Protection is prevention: The importance of hepatitis B vaccination

Prevention in Focus PiF 2026 Fall

Want to receive publications straight to your inbox?

CATIE
PiF 34 - hep B vaccine scrape image

Hepatitis B vaccination is safe and highly effective at providing immunity against the virus. This prevents not only infection but also the adverse health outcomes associated with infection, including liver disease and liver cancer. Although vaccination is the best way to prevent hepatitis B, with vaccination at birth being recommended by the World Health Organization (WHO) since 2009, the implementation of vaccine policies varies both within Canada and globally. This variation impacts vaccination rates and therefore the chance of transmission. Service providers can play a key role in supporting the uptake of vaccination by providing accurate information and facilitating access to the vaccine when appropriate. 

Receive Prevention in Focus in your inbox:

What is hepatitis B?

Hepatitis B is a virus that infects the liver. Hepatitis B is passed when the virus in bodily fluids from a person with hepatitis B enters another person’s body. This usually happens through blood, but it is also possible for the virus to pass through semen or vaginal fluid. Without proper care, hepatitis B can lead to serious health problems such as liver failure, liver cancer and early death.

More than 95% of healthy unvaccinated adults who get hepatitis B clear the virus on their own during the acute infection phase.1 Once someone has cleared the virus, they have lifelong immunity and cannot pass the virus to another person. However, if the virus is not cleared during the acute infection phase, the infection becomes chronic. This is more likely to happen for unvaccinated infants and children. In fact, about 90% of infants who are exposed from birth up to one year old and about 20% to 30% of children who are exposed between one and five years of age will develop chronic hepatitis B.2 

Hepatitis B is usually asymptomatic, meaning there are often no signs or symptoms of infection until the liver is severely injured. Many people go undiagnosed for years — even decades — before they start to experience health problems. While treatment is available to control the virus, there is no cure for hepatitis B. Considering this, preventing infection through vaccination is the most important strategy to avoid adverse health outcomes. 

Hepatitis B vaccination is safe and effective

Current hepatitis B vaccines are very safe.3,4 Globally available in either two- or three-dose formulations,* they are highly effective in preventing infection in both children and adults; approximately 98%–100% of children and 90%–95% of adults who receive the full two- or three-dose vaccine series develop an immune response that protects them against hepatitis B.4,5 In most cases, this protection lasts for up to 30 years.3–5

The hepatitis B vaccine has also been shown to be effective at preventing transmission from a pregnant parent with hepatitis B to their baby during birth.6 Specifically, when the baby receives the first vaccine at birth and completes the vaccine series in infancy, the chance of transmission is reduced by approximately 70%–90%.3,6 The risk of perinatal transmission is further reduced by 83%–97% when the infant is also given a hepatitis B immunoglobulin (HBIG) injection at birth, which provides immediate but temporary passive protection until the infant develops immunity after receiving the vaccine.6–9 In cases where the pregnant parent has a high viral load, they may also be given treatment in the final trimester of pregnancy, reducing transmission by approximately 98%.10 

Long-term hepatitis B vaccination programs have been highly effective at reducing both rates of new hepatitis B infections and overall rates of hepatitis B infections in many regions around the world.3,4 For example, since universal infant and catch-up vaccination began in Nunavut in 1995, the chronic infection rate (measured by the prevalence of hepatitis B surface antigen [HBsAg]) decreased from 2.5% in the unvaccinated cohorts to 0.21% in the vaccinated cohorts.11 After mass vaccination was introduced in Italy in 1983, acute hepatitis B incidence decreased from 91/100,000 to 10/100,000.11 

Preventing these infections has also led to a reduction of liver disease, liver cancer and related deaths in vaccinated cohorts.3–5 For instance, since a universal infant vaccine program was implemented in 1984, studies conducted over several decades showed Taiwan experienced a decrease of more than 90% in chronic liver disease and cancer deaths, as well as a decrease of more than 80% in liver cancer incidence.3 Similar results have also been shown in regions that implemented universal infant and/or catch-up vaccination for children and adults, including China, South Korea and Alaska.4

Hepatitis B vaccination in Canada 

Initial implementation of the vaccine

Invented in 1969, the hepatitis B vaccine was the first cancer-preventing vaccine ever produced. It was licensed and became more widely available in the 1980s following advances in vaccine technology. At this time, Canadian hepatitis B vaccine recommendations centred on providing vaccination to people who participated in specific behaviours that increased the risk of transmission (e.g., injection drug use, having multiple sex partners, being born to a pregnant parent with hepatitis B).12 

By the 1990s, rising infection rates and related deaths in Canada led to a shift away from targeted vaccination approaches toward universal childhood vaccination programs.12,13 At the time, more infections were occurring in adolescence or young adulthood than in infancy or childhood, primarily through sexual activity.13,14 In response, provinces and territories started to adopt universal pre-adolescent programs to immunize individuals before they became sexually active.14 Pre-adolescent hepatitis B vaccination was gradually adopted across all provinces and territories throughout the 1990s.15

Vaccine recommendations over time

By 2009, the World Health Organization (WHO) officially recommended birth dose vaccination for all newborns because of a growing recognition that a significant number of infections were being passed from parent to child during birth or though close household contact during early childhood (i.e., from an adult to an unvaccinated child or between unvaccinated children through direct contact with blood or other bodily fluids).16 This vaccination strategy provides the first dose of the hepatitis B vaccine within 24 hours of birth, with the remaining two doses completed in early infancy at least four weeks apart. 

In 2025, Canadian guidelines for hepatitis B care were released by the Canadian Association for the Study of the Liver (CASL) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada, which recommend universal infant vaccination, ideally at birth, across all Canadian provinces and territories.17 

Current state of vaccination

As provinces and territories are responsible for setting vaccine policies, hepatitis B vaccine schedules vary across Canada. Presently, three provinces and territories offer birth dose vaccination (Nunavut, Northwest Territories, New Brunswick), five offer infant (i.e., at two months of age) vaccination (British Columbia, Alberta, Quebec, Prince Edward Island and Yukon) and five offer adolescent vaccination (Saskatchewan, Manitoba, Ontario, Nova Scotia and Newfoundland).15,18 An up-to-date vaccine schedule for each province can be found in the Canadian Immunization Guide.

Owing to variable implementation of vaccine policies in Canada and inconsistent access to vaccination globally, most provinces have implemented adult catch-up vaccination programs for populations at risk (e.g., people who use drugs, immigrants and newcomers from countries where hepatitis B is common, gay and bisexual men who have sex with men). These programs are based on recommendations by the National Advisory Committee on Immunization (NACI).15 The 2025 CASL/AMMI hepatitis B guidelines also recommend universal catch-up vaccination for adults who did not complete their vaccine series, or who are unsure if they were vaccinated,17 but this recommendation has yet to be adopted by the provinces and territories.18

Implications for service providers and policy-makers

Vaccine recommendations and coverage vary both within Canada and globally, meaning service providers may encounter people who have not been vaccinated for a variety of reasons. Ensuring these individuals have adequate information and access to vaccination can improve vaccine uptake, preventing infection for the individual and the broader population.

Some actions service providers can take to support vaccine uptake include the following:

Ensure they have accurate, evidence-based knowledge about hepatitis B and the vaccine. Service providers should understand basic information about hepatitis B, including how it is transmitted and prevented, how it is diagnosed and what care is available, so that they can provide appropriate education and services to clients. 

Be aware of current hepatitis B guidelines and regional vaccine schedules. Service providers can refer to available guidelines about vaccination and should be aware of vaccine schedules in their region. Where universal birth dose vaccination is not implemented, service providers can consider advocating for updated vaccine schedules in their region to help expand access to vaccination.

Educate their clients about hepatitis B. Service providers can educate their clients about the asymptomatic nature of a hepatitis B infection and should inform them that there is no cure for the infection. By conveying the importance of vaccination as a key prevention strategy for this infection, service providers can encourage individuals and/or their close contacts to access testing to verify their immune status, as well as vaccination for those not immune. Supporting clients to make informed decisions about vaccination is key to successful vaccine uptake in community. Service providers can provide clear, non-judgmental information through ongoing education, accessible services and trust-building with their clients.

Facilitate access to vaccination (as appropriate). Service providers can provide or facilitate access to hepatitis B screening to verify if a person has immunity to the virus, either from a past infection or from being vaccinated. For those who are not immune, offering the vaccine or linking to other service providers who can offer it can help ensure a person is protected from infection. 

Support equitable access to hepatitis B vaccination. Policy-makers can improve vaccine uptake by implementing evidence-based vaccine schedules, reducing barriers to screening and vaccination and ensuring that people who are not immune — including those who may have missed routine immunization because of differences in vaccine schedules across jurisdictions or countries — can access vaccination services.

*While a two-dose formulation of the vaccine is available for adolescents, there is no two-dose formulation approved for adults in Canada. Adults may have received this formulation in other countries where it is available.

Resources

Canadian Immunization Guide

Canadian Hepatitis B Guidelines

References

  1. Ganem D, Prince AM. Hepatitis B virus infection — natural history and clinical consequences. New England Journal of Medicine. 2004 Mar 11;350(11):1118-29.
  2. Paganelli M, Stephenne X, Sokal EM. Chronic hepatitis B in children and adolescents. Journal of Hepatology. 2012 Oct 1;57(4):885-96.
  3. Al-Busafi SA, Alwassief A. Global perspectives on the hepatitis B vaccination: challenges, achievements, and the road to elimination by 2030. Vaccines. 2024 Mar 8;12(3):288.
  4. Mironova M, Ghany MG. Hepatitis B vaccine: four decades on. Vaccines. 2024 Apr 17;12(4):439.
  5. Kramvis A, Mammas IN, Spandidos DA. Exploring the optimal vaccination strategy against hepatitis B virus in childhood. Biomedical Reports. 2023 Jul 1;19(1):48.
  6. Ulrich AK, Fleming DF, Smith EA et al. Hepatitis B vaccination at birth: safety, effectiveness, and public health benefit. Pediatrics. 2026 May 1;157(5):e20250757833.
  7. Dobritoiu R, Pacurar D, Vlad RM et al. Vertical transmission of hepatitis B and C—then and now—a comprehensive literature systematic review. Viruses. 2025 Oct 1;17(10):1395.
  8. Bitnun A, Sauve L, Fanella S. Reducing perinatal infection risk in newborns of mothers who received inadequate prenatal care. Canadian Paediatric Society position statement. 2024 Jan 3. Available from: https://cps.ca/en/documents/position/reducing-perinatal-infection-risk-in-newborns-of-mothers-who-received-inadequate-prenatal-care
  9. di Filippo Villa D, Navas MC. Vertical transmission of hepatitis B virus—an update. Microorganisms. 2023 Apr 26;11(5):1140. 
  10. Samadi Kochaksaraei G, Shaheen AA, Seow CH et al. Tenofovir disoproxil fumarate therapy to prevent hepatitis B virus vertical transmission—a review of maternal and infant outcomes. Liver International. 2022 Aug 1;42(8):1712-30.
  11. Gregorio GE V, Velasco-Aro SJG. HBV catch-up vaccination in children and adults with incomplete or unknown vaccination to reduce hepatitis B-related morbidity: a systematic review. Acta Medica Philippina. 2025;59(12):68-76.
  12. Delage G, Carter AO. Hepatitis B infection in Canada: epidemiology and implications for control. Canadian Family Physician. 1992;38:2656-66.
  13. Carter AO, Walsh P. National Advisory Committee on Immunization (NACI) statement on universal immunization against hepatitis B. Canada Diseases Weekly Report. 1991 Aug 1;17(31):165-71.
  14. MacDonald NE. Moving towards a universal hepatitis B vaccine program for Canadian children. Canadian Journal of Infectious Diseases. 1995;6(3):129-30.
  15. Government of Canada. Hepatitis B vaccines: Canadian immunization guide. In Canadian Immunization Guide. 2026. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-7-hepatitis-b-vaccine.html
  16. World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection. Geneva; 2024 Mar. Available from: https://www.who.int/publications/i/item/9789240090903
  17. Osiowy C, Alvarez F, Coffin CS et al. The management of chronic hepatitis B: 2025 guidelines update from the Canadian Association for the Study of the Liver and Association of Medical Microbiology and Infectious Disease Canada. Canadian Liver Journal. 2025 May 26;8(2):368-401.
  18. Action Hepatitis Canada. Progress toward viral hepatitis elimination in Canada: 2025 report. Toronto (ON); 2025 May. Available from: https://www.actionhepatitiscanada.ca/progressreport.html

Externally reviewed by: Mia Biondi & Kim Roth

About the author(s)

Madison Kennedy is CATIE's knowledge specialist in hepatitis. She has a Master of Public Health degree in health promotion and previously worked in sexual and reproductive health service delivery and research.