Interchangeability Of Hepatitis A Vaccines
Vaccine manufacturers use slightly different methods to produce the vaccines and quantify the hepatitis A virusantigen content. All monovalent hepatitis A vaccines that are given as a 2-dose course are interchangeable. See Table. Recommended doses and schedules for monovalent hepatitis A vaccines.
Schedules that mix combination hepatitis A/hepatitis B vaccines with monovalent vaccines are not routinely recommended.
An adult dose of Twinrix 720/20 contains half the hepatitis A antigen content of an adult dose of Havrix adult vaccine. These vaccines are therefore not interchangeable.
The only absolute contraindications to hepatitis A vaccines are:
- anaphylaxis after a previous dose of any hepatitis A vaccine
- anaphylaxis after any component of a hepatitis A vaccine
Combination hepatitis A/hepatitis B vaccines are contraindicated in people with a history of anaphylaxis to yeast.
What Causes Hepatitis A
The hepatitis A virus causes this type of hepatitis and spreads through contact with an infected persons stool. Contact can occur by
- eating food made by an infected person who did not wash his or her hands after using the bathroom
- drinking untreated water or eating food washed in untreated water
- placing a finger or an object in your mouth that came into contact with an infected persons stool
- having close personal contact with an infected person, such as through sex or caring for someone who is ill
You cannot get hepatitis A from
- being coughed on or sneezed on by an infected person
- sitting next to an infected person
- hugging an infected person
A baby cannot get hepatitis A from breast milk.4
Where Is It Found
HAV is common in areas with poor sanitation and restricted access to clean water. In countries with high HAV endemicity, as in some African and Asian countries, many adults are immune to HAV as a result of infection during childhood, and epidemics of hepatitis A are uncommon. In areas such as Central and South America, Eastern Europe and parts of Asia with intermediate HAV endemicity, childhood transmission is less common and so more adolescents and adults are vulnerable to infection outbreaks then become more likely. In countries such as Australia, the United States and Western Europe where there is low HAV endemicity, infection is less common in the general community, but disease occurs among people in high-risk groups as community-wide outbreaks.
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Postexposure Prophylaxis For Hepatitis A
What are the current CDC guidelines for postexposure protection against hepatitis A?
Hepatitis A vaccine should be administered as soon as possible, within 2 weeks of exposure, to all unvaccinated people aged 12 months who have recently been exposed to hepatitis A virus . In addition to hepatitis A vaccine, co-administration of GamaSTAN S/D immune globulin is recommended under certain circumstances according to age and health status of the exposed person.
Should patrons of an establishment implicated in an outbreak of hepatitis A receive postexposure prophylaxis ?
Because common-source transmission to patrons is unlikely, PEP administration to patrons is typically not indicated. However, PEP may be considered for those patrons potentially exposed to a symptomatic food handler if a) the food handler directly handled uncooked or cooked foods without gloves AND had diarrhea or poor hygienic practices and b) the patron can be identified and treated within 2 weeks of exposure, though the risk to these patrons still remains low .
In settings in which repeated exposures to hepatitis A virus might have occurred , consideration of PEP use is warranted. PEP in this scenario should generally consist of vaccination for all age groups, though immune globulin may be considered for exposed people who are immunocompromised or have chronic liver disease.
What should be done when a case of hepatitis A is found in a setting providing services to children or adults ?
Should I Get The Hepatitis A Vaccine
Hepatitis A
Hepatitis A vaccination is recommended for:
- Travelers to countries that have high rates of hepatitis A
- Family members or caregivers of a recent adoptee from countries where hepatitis A is common
- Men who have sex with men
- People who use injection and non-injection drugs
- People with chronic liver diseases, such as hepatitis B or hepatitis C
- People who are teated with clotting-factor concentrates
- People who work with hepatitis A infected animals or in a hepatitis A research laboratory
- People who are experiencing homelessness
- People age 40 and older at increased risk for hepatitis A infection, or who are at increased risk for severe disease from hepatitis A infection who also have other risk factors
- People age 19 or older at increased risk for hepatitis A infection, or who are at increased risk for severe disease from hepatitis A infection who also have other risk factors
Health care providers recommend that all children receive a hepatitis A vaccination at around 1 year of age, but many adults have never received the vaccine because it only became available in 1995.
Health care personnel and patients with the following conditions should discuss the hepatitis A vaccination with their health care provider: pregnancy, immunocompromising conditions, HIV infection, heart disease, chronic lung disease, chronic alcoholism, asplenia, kidney failure.
You should NOT get the hepatitis A vaccination or you should wait, if you:
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Why Is Hepa Recommended
The HepA vaccine not only protects the kids who get it. It also can help prevent outbreaks. An outbreak is when a disease happens in greater numbers than expected in a particular area.
Childcare centers are a common site of hepatitis A outbreaks. Some kids can be infected and not have symptoms. But they can still spread the virus to others. Having many young kids vaccinated against hepatitis A can stop it from spreading in a community.
Hepatitis A And International Travel
Who should receive protection against hepatitis A virus before travel?
All susceptible people traveling to or working in countries that have high or intermediate HAV endemicity are at increased risk for HAV infection. These travelers should be vaccinated or receive immune globulin before departure . For more information on international travel and hepatitis A, see CDCs travel page or ACIP updated recommendations on Prevention of Hepatitis A after Exposure to Hepatitis A Virus and in International Travelers.
How soon before international travel should the first dose of hepatitis A vaccine be given?
All unvaccinated people 12 months of age planning travel to an area with high or intermediate HAV endemicity should receive a single dose of vaccine as soon as travel is considered they should then complete the vaccine series with the appropriate dose and schedule. People traveling within 2 weeks should receive the initial dose of hepatitis A vaccine before departure and also simultaneously may be administered IG at a separate anatomic injection site for additional short-term protection . The hepatitis A vaccine series should be completed according to the routine schedule. Information on immune globulin dosing and additional information on hepatitis A vaccine and travel is available.
What should be done to protect international travelers < 6 months of age and other travelers unable to receive hepatitis A vaccine?
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Vaccine Side Effects And Risks
The vaccine is generally well tolerated. Common side effects include pain and redness where the needle was given usually, resolves in a few days. Less common side effects may include headache, irritability, malaise, mild fever, fatigue, weakness, muscle or joint pain, loss of appetite, nausea, vomiting, and diarrhea.
Very rarely is a risk for severe allergic reaction . If you have symptoms such as hives, wheezy breathing, swelling around the mouth or throat, seek immediate medical care. It is important to always report serious or unexpected reactions to your health care provider or to Toronto Public Health at 416-392-1250.
How And When Should You Receive The Hepatitis A Vaccine
You receive the injection of the hepatitis A vaccine in the muscle of your upper arm. Start the vaccine series when you are at risk of infection and at least one month before traveling. You need two doses six to twelve months apart.
There are also combination vaccines for adults that protect against both hepatitis A and hepatitis B. However, these have a different dosing schedule. Ask your doctor for details. You might prefer this option if, for example, you are traveling to countries with high rates of both diseases.
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Are There Any Adults Who Should Not Get The Vaccine
Do not get the hepatitis vaccine if you:
- Have ever had a severe allergic reaction to a hepatitis A vaccine or to any vaccine component hepatitis A vaccines contain alum and some contain 2-phenoxyethanol.
- Are ill, unless it is a mild illness
- Are pregnant, unless you are at greater risk for contracting hepatitis A
What Are The Side Effects Of The Hepatitis A And B Vaccine
Possible side effects from hepatitis A and B vaccines are typically mild. They can include soreness at the site of the shot, headache, fever or tiredness.
Any vaccine carries a very small risk of severe allergic reaction. Go to the ER if you experience difficulty breathing, dizziness or swelling in the face.
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Do I Need To Pay For Hepatitis A Immunisation
Vaccines covered by the NIP are free for people who are eligible. See the NIP Schedule to find out which vaccines you or your family are eligible to receive.
Eligible people get the vaccine for free, but your health care provider may charge a consultation fee for the visit. You can check this when you make your appointment.
If you are not eligible for free vaccine, you may need to pay for it. The cost depends on the type of vaccine, the formula and where you buy it from. Your immunisation provider can give you more information.
Vaccine For Hepatitis B
Hepatitis B Vaccine
It takes only a few shots to protect yourself and your loved ones against hepatitis B for a lifetime.
The hepatitis B vaccine is a safe and effective vaccine that is recommended for all infants at birth and for children up to 18 years. The hepatitis B vaccine is also recommended for adults living with diabetes and those at high risk for infection due to their jobs, lifestyle, living situations, or country of birth. Since everyone is at some risk, all adults should seriously consider getting the hepatitis B vaccine for a lifetime protection against a preventable chronic liver disease.
The hepatitis B vaccine is also known as the first anti-cancer vaccine because it prevents hepatitis B, the leading cause of liver cancer worldwide.
You cannot get hepatitis B from the vaccine. All hepatitis B vaccines that have been used since 1986 are made synthetically meaning the hepatitis B vaccines do not contain any blood products. Learn more.
If you have a current HBV infection or have recovered from a past HBV infection, the hepatitis B vaccine series will not benefit you or clear the virus. However, the vaccine can provide a lifetime of protection for loved ones who do not have hepatitis B and get the vaccine as soon as possible. Testing is the only way to know if you or your loved ones have a current infection or have recovered from a past infection.
Hepatitis B Vaccine Recommendations
Three-Dose Hepatitis B Vaccine Schedule
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Safety Of Hepatitis Vaccines
Hepatitis vaccines have been given to millions of people all across the world without any evidence of serious side effects. “They’re very safe, and they’re extremely effective,” says Poland.
If you are not sure whether you should have hepatitis vaccines, talk with your doctor about your specific concerns.
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Hepatitis A In Other Countries
Hepatitis A occurs worldwide. Developing countries with poor hygiene measures are at higher risk of hepatitis A infection and transmission.
In areas of high endemicity, such as parts of Africa, Asia, Central America and South America, up to 90% of children have been infected with hepatitis A.2
Hepatitis A is commonly reported in foodborne outbreaks.
Inactivated hepatitis A vaccines are prepared from hepatitis A virus harvested from human diploid cell cultures.
Different strains of HAV are in different vaccines, but there is only 1 known serotype. Immunity induced by a particular strain probably protects against all strains. 7
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Hepatitis A Vaccine: Canadian Immunization Guide
For health professionals
Last partial chapter update
: The immunoglobulin dosage for Hepatitis A pre-exposure and post-exposure prophylaxis was increased based on the Product Monograph update for GamaSTAN®, which is available on Health Canada’s Drug Product Database.
Last complete chapter revision: March 2018
Should Pregnant Or Breast
The safety of hepatitis A vaccination during pregnancy has not been determined however, because hepatitis A vaccine is produced from inactivated virus, the risk to the developing fetus is probably low. The risk associated with hepatitis A vaccine should be discussed with your health care provider to determine if vaccination is right for you.
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What Is The Hepatitis A Vaccine
Hepatitis A vaccination provides the best form of protection against the virus. Most vaccinations come in two doses given six months apart. Most children are vaccinated around one-year-old.
Studies indicate the vaccine protects for 40 years or more.
Immune globulin is an alternative to hepatitis A vaccination that provides short-term protection for travellers. This is also offered at Passport Health locations across North America.
How Common Is Hepatitis A
In the United States, hepatitis A has become relatively uncommon. After the hepatitis A vaccine became available in 1995, the rate of hepatitis A infections declined by 95 percent in the United States. The number of reported cases of hepatitis A fell to 1,239 in 2014, the lowest yearly number of cases reported since the disease could be tracked.1 However, the number of reported cases increased to 3,366 in 2017, almost 3 times higher, mostly due to outbreaks among people who use drugs and people experiencing homelessness.1 Early reports suggest that the numbers of cases and outbreaks of hepatitis A increased further during 2018 and continue at these higher rates in 2019.2
Hepatitis A is more common in developing countries where sanitation is poor and access to clean water is limited. Hepatitis A is more common in parts of Africa, Asia, Central and South America, and Eastern Europe than it is in the United States.
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Liver Anatomy And Function
Main Function of the Liver
The liver is an essential organ that has many functions in the body. The liver plays an important role in detoxifying the body by converting ammonia, a byproduct of metabolism in the body, into urea that is excreted in the urine by the kidneys. The liver also breaks down medications and drugs, including alcohol, and is responsible for breaking down insulin and other hormones in the body. The liver also stores vitamins and chemicals that the body requires as building blocks.
Many different disease processes can occur in the liver, including infections such as hepatitis, cirrhosis , cancers, and damage by medications or toxins.
Symptoms of liver disease can include:
- Jaundice
How Should I Use This Medicine
This vaccine is for injection into a muscle. It is given by a health care professional.
A copy of Vaccine Information Statements will be given before each vaccination. Read this sheet carefully each time. The sheet may change frequently.
Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.
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Complications Of Hepatitis A
Complications of hepatitis A are uncommon. Rarely, it may develop into fulminant hepatitis, for which mortality can be as high as 60%. 2,11 The case-fatality rate of hepatitis A increases with age and varies according to the population.2
Hepatitis A does not cause chronic liver disease. Relapse occurs in up to 10% of cases, but all relapsed cases recover.
What May Interact With This Medicine
- medicines that suppress your immune function like adalimumab, anakinra, infliximab
- medicines to treat cancer
- steroid medicines like prednisone or cortisone
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
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Hepatitis A And Hepatitis B Vaccine Dosing Information
Usual Adult Dose for Hepatitis B Prophylaxis:
Primary immunization: 1 mL IM in the deltoid area at 0, 1 and 6 months.Alternatively, a 4 dose schedule given on days 0, 7, and 21 to 30 followed by a booster at month 12 may be used.
Usual Adult Dose for Hepatitis A Prophylaxis:
Primary immunization: 1 mL IM in the deltoid area at 0, 1 and 6 months.Alternatively, a 4 dose schedule given on days 0, 7, and 21 to 30 followed by a booster at month 12 may be used.
What Is This Medicine
HEPATITIS A VACCINE HEPATITIS B VACCINE is a vaccine to protect from an infection with the hepatitis A and B virus. This vaccine does not contain the live viruses. It will not cause a hepatitis infection.
This medicine may be used for other purposes ask your health care provider or pharmacist if you have questions.
COMMON BRAND NAME: Twinrix
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Vaccines For Hepatitis A And B
Our immune system battles foreign invaders every day, such as when we get a cold virus. When this happens, we develop immunity to that specific virus. This means that our body will fight off the virus if it is ever exposed to it again.
The same protection happens with vaccines. However, the benefit of a vaccination is that you don’t have to go through being sick to enable your body to fight off disease.
Gregory Poland, MD, director of the Mayo Clinic’s Vaccine Research Group, explains that hepatitis vaccinations contain a small amount of the inactive virus. When you get a dose of the vaccine, he says, your immune cells respond by developing immunity against the virus. This immunity lasts over a long period of time.
“So if I get these two doses of hepatitis A vaccine, and then I get exposed 30 years from now, my body will remember that immunity to the vaccine and rapidly start producing antibodies again,” says Poland.
Due to the way hepatitis vaccinations are developed, it is impossible to contract the virus from the vaccine itself, according to Poland.
The hepatitis A vaccine is usually given in two shots and the hepatitis B vaccine is administered as a series of three shots. The most common side effects are redness, pain, and tenderness where the shots are given.
To get long-term protection from these viruses, it’s important to receive all the shots as scheduled. However, if you received one shot and never went back for the others, it’s not too late to catch up.