Hepatitis B Vaccination for Adults with Chronic Kidney Disease (CKD)

You have been given this leaflet because you are eligible for hepatitis B vaccination. It should answer any questions you may have about having the vaccine.

What is Hepatitis B?

Hepatitis B is an infection of the liver. It is caused by the hepatitis B virus (HBV) and can be passed on by infected blood and body fluids.

Even if an infected individual does not show any symptoms, they can become a chronic carrier of the infection, which can result in damage of the liver. They can also risk spreading the virus and infecting others.

Why am I at risk of being exposed to Hepatitis B?

The chance of getting hepatitis B infection in the UK is very low, but you will be at a slightly higher risk as a person with kidney disease. This is because:

• There is a small possibility that you may be exposed to blood and other body fluids during treatment with haemodialysis
• Your reduced kidney function means you are more at risk of infections or disease.
• If you travel abroad and receive medical treatment whilst outside the UK you may be more at risk of picking up the hepatitis B virus, particularly if you are having haemodialysis or an operation. Some countries have a higher rate of hepatitis B infection, and their procedures and policies may not be as strict as in the UK.
• If you have a kidney transplant in the future, you will need to take medicines which suppress your immune system (immunosuppressive drugs). This makes it more difficult for your body to fight infections and can increase the likelihood of developing a severe hepatitis B infection if exposed to the virus.

What can be done to protect me from Hepatitis B?

Although the possibility of getting hepatitis B infection cannot be completely removed, The Leeds Renal Unit has procedures in place to reduce this risk, and staff take all the appropriate precautions when dialysing people to minimise the exposure to any blood borne infection.

Regular blood tests are also carried out to check for hepatitis B and other viruses in the blood.

The Department of Health and The UK Kidney Association also recommend that all people with chronic kidney disease who may need haemodialysis treatment or a kidney transplant in the future are immunised against hepatitis B infection. As well as protecting the individual from hepatitis B, it also prevents the disease from spreading and causing harm to other people.

To ensure the best protection against hepatitis B infection, vaccination is offered before starting dialysis or getting a transplant, because you will respond better to the vaccine. However, immunisation against hepatitis B can also be carried out if you are already on haemodialysis, peritoneal dialysis or have a functioning transplant as you can still be protected.

How is the vaccine given?

The renal team will advise you when you need to start the vaccination course. The course of injections will be given on attendance at routine renal outpatient appointments, or you may be asked to attend your nearest dialysis unit by appointment where a nurse can administer the injection there. If you are already on haemodialysis, then the renal dialysis nurses will administer the injections when you attend for dialysis.

The Leeds Renal Unit use either Fendrix® or HBvaxPRO. The brand of hepatitis B vaccine that you will receive will depend on which is available. The injection is given at specified time intervals over a period of six months. It is given into the muscle of the upper arm.

It is important that you complete the full course of injections. If you do not, you may not be fully protected against developing the hepatitis B infection.

The vaccine encourages the body to produce antibodies, which will fight the hepatitis B virus if it was to enter the blood stream.

A blood test will be taken at the end of the course of injections to check the level of antibodies in your blood. This blood test should be within 4 – 8 weeks after your final vaccine was given.

Sometimes in patients with chronic kidney disease it is harder to produce the antibodies, so a second course of injections or a booster of the vaccine may be needed.

Once the full course has been completed the antibody level is checked every year and a further booster injection will be given if required.

There are a few people who may not respond to the vaccines and will not produce enough antibodies even with repeated courses, to protect them from the virus. If this is the case, then this will be discussed with you by your kidney doctor.

When should I not receive the vaccine?

Before you receive your first dose of hepatitis B vaccine, please tell your nurse or doctor if you have ever had a severe reaction to any vaccine in the past.

If you are unwell and have a high temperature or severe infection when your vaccination is due, then the vaccine should be given after you have recovered.

If you have a minor infection, such as a cold, then this should not be a problem, but discuss this with your pre-dialysis / dialysis nurse or doctor first.

Are there any side effects from the vaccine?

The hepatitis B vaccine is very safe and well tolerated. It is an inactivated (dead) vaccine, so it cannot cause the infection itself.

The most common effect that you may experience is some redness and soreness at the site of the injection.

Rarely you may have a headache, or mild fever and flu-like symptoms. These should only last a couple of days.

In very rare instances as with any vaccine, some people may experience more severe side effects such as an anaphylactic or allergic reaction. If you get a rash, swelling of the face or difficulty in swallowing or breathing, you must seek urgent medical help.

If you feel unwell after having the vaccine or are worried about side-effects, please speak to your kidney nurse for advice.

Who can I contact if I have any further questions?

Where can I find more information?