Safe and effective vaccines have long been the frontlines of our nation’s disease prevention strategy. As one of the most beneficial and cost-efficient health interventions available, vaccines have dramatically reduced the incidences of diphtheria, measles and smallpox. [i],[ii]
The evidence shows that vaccination can save lives.ii It’s time that we fully apply that same defense against a highly transmissible virus: hepatitis B.[iii]
Hepatitis B is a serious liver infection caused by the hepatitis B virus.[iv] Treatments are available, but no cure exists for hepatitis B. Per the Centers for Disease Control and Prevention (CDC), the best way to prevent hepatitis B is by being vaccinated.[v] For most people, hepatitis B clears on its own.[vi] But for those who don’t clear the virus, the resulting health complications can be lifelong or even deadly.vi
There is no way of knowing who will clear the virus and who will not. And unfortunately, 80% of people are unaware they are infected.[vii]
Currently, 296 million people globally are living with chronic hepatitis B.vi From 2016-2020, more than 75% of acute infections occurred among people aged 30–59 years.[viii] In 2022, the CDC issued a universal recommendation that all previously unvaccinated adults aged 19-59 years receive hepatitis B vaccination. V,[ix]*
As a result of the updated age-based vaccination recommendation, patient identification is easier than ever. It’s time to take stock of our current efforts in adhering to these recommendations, while also highlighting the strategies that will drive future success.
First and foremost, there is an awareness and communication gap that needs to be addressed. According to a recent survey conducted by HealthLeaders, 65% of respondents had little to somewhat of an understanding of the timing, rationale and importance of the universal CDC recommendation for adult hepatitis B vaccination.[x]
“It is critical that institutions and their healthcare staff not only educate themselves but create a plan to implement the 2022 CDC adult hepatitis B vaccination recommendation,” said Dr. Arun B Jesudian, Associate Professor of Clinical Medicine, Director of Liver Quality and Director of Inpatient Liver Services, Weil Cornell Medicine. “Beginning in 1991, hep-b vaccination became the standard of care for infants as part of a routine vaccination series, making it the first shot they likely received before leaving the hospital. However, we know that many adults are still unprotected. In fact, 80% of adults born before 1991 may not have vaccine-induced immunity.”[xi]
In the same HealthLeaders survey, nearly 80% of respondents agreed that in order for a health system to effectively adopt and implement the CDC’s universal hepatitis B recommendation to vaccinate adults, they need to communicate with and educate healthcare professionals about this important recommendation, while also evaluating their progress towards vaccinating the large adult population now recommended for hepatitis B vaccination.xi
So how can institutions effectively and efficiently implement an adult hepatitis B vaccination strategy?
Communication is Key
It’s well established that communication in the workplace is important as it boosts employee morale, engagement, productivity, and satisfaction. Most importantly, it can help an institution adhere to the guidelines and recommendations set forth by governing bodies, such as the CDC. For the CDC universal adult hepatitis B vaccination recommendation, it’s suggested to share important messages, including 1) timing and rationale of recommendation 2) expectations for implementing the updated CDC recommendation 3) progress in implementing the CDC recommendation and vaccinating the adult population recommended for hepatitis b vaccination.
Education is Imperative
It’s important that these healthcare professionals understand the reason for the CDC universal adult hepatitis B vaccination recommendation, including how to identify and vaccinate all eligible patients.
Additionally, this knowledge can help healthcare professionals make a strong recommendation to patients for universal adult hepatitis B vaccination.ix*,[xii] To start the conversation with patients you can say something like, “Based on your date of birth, you likely did not receive the hepatitis B vaccine series as a child. The CDC now recommends that previously unvaccinated adults aged 19-59* get caught up on their hepatitis B vaccination status, and I recommend that you get started today.”ix*,xiii
Evaluation is Central to Ensuring Success
To ensure improvement in adult hepatitis B vaccination rates, it is vital to monitor care gaps and identify missed opportunities for where recommending vaccination for adult patients may be addressed.
There are tools and resources available to help facilitate adult hepatitis B vaccination rates in health systems and drive effective implementation at HeplisavBresources.com.
Since there are now ~133 million adults who may be eligible for vaccination, many institutions are choosing a two-dose hepatitis B vaccine to help vaccinate adults more efficiently.[xiii]** HEPLISAV-B [Hepatitis B Vaccine (Recombinant), Adjuvanted] is the only 2-dose adult hepatitis B vaccine that provides series completion in just one month.[xiv] In fact, the HealthLeaders survey revealed that 69% of respondents said that a two-dose vaccine (vs. 3-dose or 4-dose options) would be the most efficient dosing regimen to promote vaccine series completion assuming efficacy and safety are equivalent.xi
If you or your institution have not yet created an implementation plan for the CDC adult universal hepatitis B vaccination recommendation, the time is now and effective implementation starts with you and your teams!
* The CDC also recommends hepatitis B vaccination for adults aged ≥60 years with risk factors. Adults aged ≥60 years without risk factors may receive hepatitis B vaccination.
**Adults eligible for influenza vaccines calculated from population aged 18+ in 2022; adults eligible for shingles vaccines calculated using adults turning 50 years old in 2022, adults aged >50 who are unvaccinated based on CDC coverage rates, and immunocompromised adults aged 19-49; adults eligible for pneumonia vaccines included adults aged 65+ and at-risk adults aged 18-64 excluding smokers, patients with chronic heart disease, and patients who are immunocompromised; adults eligible for hepatitis B vaccination calculated using US census data published in 2018, CDC coverage data, and risk factor analyses.
HEPLISAV-B is indicated for prevention of infection caused by all known subtypes of hepatitis B virus in adults age 18 years and older.
IMPORTANT SAFETY INFORMATION
Do not administer HEPLISAV-B to individuals with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any hepatitis B vaccine or to any component of HEPLISAV-B, including yeast.
Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of HEPLISAV-B.
Immunocompromised persons, including individuals receiving immunosuppressant therapy, may have a diminished immune response to HEPLISAV-B.
Hepatitis B has a long incubation period. HEPLISAV-B may not prevent hepatitis B infection in individuals who have an unrecognized hepatitis B infection at the time of vaccine administration.
The most common patient-reported adverse reactions reported within 7 days of vaccination were injection site pain (23%-39%), fatigue (11%-17%), and headache (8%-17%).
Please see Full Prescribing Information at HEPLISAVBHCP.com, click here.
[i] Rodrigues CMC, Plotkin SA. Front Microbiol. 2020; 11:256.
[ii] Roush SW, Murphy TV. JAMA. 2007;298(18):2155-2163
[iii] Tripathi N, Mousa OY. Hepatitis B. [Updated 2023 Jul 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
[iv] Hepatitis B Foundation. Accessed July 12, 2022. https://www.hepb.org/what-is-hepatitis-b/faqs/is-there-a-cure-for-hepatitis-b/.
[v] Immunization Practices Advisory Committee. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep. 1991;40(RR-13):1-19.
[vi] CDC. Frequently Asked Questions. Accessed April 28, 2023. https://www.cdc.gov/hepatitis/hbv/bfaq.htm#bFAQa08.
[vii] Ogawa E, et al. JAMA Network Open. 2020;3:e201844.
[viii] CDC. Viral hepatitis surveillance report 2020. Accessed July 21, 2023. https://www.cdc.gov/hepatitis/statistics/2020surveillance/hepatitis-b/table-2.2.htm.
[ix] Centers for Disease Control and Prevention. Recommended adult immunization schedule for ages 19 years or older, United States, 2022. Accessed July 20, 2023. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf.
[x] HealthLeaders Survey conducted in 2023 of 101 members of the HealthLeaders council and audience.
[xi] He WQ, Guo GN, Li C. The impact of hepatitis B vaccination in the United States, 1999-
2018. Hepatology. 2022;75(6):1566-1578. doi:10.1002/hep.32265.
[xii] Bjork A, Morelli V. Immunization strategies for healthcare practices and providers. In: Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th ed. Public Health Foundation; 2021:29-42.
[xiii] Data on file. Dynavax Technologies Corporation; 2022.
[xiv] HEPLISAV-B. Package insert. Dynavax Technologies Corporation; 2023 for dosing see section 2.1.
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