Accelerating Hepatitis B Vaccination

An estimated 296 million people are living with chronic hepatitis B virus infection across the world, with roughly 820,000 people dying of associated complications each year. The majority of people with chronic hepatitis B are in the Asia-Pacific region, and 79% of deaths occur there.

Hepatitis B infection is preventable through immunization with three doses of vaccine that are usually spread out over six months. While this vaccine schedule works well for infants, it takes too long as a “catch-up” regimen for adults who were not vaccinated in childhood. The long interval between vaccinations also increases the risk of not receiving the second and third doses. In 2012, the World Health Organization (WHO) recommended a rapid regimen of hepatitis B vaccination for adults that could be given over just 21 days. However, this recommendation has not been widely implemented.

TREAT Asia has partnered with the Community Network for Empowerment (CoNE) in Manipur, India, and the Department of Hepatology of the Sanjay Gandhi Postgraduate Institute of Medical Sciences in Lucknow, India, to conduct a retrospective study to evaluate how well a rapid regimen protects against hepatitis B. The 677 participants were people living with HIV and people who inject drugs who had all completed the WHO-recommended rapid regimen of hepatitis B vaccination within the past five years.

Between April and August 2023, half had blood tests to check whether they had achieved protection against hepatitis B, and 86% of them had high enough blood levels to prove they had gained immunity. The participants who did not respond to the rapid regimen will be provided with a booster and their hepatitis B antibodies evaluated again after a month.

These results show that the 21-day rapid vaccination regimen is feasible in people who inject drugs and people living with HIV, and can lead to high rates of protection against hepatitis B. Broader use of this approach would prevent unvaccinated adults from acquiring new infections and lead to better control of hepatitis B in the community. Larger studies are needed to optimize strategies to scale up use of the rapid regimen.

“The rapid regimen has been shown to be easy to comply with and highly effective among people who inject drugs and people with HIV. The results are encouraging, although we would need better quality data from a randomized controlled trial of appropriate size to complement our study findings” said Dr. Amit Goel, head of the Department of Hepatology at the Sanjay Gandhi Postgraduate Institute of Medical Sciences. “A serious discussion is urgently needed to explore the use of such a rapid vaccination schedule for public health benefits, at least for those who are at high risk of acquiring HBV infection,” he added.

Giten Khwairakpam is program manager, community and policy, for amfAR’s TREAT Asia program in Bangkok, Thailand.