The hepatitis B virus (HBV) is estimated to affect over one million people in the United States. People infected with the virus are at risk for chronic liver disease; the medical textbook "Current Diagnosis and Treatment in Family Medicine" indicates that up to 25 percent of patients infected with HBV as infants will go on to die of liver disease as adults. There is also the risk that infected individuals will transmit the virus to others. The HBV vaccine provides protection against infection from this virus; however, in certain situations, the vaccine should not be given--it is contraindicated.
Hypersensitivity to Yeast or Other Vaccine Components
The HBV vaccine consists of a portion of hepatitis B virus; this subunit cannot actually infect people with the virus, but does cause the immune system to respond, which is how a person receiving the vaccine gets immunity from the virus. The vaccine is actually created by putting part of the hepatitis B gene into yeast cells. Because of this, people with sensitivities or allergies to yeast should not receive this vaccine. Similarly, a patient with hypersensitivity to other components of the vaccine should also not get the HBV vaccine. According to the Institute for Vaccine Safety at the John Hopkins Bloomberg School of Public Health, there are two vaccine formulations. The formulation with the brand name "Engerix-B" contains a tiny amount of the preservative thimerosal, as well as mercury, aluminum hydroxide and the chemicals disodium phosphate and sodium dihydrogen phosphate. People with an allergy or sensitivity to any of these ingredients should not receive this formulation of the Hepatitis B vaccine.
The formulation sold as the brand "Recombivax HB" only contains aluminum hydroxide in addition to the yeast. Because this component is used in both types of formulations, a person with an allergy to aluminum hydroxide would want to avoid receiving either formulation of the hepatitis B vaccine.
Multiple Sclerosis
The pharmacology database MicroMedex warns that patients with multiple sclerosis may be at risk if given the HBV vaccine. Multiple sclerosis is an autoimmune neurologic disease that can flare up without warning; according to product information from Engerix-B, the HBV vaccine, vaccination may result in worsening of multiple sclerosis symptoms. Having multiple sclerosis should not be considered an absolute contraindication for the vaccine--just that patients with the disease should be aware that there have been rare cases of aggravation of multiple sclerosis symptoms. Because of these rare cases, patients may want to weigh the risk of this occurring against the benefit of receiving the vaccine.
Recent Severe Illness or High Fever
The online medical reference UpToDate suggests that a recent cold or other mild illness is not necessarily an absolute contraindication to receiving the HBV vaccine. However, according to UpToDate and the Engerix-B product information, a patient who has has been moderately or severely ill or who has had a high fever should postponing receiving the vaccine until his symptoms have resolved.
References
- "Current Diagnosis and Treatment in Family Medicine"; Jeannette E. South-Paul, Samuel C. Matheny, and Evelyn L. Lewis; 2008
- "UpToDate"; Denise S. Basow; 2010
- Thomson HC: MicroMedex Hepatitis B Vaccine
- Engerix-B: Product Information
- Components of Hepatitis B Vaccines
