Hepatitis B vaccination: who needs it, doses and side effects in the UK

Hepatitis B is a liver infection caused by a virus. The NHS says it is spread through blood and body fluids, for example through unprotected sex, injecting drugs with shared needles, being injured by a used needle, tattoos or piercings with unsterilised equipment, and from a mother to her baby at birth. The chance of catching it in the UK is low, and donated blood in the UK has been tested for hepatitis B since 1972.

Most people who get hepatitis B have no symptoms or mild symptoms, and the infection usually lasts for 1 to 3 months. The NHS says that if it lasts longer than 6 months it is called chronic hepatitis B, for which there is no known cure; it is usually treated with antivirals and regular check-ups with a liver specialist. The NHS vaccine page adds that hepatitis B can be very serious, can make the liver suddenly stop working or cause gradual damage over time, and can increase the chance of liver cancer.

The UK Health Security Agency, in its Green Book chapter for professionals, notes that jaundice only occurs in about 10% of younger children and 30 to 50% of adults with a new infection, and that acute infection may occasionally lead to fulminant hepatic necrosis, which is often fatal. Vaccination is the most effective way to prevent infection, which is why the NHS describes it as the best way to prevent hepatitis B.

All babies in the UK are offered protection as part of the NHS vaccination schedule. The NHS says babies have 3 doses of the 6-in-1 vaccine at 8, 12 and 16 weeks old. If a mother has hepatitis B, the baby has a much higher chance of infection, so babies are given extra doses: within 24 hours of birth, at 4 weeks old, and at 12 months for those born on or before 30 June 2024. Babies born on or after 1 July 2024 are given a new fourth dose of the 6-in-1 vaccine at 18 months old instead, which gives 6 doses in total.

For adults, the NHS says vaccination is recommended for people at higher risk of catching, or getting seriously ill from, hepatitis B. The groups are listed in the table below.

The NHS says the vaccine is given as an injection into the upper arm or thigh. You need at least 3 doses for the best protection, usually with a gap of a month between each. If faster protection is needed, for example before travel, 3 doses can be given within 21 days with a fourth dose 12 months after the first. Some people, such as babies exposed to hepatitis B before birth, need more than 3 doses.

Booster doses are not usually needed. The NHS says you usually only need one if you are a healthcare worker and blood tests show 3 doses have not given enough protection, you have kidney failure and a blood test shows your protection has reduced, or you are exposed to hepatitis B. The Green Book summary also records that the single booster dose for healthy adults who have completed a primary course was removed in an April 2024 update.

You can have the hepatitis B vaccine at the same time as other vaccines, including the rotavirus and MMR vaccines. Several brands are used in the UK, including vaccines that protect against hepatitis B only and combined hepatitis A and B vaccines for people also at risk of hepatitis A.

The NHS says most side effects are mild and do not last long. They can include swelling or pain where the injection was given, feeling tired, sleepy or irritable, headache, feeling or being sick, diarrhoea, stomach ache and a high temperature. More serious side effects such as a severe allergic reaction are very rare, and the person who vaccinates you is trained to treat these immediately.

Most people who need the vaccine can have it, including when pregnant or breastfeeding. The NHS says the only reason you cannot have it is if you have had a serious allergic reaction (anaphylaxis) to a previous dose or to an ingredient. If you have a high temperature or feel too unwell for normal activities, wait until you feel better.

The NHS says research shows 90% of adults and over 98% of babies have good protection from hepatitis B after being vaccinated, and that protection against long-term infection could last 20 to 30 years. The vaccine can work less well in some people, for example those with kidney failure, so extra doses are sometimes needed.

The NHS stresses that there is still a chance of getting hepatitis B after vaccination, so it remains important to reduce your risk, for example by using condoms during sex and not sharing toothbrushes or needles. The vaccine also only protects against hepatitis B, not hepatitis A or C; combined hepatitis A and B products exist for people at risk of both.

The route depends on why you need it. According to the NHS, babies are usually contacted by the GP surgery; people at risk through work should speak to their employer; people at risk through sexual activity can visit a sexual health clinic; and other higher-risk people, for example someone with a household contact with hepatitis B or a condition that raises their risk, can speak to their GP surgery.

Travel is different. The NHS says people travelling to higher-risk parts of the world can get the vaccine from travel vaccination clinics, pharmacies with travel health services and some GP surgeries, and will usually have to pay. The TravelHealthPro website can be used to check the risks for a destination. A private vaccination is therefore a normal route for travel, whereas for people in NHS risk groups it is normally provided without charge.