Hepatitis B Vaccine: Facts, Risks, and Common Questions

Hepatitis B is a virus that can quietly damage your liver for years before causing symptoms. In some people, it leads to chronic infection and serious complications like cirrhosis or liver cancer. The hepatitis B vaccine helps prevent infection and has been used in the U.S. for more than 40 years.

It’s normal to have questions about how the vaccine works, who needs it, and what the risks are. Below, we’ll review the basics so you can make an informed decision.

What is the hepatitis B vaccine?

The hepatitis B vaccine protects people from getting sick with the hepatitis B virus. It doesn’t contain any live virus. And it can’t cause hepatitis B or any other illness.

There are several hepatitis B vaccines available in the U.S. They vary by:

• Age group: Some hepatitis B vaccines are approved for both children and adults, while others are only approved for adults.

• Type of protection: Some vaccines protect only against hepatitis B. Others are part of combination vaccines that protect against hepatitis B and additional illnesses in a single shot.

Here’s a quick look at the different hepatitis B vaccines.

Your healthcare team can help you decide which vaccine is best for you based on your age, health history, and vaccination needs.

Is the hepatitis B vaccine safe and effective?

The hepatitis B vaccine has been used in the U.S. since 1981. That means there’s more than 4 decades of safety and effectiveness data. Over that time, rates of hepatitis B infection in the U.S. have dropped by about 80% because of widespread vaccination. 

More than 95% of infants, children, and young adults who receive the hepatitis B vaccine develop antibody levels high enough to protect against infection. Among healthy adults under age 40, protection rates are also above 90%. Newer hepatitis B vaccines are even more effective. For example, Heplisav-B produces protective antibody levels in about 90% to 100% of adults. 

Older adults and people with weakened immune systems may not respond as well to Hepatitis B vaccines. 

Most people can safely receive a hepatitis B vaccine. It’s safe to get vaccinated against hepatitis B if you’re pregnant.

Does the hepatitis B vaccine cause side effects?

Serious side effects from the hepatitis B vaccine are rare. Like all vaccines, the hepatitis B vaccine can cause minor side effects, like:

• Headache

• Fever

• Arm soreness

• Bruising at the injection site

• Itchiness at the injection site

These side effects go away within a few hours to a few days.

What are the benefits of the hepatitis B vaccine?

The hepatitis B vaccine offers long-term — and often lifelong — protection against the hepatitis B virus. By preventing infection, it also lowers your risk of developing serious liver conditions, including:

• Chronic liver damage

• Liver failure

• Cirrhosis (permanent scarring of your liver)

• Liver cancer

• Hepatitis D infection, which can only occur in people who already have hepatitis B

These conditions can have lasting effects on your health. They require ongoing medical care, hospitalization, or even a liver transplant.

There’s no cure for chronic hepatitis B. Treatments can help control the virus and slow liver damage. But they usually need to be taken long term and don’t work well for everyone. Preventing infection is the best way to avoid these complications.

What are the risks of the hepatitis B vaccine​?

The hepatitis B vaccine has a strong safety record. Serious side effects are rare.

Rare but reported events include:

• Severe allergic reaction (anaphylaxis): This is very uncommon, occurring in about 1 in 1 million doses. People who have had a severe allergic reaction to a previous hepatitis B vaccine dose shouldn’t receive another dose.

• Serum sickness: This delayed reaction can cause joint pain, rash, and fever days to weeks after vaccination. It’s uncommon and usually resolves on its own.

• Guillain-Barré syndrome (GBS): Guillain-Barré syndrome causes temporary weakness and paralysis. There’s no evidence that the vaccine directly causes GBS. But some people have reported GBS after getting vaccinated. These reports are very rare.

• Neurologic or autoimmune conditions: Some people have reported a new diagnosis of conditions such as autism, multiple sclerosis (MS), lupus, or other immune-related disorders soon after receiving the hepatitis B vaccine. This timing can feel concerning because the diagnosis happens close to the vaccination. But studies haven’t shown that the hepatitis B vaccine directly causes these conditions. Many autoimmune and neurologic disorders first appear in adolescence or adulthood, which are also common ages for vaccination. When two events happen around the same time, it can seem like one caused the other. But in most cases, the condition was likely already developing and the timing of the diagnosis was coincidental rather than triggered by the vaccine.

• Rare blood disorders: Rare blood conditions have been reported after hepatitis B vaccination, including aplastic anemia and hemolytic anemia. If you have an autoimmune condition or a strong family history of immune system disorders, your healthcare team may recommend closer follow-up after vaccination.

Ongoing safety monitoring systems continue to track vaccine side effects. For most people, the benefits of preventing hepatitis B outweigh the risk of rare side effects. 

Who should receive the hepatitis B vaccine?

The American Academy of Pediatrics (AAP) recommends the hepatitis B vaccine for all newborns and infants. They also recommend the vaccine for children and teens younger than 19 years old who weren’t fully vaccinated as babies.

For adults who weren’t vaccinated as children, experts recommend getting the hepatitis B vaccine if you:

• Work in a healthcare setting

• Are frequently exposed to blood or blood products

• Currently use or have used injectable drugs

• Work or live in a long-term health facility or a correctional facility

• Live with someone who has hepatitis B

• Have a sexual partner who has hepatitis B

• Have human immunodeficiency virus (HIV)

• Have a liver condition or illness (like hepatitis C)

• Have diabetes

• Are receiving dialysis

• Frequently travel to countries with high rates of hepatitis B

Even if you don’t fall into one of these groups, you can still choose to get vaccinated. The hepatitis B vaccine is available to any adult who wants protection.

Why is the hepatitis B vaccine given to babies and children?

Hepatitis B spreads through contact with blood and certain body fluids. Since young children don’t usually come into contact with these things, many parents wonder why the vaccine is given so early in life.

The answer has to do with how the immune system responds to the virus. When someone is exposed to hepatitis B, their immune system tries to clear the infection. Many adults are able to fight it off completely. But infants and young children are less likely to eliminate the virus.

As a result, children are much more likely to develop chronic hepatitis B. About 90% of infants and 50% of young children who are infected will develop lifelong infection, compared with about 5% of healthy adults. Chronic hepatitis B can silently damage your liver for years, increasing the risk of cirrhosis, liver failure, and liver cancer later in life.

The birth dose is especially important for babies born to mothers who have hepatitis B or whose hepatitis B status is unknown at the time of delivery. During birth, a baby can be exposed to the virus through contact with the mother’s blood. Giving the vaccine within the first 24 hours of life helps prevent infection. When needed, the healthcare team may also give hepatitis B immune globulin (HBIG) along with the vaccine. This approach is about 95% effective at protecting a baby from developing hepatitis B. 

Early vaccination of infants also provides protection in case of unexpected exposures. In countries that have widely adopted infant vaccination, hepatitis B infection in children under 5 has dropped nearly 80%. 

What is the hepatitis B vaccine schedule?

The hepatitis B vaccine schedule is different for adults and children.

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Written by:

Jennifer Clements, MD, MSEd, NBHWC

Jennifer Clements, MD, MSEd, NBHWC, is a board-certified physician and health coach who believes in achieving optimal health through healthy lifestyles. She’s a diplomate of the American Board of Obesity Medicine.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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