swelling, pain around the injection site and swollen lymph nodes also show up in a hepatitis B vaccine. Side effects such as mild fever, headache, body aches or tiredness are rare. In individual cases, allergic reactions occur.

Hepatitis vaccine & multiple sclerosis

The Hernán study attracted particular attention in 1990: The hepatitis B vaccine was a possible trigger for multiple sclerosis (MS). The assumption was later examined in further studies, but could not be proven scientifically until now.

According to current expert opinion, the hepatitis B vaccine can not trigger a relapses of the disease in existing MS disease.

Hepatitis vaccination & pregnancy

Both hepatitis vaccinations can be given during pregnancy if there is an increased risk of infection. This may be the case, for example, when the pregnant woman comes into contact with the pathogens of hepatitis A or B professionally.

In lactation is one Hepatitis vaccination in principle also possible. As a precaution also applies here: The vaccine should be carried out only if it is really necessary.