Which vaccines do people with hepatitis B still need?

The hepatitis B vaccine does not treat hepatitis B

The hepatitis B vaccine prevents infection; it does not treat existing chronic hepatitis B. For someone already HBsAg positive, vaccination does not clear the virus or turn HBsAg negative.

The people who need hepatitis B vaccination are household members, partners, and contacts without evidence of immunity. They should be tested for HBsAg, anti-HBs, and anti-HBc, and those without infection or antibody should complete the series.

Hepatitis A vaccine: worth discussing with chronic hepatitis B

Hepatitis A and hepatitis B are different viruses, but coinfection or superinfection can make hepatitis more severe. People with chronic liver disease, including chronic hepatitis B, are usually advised to check hepatitis A immunity and to be vaccinated if not immune.

Ask at your next visit: have I been tested for hepatitis A antibody, and do I need the vaccine? People who have had hepatitis A or were vaccinated usually do not need it again.

Flu and pneumococcal vaccines: by risk

Influenza vaccination is usually annual, and people with chronic liver disease are among those recommended to receive it. Inactivated flu vaccines do not contain live virus and do not cause hepatitis B.

Pneumococcal vaccination is also recommended for people with cirrhosis or chronic liver disease, with the type and number of doses set by local immunisation schedules and age. Tell the vaccinator about your liver stage and medicines.

COVID-19 and other vaccines

Follow the current local recommendation for COVID-19 vaccination; chronic liver disease is generally not a contraindication. Other vaccines, such as tetanus or travel vaccines, depend on destination, occupation, and exposure risk.

Live attenuated vaccines, including some travel vaccines, MMR, and varicella, usually need caution or avoidance in people who are immunocompromised or on immune-suppressing treatment, and a clinician should decide. Chronic hepatitis B alone is not immunosuppression.

What to tell the vaccinator

Tell them which antivirals you take, whether you have cirrhosis, whether you are on immune-suppressing treatment or chemotherapy, whether you have fever or an acute hepatitis flare, any past vaccine allergy, and whether you are pregnant or planning pregnancy.

If hepatitis is active or you feel unwell, you can discuss delaying vaccination until things are stable. A mild cold is usually not an absolute contraindication; the vaccination site will assess.

Questions to ask at your visit

1. Have I been tested for hepatitis A and hepatitis B antibodies, and do I need vaccination?
2. Do I need a flu vaccine this year?
3. I have cirrhosis; do I need pneumococcal vaccination?
4. Could my antiviral or immune-suppressing treatment affect vaccination?
5. I am travelling; which vaccines should I get in advance and which should I avoid?
6. If I develop fever or fatigue after vaccination, whom should I contact?

Action checklist

Confirm the hepatitis B screening and vaccination status of family members and partners. Ask whether you need hepatitis A vaccine. Get the flu vaccine annually as recommended. If you have cirrhosis, ask about pneumococcal vaccine. Tell the vaccinator about your liver stage and medicines. Keep a record of every dose. If you have fever or a hepatitis flare, consult before vaccinating.