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Who Really Needs the Hepatitis B Vaccine?

People with diabetes have twice the chance of becoming infected with this liver disease

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Even though there's an effective vaccine to prevent it, the Centers for Disease Control and Prevention (CDC) estimates that about 862,000 Americans are living with chronic, long-term hepatitis B, with the infection causing thousands of of cases of liver failure, cirrhosis and liver cancer ever year.

The virus attacks the liver silently at first, so many people don't realize they are infected until decades later, when the virus has already done extensive damage or caused liver cancer, says John Scott, M.D., an infectious disease specialist and associate medical director of the Hepatitis and Liver Clinic at Harborview Medical Center in Seattle. “It's a bad cancer, it can be very aggressive,” Scott says.

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In the United States, there are about 21,000 new cases of hepatitis B infection a year, mostly in unvaccinated adults, the CDC says. The infection, detected with a simple blood test, is spread through the transfer of blood, semen, or other body fluid.

While children are routinely vaccinated against hepatitis B, which can be spread from mother to baby at birth, it's only recommended for certain groups of adults — including diabetics — and only 16 percent of Americans age 50 or older have received the vaccine.

Because children are vaccinated, the virus is more commonly spread through sexual contact or by sharing needles, syringes or other drug-injection equipment. The opioid epidemic has caused a spike in the number of cases.

Another at-risk group? People with diabetes. They're twice as likely as others to get hepatitis B, since their equipment can come into contact with infected blood, or they can contact the virus through breaks in their skin. The virus can also spread through improper reuse or sharing of glucose monitoring equipment, especially among people who live in long-term care facilities.

The hepatitis B vaccine is recommended for all diabetics under 60 years of age. If you're diabetic and over age 60, the CDC recommends talking to your doctor about whether to get the vaccine, says Jefferey Goad, a pharmacist and public health expert who is vice president of the National Foundation for Infectious Diseases.

Medha Munshi, M.D., director of the Joslin Geriatric Diabetes Program at Harvard Medical School in Boston, says she typically recommends the vaccine for older diabetics who need insulin injections or fingersticks to monitor their blood glucose levels, especially if they live in a long-term care facility. That's because Hepatitis B outbreaks have broken out in nursing homes and assisted living centers because of improper sterilization and infection control between patients.

"If you are exposed to needles, then my clinical judgment would be you should have it because you're at higher risk,” she says.

You should also consider the vaccine if you're traveling to a hepatitis B hot spot, which includes many countries in southeast Asia and Africa, EGoad says.

What to know about the hepatitis B vaccine

Who needs it: Adults 50 and older who are at high risk for contracting hepatitis B including healthcare and public-safety workers, sexually active people who aren't in a long-term monogamous relationship, and people who inject drugs, including people with diabetes who are under age 60. (Diabetics age 60-plus should talk to a doctor about whether to get the vaccine). Other groups at risk include those with a chronic liver condition, people with HIV or on kidney dialysis, men who have sex with men, prison inmates, and anyone who plans to travel to a country where hepatitis B virus transmission is common. (To check, go to, click on the country you're visiting and then “vaccinations").

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How often: The traditional vaccine requires three doses over six months, but a new one (Heplisav-B) approved in 2018 requires just two doses in one month and has been shown to yield a better antibody response in older adults. Another new vaccine called Sci-B-Vac also shown to be more effective in older adults was submitted to the FDA for approval in 2021. There is also a combination vaccine for both hepatitis A and B called Twinrix, which is given in three doses over six months.

Why you need it: The hepatitis B virus is 50 to 100 times more infectious than HIV and can survive outside the body for at least a week. It's spread through the transfer of bodily fluids such as blood or semen, or from mother to baby. You can also pick it up by sharing an item such as a razor or a toothbrush that was used by an infected person.

Parting shot: Because those that are infected may not have symptoms, they can end up with serious liver disease, and they can also spread the disease to others without knowing it. If you think you may have hepatitis B, a simple blood test can determine if you are infected.

Editor’s note: This article was first published on Oct. 26, 2020. It was updated in September 2021 with new information.

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