Hepatitis B is a serious disease caused by a virus that attacks the liver.5 The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.6 HBV is transmitted when blood, semen, or another body fluid from a person infected with the virus enters the body of someone who is not infected.7 The Advisory Committee on Immunization Practices (ACIP) recommends that all children receive their first dose of HepB vaccine at birth and complete the vaccine series by age 6–18 months.8 ACIP also recommends that older children and adolescents who did not previously receive the HepB vaccine be vaccinated.9
In addition, HBV has long been recognized as an occupational risk for healthcare workers, including trainees.10 The virus remains infectious for prolonged periods on environmental surfaces and is transmissible in the absence of visible blood.11 In healthcare settings, this contact occurs primarily through contaminated needles, syringes, or other sharp instruments.12 Healthcare workers do not recognize all exposures to potentially infectious blood or body fluids and, even if exposures are recognized, often do not seek post-exposure prophylactic management.13 In serologic studies conducted in the United States during the 1970s, healthcare workers had a prevalence of HBV infection approximately 10 times that of the general population.14
In 2011, ACIP reaffirmed that unvaccinated and incompletely vaccinated healthcare workers at reasonably anticipated risk for blood or body fluid exposure should receive HepB vaccination before potential exposure.15
From 1983 to 2010, the number of HBV infections among healthcare workers declined by approximately 98%, from an estimated 17,000 acute HBV infections in 1983 to 263 in 2010.16 That decrease probably resulted from routine pre-exposure HepB vaccination and reduced risk for exposure through improvements in infection-control practices.17
The results of this assessment show that 17 states have HepB vaccination and immunity requirements for healthcare workers,18 and six states have requirements for patients.19 This menu assesses and provides examples of state laws that expressly establish HepB vaccination and exemption requirements for healthcare workers and patients in hospitals, long-term care facilities, and ambulatory care facilities.20
Specifically, this menu indicates which states require the aforementioned facilities to 1) assess the HepB vaccination status of all or specific patient or employee populations, 2) offer or provide for HepB vaccination for all or specific patient or employee populations, and 3) ensure that all or some patients or employees have received HepB vaccination. This menu also assesses which states require those facilities to offer medical, religious, or philosophical exemptions to all or some patient or employee populations. Because of this wide range of categories, each law may be assessed from different angles. In many cases, a single law specifies the applicable healthcare facility and also identifies whether the law applies to all or to particular patient populations and/or to all or particular employee populations.
For example, some states require hospitals to offer HepB vaccination to newborns only. Those same states might require long-term care facilities to ensure that all employees who are at risk of exposure to HBV are fully vaccinated against the virus. For the purposes of this menu, “vaccination laws” refer to laws regarding either vaccination or demonstration of hepatitis B immunity.21
Three broad types of facilities are included in this assessment: hospitals, long-term care facilities, and ambulatory care facilities. State HepB vaccination laws that apply to one or more of these facility types were identified. Ten states have HepB vaccination laws applicable to hospital settings.22 Ten states have HepB vaccination laws that apply to long-term care facilities.23 Lastly, 14 states have HepB vaccination laws specific to ambulatory care facilities.24
CDC recommends HepB vaccination for children and adults. Visit CDC’s Hepatitis B Vaccination web page for more information.