Why is the WA Department of Health funding hepatitis B vaccination for Aboriginal adults?
The burden of chronic hepatitis B virus (HBV) infection and the risk of acquiring a new infection are higher among Aboriginal and Torres Strait Islander people than the general Australian population.
The Australian Technical Advisory Group on Immunisation (ATAGI) therefore recommends that all Aboriginal and Torres Strait Islander people have their risks and vaccination status for hepatitis B reviewed and if they are non-immune to receive vaccination, as detailed in the Australian Immunisation Handbook (external site) (see Recommendations section).
The new Aboriginal Adult Hepatitis B Vaccination Program that provides hepatitis B vaccination for non-immune Aboriginal people aged 20 years and over is included in the updated WA Immunisation Schedule (effective 01/12/2020); scheduled and catch-up vaccinations for persons under 20 years continue to be available through the National Immunisation Program.
What should I do if I am a health care provider for an Aboriginal person aged 20 years or older who has no record of being vaccinated against hepatitis B?
Establish if the person has been previously tested for immunity to hepatitis B. If the individual has not been tested for immunity to hepatitis B, order hepatitis B serology and refer to table below:
| Test result |
Action required |
| Immunity due to previous resolved infection |
None |
| Chronic hepatitis B infection |
Refer them to their primary care provider for further evaluation and management AND inform your local public health unit so that any non-immune high-risk contacts can be appropriately protected |
| No evidence of prior or current hepatitis B infection |
Initiate a three-dose hepatitis vaccination series |
Is a blood test recommended to confirm immunity after a full course of hepatitis B vaccination?
Not routinely. Post-vaccination serological testing is recommended 4–8 weeks after completing the primary course only for:
- people at significant occupational risk, such as healthcare workers whose work involves frequent exposure to human tissue, blood or body fluids
- people at risk of severe or complicated hepatitis B, such as people who are immunocompromised and those with pre-existing liver disease not related to hepatitis
- people who may respond poorly to hepatitis B vaccination, such as haemodialysis patients and those with bleeding disorders who received the vaccine subcutaneously
- close contacts of people who are infected with hepatitis B virus,including sexual partners, household contacts and household-like contacts.
Do Aboriginal persons who completed a primary course of hepatitis B vaccination some time ago need to be serologically tested now or just re-vaccinated?
Usually neither. Booster doses are not recommended in immunocompetent people after a primary course because there is good evidence that a completed primary course of hepatitis B vaccination provides long-lasting protection. The standard three-dose schedule is effective in achieving protective antibody titres in over 90% of immunocompetent adults with seroconversion rates of approximately 35% after the first dose and rising thereafter.2
Immunocompetent people who have a documented history of a primary course of hepatitis B vaccination and who are not in a high-risk occupation/situation (as described above) are not recommended to be tested for immunity after vaccination.
Persons on renal dialysis, HIV positive persons and those who have received a haematopoietic stem cell transplant, need individualised care and should be managed by a specialist.
How should I manage a patient who completed a primary course of hepatitis B vaccination and was serologically tested more than 8 weeks after their final dose?
Although assessing vaccine-induced immunity among persons who completed the hepatitis B vaccination series more than 8 weeks prior is not routinely recommended, it is a common occurrence.
If your patient was tested more than 8 weeks after completion of the hepatitis B vaccine series and they have surface antibody levels equal to or above 10 IU/mL, they can be considered immune and no further vaccinations are recommended.
If your patient was tested more than 8 weeks after completion of the hepatitis B vaccine series and they have surface antibody titres below 10 IU/mL, further evaluation is needed to determine if they are:
a) Immune – i.e. they initially produced a protective immune response, but over time their antibody levels have fallen below the limits of detection on the laboratory test, or
b) Not immune – i.e. they failed to mount a protective immune response after completing the vaccination series.
To distinguish between these two scenarios, the patient should be given a single booster dose of hepatitis B vaccine (i.e. a fourth dose) and be tested for surface antibodies between 4 and 8 weeks afterwards.
- If they now have hepatitis B surface antibody levels equal to or above 10 IU/mL, they can be considered immune and no further vaccinations are recommended. Vaccine-induced antibody levels decline with time and may eventually become undetectable; however, a positive amnestic response triggered by a fourth vaccine dose is evidence that they are still protected.
- If their hepatitis B surface antibody level is still below 10 IU/mL, they should be given two further doses at monthly intervals, followed by serology testing 4 weeks after the last dose. If they demonstrate hepatitis B surface antibody levels equal to or above 10 IU/mL, they can be considered immune.
- If after two 3-dose courses of vaccine the patient’s hepatitis B surface antibody levels are still below 10 IU/mL, they should not receive further doses of vaccine. Persons who have not mounted a protective immune response after two courses of hepatitis B vaccine are considered “non-responders”. When this occurs, chronic HBV infection should be excluded as a cause of the vaccine failure. Non-responders should be informed that if they are exposed to HBV infection they should seek prompt medical attention so that they can receive hepatitis B Immunoglobulin within 72 hours of the exposure.
Are all the hepatitis B vaccine primary series or booster doses given as part of this program provided for free?
Yes. The goal of the program is to minimise the risk of hepatitis B infection among Aboriginal adults in WA. The 3-dose primary vaccination series and all medically-indicated subsequent booster doses are funded for Aboriginal and Torres Strait Islander people aged 20 years or more.
Where can I find out additional information?
The information provided in these FAQs is a synopsis only; for more details see:
Last reviewed: 06-01-2021