I Am Not Sure if I Had Hep a Vaccine Can I Take It Again

Hepatitis A

Illness Bug Immune Globulin Vaccine Recommendations Travel - International For Special Groups Vaccine Prophylactic Administering Vaccines Contraindications and Precautions Twinrix Vaccine Storage and Handling

Affliction Problems

What is hepatitis A?

Hepatitis A is a liver disease common in many parts of the world and acquired by hepatitis A virus (HAV), a picornavirus that causes astute inflammation of the liver. It is not related to the common viruses that cause hepatitis B or C.

What are the signs and symptoms of hepatitis A?

Illness caused by HAV infection cannot exist distinguished from other types of astute viral hepatitis, but it typically has an abrupt onset that tin can include fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice. The likelihood of having symptoms with HAV infection is related to age. In children younger than age 6 years, 70% of infections are asymptomatic. When illness does occur in young children, it is typically not accompanied by jaundice. In older children and adults, infection typically is symptomatic, with jaundice occurring in more than than 70% of patients.

Hepatitis A signs and symptoms usually resolve in two-3 months, although 10% to 15% of symptomatic people take prolonged disease (usually referred to as relapsing hepatitis A) lasting up to 6 months and should be considered infectious during that fourth dimension.

How is HAV transmitted?

Person-to-person spread through the fecal-oral route is the master ways of HAV manual. Peak infectivity in infected people occurs during the two calendar week catamenia earlier the onset of jaundice when the concentration of virus in the stool is highest and most people are no longer infectious one calendar week after jaundice onset. Before routine vaccination of children was recommended, children were a key source of infection considering most infected children had no symptoms and could shed virus in stool for weeks or months. Manual currently occurs primarily amidst susceptible adults.

Common-source outbreaks and sporadic cases can occur from exposure to fecally-contaminated food or water. Uncooked HAV-contaminated foods have been recognized as a source of outbreaks. Cooked foods as well tin can transmit HAV if the temperature during food grooming is inadequate to kill the virus or if food is contaminated after cooking, as occurs in outbreaks associated with infected food handlers. Transmission of the virus from infected food handlers to food service establishment patrons is rare, bookkeeping for 0.2% of the nearly 23,000 outbreak-associated cases of hepatitis A investigated by state health departments during 2016-2019.

Until 2017, US incidence rates of hepatitis A were driven by occasional outbreaks, often linked to viral contamination of imported food. Since 2017, communitywide outbreaks have occurred more frequently, predominantly amid people who are connected by specific risk factors, such every bit drug use, and their close contacts.

What is the incubation menses for hepatitis A?

HAV can produce either asymptomatic or symptomatic infection in humans after an average incubation period of 28 days (range: 15–50 days).

How is HAV shed?

In infected people, HAV replicates in the liver, is excreted in bile, and is shed in stool. Superlative infectivity occurs during the two-calendar week menstruation before onset of jaundice or height of liver enzymes, when concentration of virus in stool is highest. Concentration of virus in stool declines afterwards jaundice appears, with most people no longer infectious virtually a week later jaundice appears. Children can shed HAV for longer periods than adults, up to 10 weeks or longer later on onset of clinical disease.

How common is HAV infection in the The states?

The incidence of hepatitis A in the US increased more than ten-fold from 2015 to 2019, with over 18,800 cases reported to CDC in 2019. This number is an underestimate of the actual number of infections: CDC estimates that almost 37,700 cases actually occurred in 2019.

Between 2012 and 2015 the number of reported hepatitis A infections ranged from approximately 1200 to 1800 cases every year. Beginning in 2016, big foodborne outbreaks led to an increase in the number of cases and sustained, large person-to-person outbreaks began, primarily driven by infections amid unvaccinated people who utilise drugs and people experiencing homelessness and their contacts. Since so, persistent person-to-person outbreaks have led to substantial increases in hepatitis A infection, with reported cases increasing by over l% from 2018 to 2019. More information regarding ongoing multistate outbreaks can be found here: www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm.

Practise people dice from hepatitis A?

Yes. Death equally a result of fulminant hepatic failure is rare, however, older historic period (over 40 years) and preexisting chronic liver disease increases the risk of severe disease and death from hepatitis A. The person-to-person U.S. multistate outbreaks that began in 2016 have disproportionately affected adults with chronic liver affliction and other health problems related to drug use and unstable housing. From 2016 through Nov 2021, CDC received reports of nearly 43,000 cases of acute HAV infection. Of these, approximately 61% have been hospitalized and ane% (more than than 400 people) take died.

Who is nigh at risk for acquiring HAV infection?

People who are at increased risk for acquiring HAV infection include the following:

• Travelers to countries that have loftier or intermediate endemicity of HAV infection • Men who have sexual activity with men (MSM) • Users of injection and non-injection drugs (in other words, all who utilize illegal drugs) • People with occupational run a risk of exposure (those who work with HAV-infected not-homo primates or researchers handling hepatitis A virus) • People who anticipate close contact with an international adoptee coming from a state with high or intermediate endemicity of HAV infection • People living with HIV infection • People experiencing homelessness, including temporary shelters and other unstable living arrangements • People living in group settings for those with developmental disabilities and other settings where hygiene is hard to maintain • People who are incarcerated

I thought people with clotting gene disorders were at risk for hepatitis A due to their regular use of claret products. Why did ACIP decide to stop recommending routine vaccination of people with clotting factor disorders?

People with clotting factor disorders were originally recommended to receive hepatitis A vaccine (HepA) in 1996. At that fourth dimension, the process used to make clotting factor supplements did not reliably inactivate hepatitis A viruses and recipients of these products had an increased gamble of HAV infection. Modern blood donor screening and virus reduction steps have drastically reduced that risk. In addition, more than 80% of people with clotting cistron disorders now receive recombinant clotting gene concentrates that are sterilized and have no chance of HAV manual. As a result of these factors, people with clotting factor disorders at present have no greater risk of hepatitis A than the general population and are no longer recommended to receive HepA vaccine unless it is otherwise indicated.

Are people with developmental disabilities at risk of HAV infection?

Historically, HAV infection was highly endemic in institutions for people with developmental disabilities as a issue of poor hand hygiene, close living conditions and diaper utilise. Equally fewer children take been institutionalized and as conditions in institutions have improved, the incidence and prevalence of HAV infection have decreased, although outbreaks can occur in these settings. All children with developmental disabilities should receive HepA co-ordinate to U.S. routine vaccine recommendations, including catch upward vaccination of all children through age 18 years.

Equally a strategy to further reduce the adventure of hepatitis A outbreaks and reach adults in settings with a loftier proportion of people with risk factors for HAV infection, the current ACIP recommendations advise considering HepA vaccination of residents and staff in facilities where hygiene is hard to maintain, such as group homes for people with developmental disabilities and homeless shelters.

Are people with chronic liver disease at higher run a risk of acquiring HAV infection?

No. People with chronic liver illness are not at increased take chances for acquiring HAV infection. However, they are at an increased hazard for life-threatening, fulminant (severe and sudden) hepatitis if they become infected with hepatitis A. People considered to have chronic liver disease include those with hepatitis B or C infection, cirrhosis, fatty liver disease, alcoholic liver disease, and autoimmune hepatitis.

Please discuss the tests commonly used to diagnose hepatitis A.

Hepatitis A cannot be differentiated from other types of viral hepatitis on the basis of clinical or epidemiological features alone. Appropriate claret tests must be used.

• Anti-HAV: Full antibody to HAV. This diagnostic test detects total antibody of both IgG and IgM subclasses of HAV. If positive, it indicates either acute or resolved infection. • IgG anti-HAV: IgG antibody is a subclass of anti-HAV. It appears early in the course of infection, remains detectable for the person's lifetime and provides lifelong protection against illness. Its presence indicates immunity through either HAV infection or HepA vaccination. • IgM anti-HAV: IgM antibody is a subclass of anti-HAV. Its presence indicates a contempo infection with HAV (vi months or less). It is used to diagnose acute (recently caused) hepatitis A. Considering of the risk of false positive IgM anti-HAV results, people should only be tested for IgM anti-HAV if they are symptomatic and suspected of having acute hepatitis A illness. • HAV RNA tests also may be used to diagnose astute infection through the direct detection of viral RNA in serum or stool.

Total anti-HAV, which appears early in the course of infection, remains detectable for the person's lifetime and indicates lifelong protection against the infection/illness. To confirm a diagnosis of acute HAV infection, serologic testing for IgM anti-HAV is required. In the majority of persons, serum IgM anti-HAV becomes detectable 5 to 10 days earlier onset of symptoms and lasts about six months. Withal, there accept been reports of persons who exam positive for IgM anti-HAV for up to a year or more following infection. An educational program on the interpretation of hepatitis A serology is available on the CDC website at world wide web.cdc.gov/hepatitis/resources/professionals/training/serology/training.htm.

Can HAV be transmitted past blood?

Yes. On rare occasions, HAV infection has been transmitted by transfusion of blood or blood products collected from donors during the viremic phase of their infection (i.e., when HAV is in the donor'due south blood). Since 2002, tests to discover the presence of hepatitis A virus RNA in donated plasma accept drastically reduced the risk of hepatitis A transmission from products derived from blood plasma.

Is HAV transmitted by saliva?

In experimentally infected nonhuman primates, HAV has been detected in saliva during the incubation period; however, manual past human saliva has not been reported.

How common is HAV transmission in infirmary settings?

Hospital-caused HAV infection is rare. In the past, outbreaks were observed in neonatal intensive care units when infants acquired infection from HAV-infected transfused blood and subsequently transmitted HAV to other infants and staff. Outbreaks of hepatitis A caused by transmission from adult patients to healthcare personnel (HCP) are typically associated with fecal incontinence and inadequate paw hygiene, although the majority of hospitalized patients who have hepatitis A are admitted after onset of jaundice, when they are beyond the point of height infectivity. Manual in healthcare settings besides has resulted from breakdowns in standard infection control practices and transmission from one healthcare provider to some other.

How stable is HAV in the environment?

Depending on conditions, HAV can be stable in the environs for months; freezing does not inactivate (i.e., render non-infectious) HAV. HAV is inactivated by heating foods to temperatures greater than 185°F (85°C) for 1 minute. In add-on, HAV on surfaces is inactivated by disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (i.e., household bleach) in tap water.

Fairly chlorinating water through water treatment processes and dilution in public water systems kills HAV. Spas and swimming pools that are adequately treated are not likely to pose a risk for HAV outbreaks.

Do people with hepatitis A develop chronic affliction or can they get repeated infections?

No, in that location is no chronic (long-term) infection. Even the modest proportion of people who develop relapsing HAV recover later on about 6 months. Once y'all have had HAV infection and recovered, you cannot get information technology again.

Vaccination Recommendations Back to top

What is the best way to prevent HAV infection?

Vaccination with the full serial of hepatitis A vaccine (HepA) is the all-time way to forbid HAV infection. Allowed globulin (IG) also can be used for short-term protection in sure situations.

What are the hepatitis A vaccines (HepA) that are approved for use in the United States?

Recommended dosages and schedules of hepatitis A vaccines Vaccine Age group Dose Volume # Doses Schedule Havrix (GSK) 1-18 years 720 El.U.* 0.five ml two 0, half dozen-12 mos. nineteen years and older 1440 El.U.* 1.0 ml 2 0, 6-12 mos. Vaqta (Merck & Co.) one-18 years 25 U** 0.5 ml 2 0, 6-18 mos. 19 years and older 50 U** one.0 ml 2 0, 6-18 mos.

*El.U. = Elisa Units **U = Units

Combination vaccine using hepatitis A and hepatitis B vaccines Vaccine Age group Antigens used Volume # Doses Schedule Twinrix (GSK) 18 years and older Havrix (720 El.U.) combined with Engerix-B (20 mcg) one.0 ml 3 0, ane, 6 mos. iv 0, 7, 21-30 days, 12 months***

*** Accelerated schedule may be used for rapid protection prior to travel or for rapid protection of an unexposed but at-run a risk person who likewise would benefit from hepatitis B protection. Twinrix is non recommended for use every bit post-exposure prophylaxis.

Are HepA vaccine brands interchangeable?

Yes, a number of studies indicate that the ii brands of HepA, Havrix (GSK) and Vaqta (Merck), are interchangeable.

Where can I find data about vaccine shortages?

For detailed information almost HepA shortages, go to CDC's website at world wide web.cdc.gov/vaccines/hcp/clinical-resources/shortages.html.

Who is recommended to receive HepA vaccine?

The Advisory Committee on Immunization Practices (ACIP) recommends routine HepA vaccination for the post-obit groups:

• All children at age i year (12–23 months) • All children and adolescents historic period 2 through 18 years who have not previously received HepA should be vaccinated (i.e., routine catch-up vaccination) [2020] • People living with HIV infection [2020] • Travelers age 12 months and older to areas of the earth with intermediate or high HAV endemicity. Low endemicity regions include the United states of america, Canada, Western Europe, Japan, New Zealand, and Commonwealth of australia. For more information, see the CDC travel health website for current information about specific countries at world wide web.cdc.gov/travel or the CDC Yellow Book (wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/hepatitis-a). When in doubt, vaccinate. • Infants age 6 through xi months traveling outside the United States should receive 1 dose when protection against HAV infection is recommended. The travel dose does not count toward the routine HepA series which should be initiated at age one yr with the appropriate dose and schedule. In these instances, the child volition receive a total of three doses of HepA vaccine. • Men who have sex with men • Users of illegal drugs, injectable or noninjectable • People who are homeless or in unstable living arrangements, including shelters • Previously unvaccinated people who anticipate having close personal contact with an international adoptee from a country of high or intermediate endemicity during the first threescore days following the adoptee's arrival in the U.S. • People who work with HAV-infected nonhuman primates or with HAV in a research laboratory setting • People with chronic liver disease (including but not express to people with hepatitis B infection, hepatitis C infection, cirrhosis, fat liver disease, alcoholic liver disease, autoimmune hepatitis, or an ALT or AST level persistently greater than twice the upper limit of normal) • People identified during pregnancy to be at hazard for HAV infection due to presence of a specific take a chance factor for exposure or at risk for severe outcome from HAV infection (for example, those with chronic liver disease or with HIV infection). • During an outbreak, whatsoever unvaccinated person who is identified equally at run a risk for HAV infection or at risk for severe disease from HAV • Whatever person who wishes to exist immune to hepatitis A

HepA vaccination is not routinely recommended for healthcare personnel, food handlers, sewage workers, or day intendance providers because at that place is no bear witness that their occupational risks of HAV exposure are significantly college than the general population. However, any person who desires protection from HAV infection may be vaccinated.

For details about CDC recommendations for the prevention of hepatitis A, see the 2020 recommendations of the Advisory Committee on Immunization Practices (ACIP): world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

What groups of people recommended for routine HepA vaccination were added or removed in the July 2020 ACIP statement?

• [added] All children ages 2 through 18 years not previously vaccinated • [added] All people historic period ane year or older living with HIV infection • [added] People identified to be at hazard for HAV infection during pregnancy • [removed] People with clotting factor disorders

Should nosotros requite HepA to a person older than age 18 years who requests it?

Yes, unless the person is allergic to any of the vaccine components. HepA vaccination is safe and effective and is recommended for any person who wishes to obtain immunity.

Which children should be routinely vaccinated against HAV infection?

All children should receive 2 doses of HepA vaccine beginning at age ane year (i.east., 12–23 months). The 2 doses in the serial should exist administered at least 6 months apart. Any child age two through 18 years not previously vaccinated should be vaccinated. For a re-create of the ACIP recommendations on hepatitis A, get to world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

For hepatitis A vaccination, the minimum interval between the 2-dose serial is at least 6 months. Is this the aforementioned as 24 weeks?

No. The minimum interval between dose #ane and #two of HepA vaccine is 6 calendar months, not 24 weeks.

I have a child who was given her second dose of hepatitis A vaccine 4 months after the first dose. Does information technology demand to be repeated, and if so, when?

Yes. The second dose was given more 4 days before the minimum interval of vi calendar months, so it is considered invalid and should be repeated. The echo dose should be administered the proper minimum interval (6 months) after the invalid dose. If this echo dose is inadvertently given less than 6 months later the invalid dose, it does not need to be repeated again as long as the interval between the initial HepA vaccine and the most recent dose is at to the lowest degree 6 agenda months.

What are the recommendations for postexposure prophylaxis (PEP) for hepatitis A?

In 2020, CDC published revised recommendations for hepatitis A postexposure prophylaxis (PEP). Please meet the complete PEP recommendations at world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, with special attention to Table four on page 19 and Appendix B: Provider Guidance on Run a risk Cess for Hepatitis A Postexposure Prophylaxis, showtime on folio 36.

Salubrious people who have completed the HepA vaccination series at any time exercise not need additional PEP if they are exposed to HAV. People who have recently been exposed to HAV and who accept non received HepA vaccine previously should receive PEP equally soon as possible, inside ii weeks of exposure.

People age 12 months and older exposed to HAV inside the past 14 days and who accept not previously completed the HepA vaccine series should receive a unmarried dose of HepA vaccine as soon as possible. In add-on to vaccine, allowed globulin (IG; 0.1 mL/kg) may be administered to people older than historic period twoscore years depending on the providers' risk assessment. For long-term immunity, the HepA vaccine series should be completed with a 2d dose at least 6 months after the first dose. However, the second dose is not necessary for PEP. A second dose should not be administered sooner than 6 calendar months subsequently the get-go dose, regardless of HAV exposure take a chance.

People age 12 months or older who are immunocompromised or take chronic liver disease, and who have been exposed to HAV within the past 14 days and have non previously completed the HepA vaccination series, should receive both IG (0.one mL/kg) and HepA vaccine at the same visit in a dissimilar anatomic site (for example, separate limbs) every bit before long as possible afterwards exposure. For long-term immunity, the HepA vaccination serial should be completed with a second dose at to the lowest degree 6 months after the outset dose. However, the second dose is non necessary for PEP. A second dose should not be administered sooner than 6 agenda months after the first dose, regardless of HAV exposure risk.

People with HIV infection develop protective levels of antibody more than slowly and are less likely to develop protective antibody levels subsequently vaccination with HepA, peculiarly if their CD4+ count is low at the time of vaccination. Protection following vaccination of a person with HIV may wane over time. Vaccine should be administered if the exposed individual is not fully vaccinated; however, CDC as well advises clinicians to consider administering IG PEP to an private with HIV later a high-run a risk exposure (such as a household or sexual contact) even if the private has been fully vaccinated.

Twinrix contains one-half the corporeality of hepatitis A antigen as a standard unmarried-dose adult HepA vaccine. Twinrix should not be used for PEP merely may exist used to confer protection to at-take a chance but non yet exposed persons during an outbreak.

Infants younger than age 12 months and persons for whom vaccine is contraindicated should receive IG (0.1 mL/kg) instead of HepA vaccine every bit soon as possible and inside 2 weeks of exposure. MMR and varicella vaccines should non be administered sooner than 6 months afterwards IG assistants in lodge to avoid possible IG interference with the effectiveness of MMR and varicella vaccines.

When should prevaccination anti-HAV testing for susceptibility be performed?

Prevaccination serologic testing for HAV (measuring either total anti-HAV or IgG anti-HAV) is non indicated for children considering of the depression prevalence of infection in children. It also is not routinely recommended for adults but may exist considered in some settings to reduce costs associated with vaccinating people who are already immune. Prevaccination testing should not be used if information technology poses a barrier to vaccinating susceptible people, specially people who are hard to access.

Prevaccination testing is virtually likely to be toll-effective for adults who were either born in or lived for long periods of time in areas of the globe with high or intermediate hepatitis A endemicity. When evaluating people from populations with high rates of previous HAV infection, vaccination history as well should be obtained, if feasible. If testing or vaccination history is not available, practise not postpone vaccinating. At that place is no harm in vaccinating a person who has had natural infection or previous doses of vaccine.

When should postvaccination testing be performed?

Serologic testing for immunity is non necessary after routine vaccination of infants, children or adults. Testing for the presence of anti-HAV antibiotic i month or more after completing the HepA vaccination series is recommended only for people whose future clinical direction depends on knowing their immune condition and for whom revaccination might be indicated, such equally people living with HIV and other immunocompromised persons (such as transplant recipients and people vaccinated while receiving chemotherapy). In such individuals, if the results of postvaccination testing do not show an acceptable immune response (10 mIU/mL or higher), revaccination with a complete serial is recommended, followed past a second postvaccination serologic test. If that second test remains negative, no additional vaccination is recommended; still, the patient should be counseled on strategies to avoid exposure to HAV and the need for IG if an exposure occurs. If vaccination results in seroconversion, insufficient data are available to brand recommendations concerning repeat testing, booster doses or revaccination.

For Special Groups Dorsum to top

Explain the details regarding the recommendation for giving HepA vaccine to people who will exist in contact with recently adopted children.

ACIP recommends vaccination confronting HAV infection for all previously unvaccinated people who anticipate having close personal contact with an international adoptee from a country of high or intermediate endemicity during the offset 60 days post-obit the adoptee's arrival in the U.S. In add-on to the adoptee'south new parents and siblings, this group might include grandparents, other household members, regular babysitters and other caregivers. The starting time dose of HepA should be given to close contacts every bit soon as adoption is planned, ideally at to the lowest degree 2 weeks before the arrival of the adoptee. A second dose should be given no sooner than half dozen months after the outset dose.

ACIP now recommends routine hepatitis A vaccination for people experiencing homelessness. Can yous provide a definition of "experiencing homelessness"?

The 2020 ACIP recommendations for the prevention of hepatitis A ascertain a person experiencing homelessness equally 1) a person who lacks housing (regardless of whether the person is a fellow member of a family), including a person whose primary residence during the night is a supervised public or individual facility (e.thousand., shelter) that provides temporary living accommodations and a person who is a resident in transitional housing, 2) a person without permanent housing who might: live on the streets, stay in a shelter, mission, single-room occupancy facility, abandoned building, vehicle, or any other unstable or nonpermanent state of affairs, or 3) who is "doubled upward", a term that refers to a situation where persons are unable to maintain their housing state of affairs and are forced to stay with a series of friends or extended family members. In addition, previously homeless persons who are to be released from a prison house or a infirmary might be considered homeless if they do not have a stable housing situation to which they can return. The instability of a person's living arrangements is critical to the definition of homelessness.

Some people on my team are worried about initiating the HepA vaccine series in people who are homeless because we may not be able to complete the series or go along up with their records over time. How much of a concern is this?

While a complete series of HepA is recommended for long-term protection, even a single dose of HepA vaccine has been demonstrated to provide protection against hepatitis A for more than than 10 years and can prevent or control outbreaks of hepatitis A. People who are experiencing homelessness may have difficulty protecting themselves from exposure to HAV in other ways considering of their living atmospheric condition. They should be vaccinated when possible and provided a record of immunization. Reporting the HepA vaccination to a state immunization information organisation also can facilitate immunization assessment at futurity healthcare encounters.

Should healthcare providers (HCP) exist vaccinated routinely against hepatitis A?

No. A number of studies accept shown that HCP are not at significantly increased risk of HAV infection because of their occupation. However, if HCPs are going to work (or vacation) in a land with a high or intermediate owned charge per unit of HAV infection, they are at adventure of HAV infection and should exist vaccinated. The simply occupational indications for routine HepA vaccination are work with not-human primates or live HAV in a laboratory setting.

Should daycare workers be routinely vaccinated against hepatitis A?

No. In the past, outbreaks of hepatitis A occurred among children in kid care centers, infecting employees of those centers, especially those caring for infants and toddlers. Following widespread adoption of early on childhood vaccination against hepatitis A, outbreaks in child care centers are now rare.

Why is hepatitis A vaccination recommended for people with chronic liver disease?

Although not at increased risk for HAV infection, people with chronic liver disease are at increased hazard for fulminant hepatitis A, hospitalization and death if they become infected with HAV. For this reason, hepatitis A vaccination is recommended for them.

Why isn't hepatitis A vaccination recommended for sewage and solid waste disposal workers?

In published reports of 3 serologic surveys conducted among U.s. wastewater workers and advisable comparison populations, no substantial or consistent increase in the prevalence of anti-HAV was identified among wastewater workers. No work-related instances of HAV manual have been reported among wastewater workers in the United States. In addition, in the U.s., outbreaks of hepatitis A acquired by flooding, which can carry raw sewage, have not been reported.

Why is hepatitis A vaccination no longer recommended for people with clotting factor disorders?

People with clotting factor disorders were originally recommended to receive hepatitis A vaccine (HepA) in 1996. At that fourth dimension, the process used to make clotting cistron supplements did non reliably inactivate hepatitis A viruses and recipients of these products had an increased risk of HAV infection. Modernistic claret donor screening and virus reduction steps have drastically reduced that risk. In addition, more than fourscore% of people with clotting cistron disorders now receive recombinant clotting gene concentrates that are sterilized and have no risk of HAV transmission. As a event of these factors, people with clotting factor disorders at present have no greater risk of hepatitis A than the general population and are no longer recommended to receive HepA vaccine unless it is otherwise indicated.

Why is hepatitis A vaccination recommended (and IG non recommended) for infant travelers age 6 through 11 months at risk of exposure to HAV?

Because of measles. Measles is highly communicable and poses a serious threat to the health of unvaccinated infants. For this reason, all infants age half dozen through xi months who travel internationally are recommended to receive a dose of measles, mumps, and rubella vaccine (MMR) to reduce the risk of measles infection during travel.

The antibodies in allowed globulin (IG) typically used to prevent HAV infection in infants before the showtime birthday can interfere with the effectiveness of MMR vaccine. An babe who is given IG should not exist vaccinated with MMR or varicella vaccines for at least 6 months after IG administration. If an infant age half dozen through 11 months is traveling to a destination where protection from infection with HAV is desired, ACIP recommends off-label use of HepA vaccine (not IG) in addition to MMR. The HepA and MMR doses administered before the first birthday do non count toward the routine vaccination series of either vaccine: these babe travelers will still demand two doses of HepA and two doses of MMR when age appropriate.

Can pregnant women receive hepatitis A vaccine?

Yes. The ACIP recommends that meaning women at run a risk for HAV infection during pregnancy or at take chances for a severe outcome from HAV infection should be vaccinated during pregnancy if non previously vaccinated. Pregnant women should be vaccinated for the same indications as non-pregnant women. For additional data, run across page 20 of the recommendations: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Administering Vaccines Dorsum to peak

By what method should hepatitis A vaccine be administered?

Hepatitis A vaccine (HepA) should be administered intramuscularly (IM), using the appropriate injection site and needle size as determined past the patient's age and body mass.

Tin HepA vaccine be given meantime with other vaccines?

Yes. Other inactivated and/or alive virus vaccines tin be administered at the same time every bit HepA vaccine, simply should be given at a unlike anatomical site, if possible. If given in the same muscle, carve up the injections by a minimum distance of one inch.

Is HepA vaccine available to children through the Vaccines for Children (VFC) plan?

Yes, VFC-supported HepA vaccine is bachelor for children 12 months through 18 years who are VFC-eligible. In addition, combination HepA and HepB vaccine (Twinrix; GSK) is also available for people who are historic period 18 years who are VFC-eligible.

What happens if dose #two of HepA vaccine is delayed?

You practise not need to start the series over again. The immunogenicity of 1 dose of HepA vaccine is 94% to 100%; studies accept shown persistent protection from a single dose lasting more than x years. To ensure optimal long-term protection it is important to administer the second dose.

To complete a 21-twelvemonth-old patient's HepA vaccine serial, how many adult doses should I give if the patient received a single dose of pediatric HepA vaccine 5 years agone?

A person should receive the dosage of HepA vaccine appropriate for their age at the fourth dimension of assistants. You lot should give the patient i adult dose of HepA to consummate the 2-dose series. It is non necessary to restart the vaccine serial.

One of our staff gave a dose of pediatric HepA vaccine to an adult patient past error. How practice we remedy this error?

In general, if the error is discovered on the same clinic twenty-four hour period, you can administrate the other "half" of the dose on that same day. If the fault is discovered afterwards, the dose should non be counted, and and so the person should be recalled to the office and given a full historic period-advisable repeat dose.

If you give more than than an age-appropriate dose (for example, an developed dose of HepA vaccine given to a child), count the dose as valid and notify the patient/parent virtually the fault. There may be an increased run a risk of a local adverse reaction when more than than the recommended dose is given. If the mistake occurred with the kickoff dose of the serial the child should even so receive the second dose on schedule. Giving a "double" dose for the first dose does not negate the demand for a 2nd dose.

Avoid such errors by checking the vaccine vial label 3 times.

Why does a xv yr old who weighs 160 pounds receive a pediatric dose of HepA while his 110-pound female parent receives an adult dose (twice the pediatric dose)?

The efficacy data from the clinical trials were based on age at time of vaccination, and not on the weight of the individual. Hence, the dosage recommendations reflect this age-based efficacy data. The same holds true for HepB vaccine. In addition, higher response rates are expected in younger people, fifty-fifty if their weights are in a higher place the norm.

Could you lot delight provide more than information near Twinrix (the combination hepatitis A and B vaccine) and the ii schedules for its use?

Twinrix (GSK) is an inactivated combination vaccine containing both hepatitis A virus (HAV) and hepatitis B virus (HBV) antigens. The vaccine contains 720 EL.U. of hepatitis A antigen (half of the Havrix adult dose) and 20 mcg of hepatitis B antigen (the full Engerix-B developed dose).

In the U.S., Twinrix is licensed for use in people who are age xviii years or older. It can be administered to people who are at adventure for both hepatitis A and hepatitis B, such as sure international travelers, people with HIV infection, people with chronic liver illness not caused by hepatitis B, men who have sex with men, illegal drug users, or to people who simply desire to exist immune to both diseases. Primary immunization consists of 3 doses given intramuscularly on a 0, 1, and 6 month schedule. In 2007, the FDA also approved a 4-dose schedule for Twinrix. It consists of 3 doses given within 4 weeks, followed by a booster dose at 12 months (0, 7 days, 21–30 days, and 12 months). The iv-dose schedule could benefit individuals needing rapid protection from hepatitis A and hepatitis B, such as people traveling to high-prevalence areas imminently.

Twinrix cannot be used for postexposure prophylaxis.

I have seen adults who have had 1 or 2 doses of Twinrix, but nosotros only carry single-antigen vaccine in our practise. How should we complete their vaccination series with single-antigen vaccines?

Twinrix is licensed equally a 3-dose serial for people historic period xviii years and older. If Twinrix is not bachelor or if you choose not to use Twinrix to consummate the Twinrix series, you should do the following: If 1 dose of Twinrix was given, complete the series with 2 adult doses of hepatitis B vaccine and two adult doses of hepatitis A vaccine. If ii doses of Twinrix were given, complete the schedule with 1 adult dose of hepatitis A vaccine and ane adult dose of hepatitis B vaccine.

Another manner to consider this is as follows:

A dose of Twinrix contains a standard adult dose of hepatitis B vaccine and a pediatric dose of hepatitis A vaccine. Thus, a dose of Twinrix tin can be substituted for any dose of the hepatitis B series only not for whatsoever dose of the hepatitis A series.

• Any combination of 3 doses of adult hepatitis B or 3 doses of Twinrix is a complete series of hepatitis B vaccine. • One dose of Twinrix + two doses of developed hepatitis A is a complete series of hepatitis A vaccine. • Two doses of Twinrix + 1 dose of adult hepatitis A is a complete series of hepatitis A vaccine.

We're thinking of using Twinrix and nosotros're wondering whether we tin use it for doses #1 and #3 simply and use single antigen hepatitis B vaccine for dose #two?

No. Twinrix contains 50% less hepatitis A antigen component than Havrix, GSK'southward monovalent hepatitis A vaccine [720 vs. 1440 El. U.], so the patient would not receive the recommended dose of hepatitis A vaccine antigen. For this reason, 3 doses of Twinrix must comprise the series.

Allowed Globulin Back to top

What is immune globulin (IG)?

Immune globulin (IG, GamaSTAN, Grifols Therapeutics) is a sterile training of concentrated antibodies (i.e., immunoglobulins) made from pooled man plasma candy by cold ethanol fractionation. GamaSTAN is the only IG product licensed in the United States for the prevention of hepatitis A. Just plasma that has tested negative for hepatitis B surface antigen, antibody to human being immunodeficiency virus (HIV), and antibody to hepatitis C virus (HCV) is used to produce IG. In addition, the Food and Drug Administration requires that the process used to produce IG include a viral inactivation step or that terminal products test negative for HCV-RNA by polymerase chain reaction. Anti-HAV concentrations differ amidst IG lots and decreasing concentrations have been observed over the past 30 years, probably because of the decreasing prevalence of previous HAV infection among plasma donors. In 2017, the dosing of GamaSTAN for HAV prevention was increased to reflect this modify in anti-HAV potency.

How does immune globulin (IG) work?

IG provides protection against HAV infection through passive transfer of antibody. Depending on the IG dosage, protection lasts from ane to 2 months.

When administered for preexposure prophylaxis, a dose of 0.ane mL/kg volition provide protection for upwards to 1 month and a dose of 0.2 mL/kg will provide protection for up to ii months. If longer term protection is required and vaccination is contraindicated, a dose of 0.2 mL/kg tin exist repeated every 2 months. There is no maximum number of times the bimonthly doses of IG may be repeated as long as hepatitis A prophylaxis is required.

For postexposure prophylaxis, the recommended dosage is 0.1 mL/kg.

How is IG packaged and how is IG administered?

Intramuscular IG is available in single-use vials (ii mL and 10 mL). It should be administered intramuscularly, preferably in the anterolateral aspects of the upper thigh and the deltoid muscle of the upper arm. Do not apply the gluteal region equally an injection site because of the risk of injury to the sciatic nerve.

Does IG crusade adverse events?

Serious agin events from GamaSTAN IG are rare. Anaphylaxis has been reported after repeated administration to people with known immunoglobulin A (IgA) deficiency; thus, IG should non be administered to these people. IG products including GamaSTAN take been associated with the germination of blood clots (thrombosis) later administration, particularly if the patient has other chance factors for thrombosis. Patients should be counseled about this risk.

Can pregnant or lactating women receive IG?

Yes. Pregnancy or lactation is not a contraindication to IG administration if clearly needed.

A child in my practice was given hepatitis A IG (GamaSTAN, Grifols) when she was x months old afterwards her mother tested positive for hepatitis A. She'south scheduled for her 12-month-onetime well-kid visit. Will this affect her vaccination schedule?

Yes. IG may be given any time before or after inactivated vaccines. However, the antibodies in IG may interfere with the effectiveness of certain live-virus vaccines, such as measles, mumps, and rubella (MMR) and varicella vaccines. CDC recommends waiting at to the lowest degree 6 months from the date of IG administration before administering MMR and varicella vaccines.

Which people should become GamaSTAN (IG) for prevention of hepatitis A?

Please see details of the recommendations for the employ of IG for the prevention of hepatitis A provided in Table iv (page 19) and Appendices A and B of the 2020 ACIP recommendations for the prevention of hepatitis A infection: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Below is a cursory summary of the recommendations:

Preexposure prophylaxis with IG for travel to areas of intermediate or high hepatitis A endemicity:

• Infants younger than historic period 6 months and other travelers for whom HepA vaccine is declined or contraindicated • Previously unvaccinated people with chronic liver disease vaccinated inside two weeks of divergence may consider IG in add-on to vaccination, based upon the clinician's gamble cess • Previously unvaccinated people who are immunocompromised may consider IG in improver to vaccination, regardless of the timing of vaccination, based upon the clinician'southward risk assessment • Previously unvaccinated people who are over age 40 years and vaccinated within 2 weeks of departure may consider IG in addition to vaccination, based upon the clinician's risk assessment

Postexposure prophylaxis with IG inside two weeks after exposure to hepatitis A virus (HAV):

• Infants under age 12 months • Previously unvaccinated immunocompromised adults (including HIV+), in addition to vaccination • Previously unvaccinated adults with chronic liver disease, in addition to vaccination • Previously unvaccinated adults over age xl years, consider IG in addition to vaccination, based upon clinician hazard assessment • People with HIV infection, previously vaccinated, consider IG following a loftier-adventure exposure (household or sexual contact), based upon clinician risk assessment

Travel - International Back to top

Which travelers are recommended to receive HepA vaccine?

Hepatitis A vaccination is recommended for people age vi months or older who are traveling to or working in an area of the earth at intermediate or high chance of hepatitis A manual. Areas of depression risk include the United States, Canada, Nippon, New Zealand, Australia and Western Europe. Visit the CDC'due south Traveler Wellness website for more information virtually specific destinations and current outbreaks or travel notices (https://wwwnc.cdc.gov/travel/). When in incertitude, vaccinate.

What are the recommendations for vaccination of travelers to protect them from hepatitis A virus (HAV) infection?

For details on preexposure protection of international travelers age 12 months and older, refer to Appendix A on page 35 of the current ACIP recommendations for the prevention of hepatitis A: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Healthy people age 12 months through 40 years who are planning travel to an area with high or intermediate HAV endemicity and take not received HepA vaccine should receive a single dose of HepA vaccine as soon equally travel is considered and should consummate the 2-does series co-ordinate to the routine schedule.

People with chronic liver affliction as well as adults older than twoscore years of historic period, immunocompromised persons, and persons with other chronic medical conditions planning to depart to an expanse with high or intermediate HAV endemicity in less than 2 weeks should receive the initial dose of HepA vaccine and may too simultaneously be administered IG at a divide anatomic injection site (for instance in separate limbs).

ACIP revised its recommendations for preexposure hepatitis A vaccination for travelers in 2018 to include vaccination of infants half dozen through 11 months of age. All infants of this age traveling internationally should be given a dose of measles, mumps, rubella vaccine (MMR) before travel. Due to the potential interference of hepatitis A allowed globulin (IG) with MMR vaccine effectiveness, an off-label dose of HepA vaccine is recommended instead of IG in this situation. The travel-related dose for infants 6–11 months of age should not be counted toward the routine 2-dose series. The routine two-dose HepA and MMR vaccination series should exist initiated at age 12 months according to the routine, age-advisable vaccination schedule.

Infants younger than 6 months and travelers who elect not to receive vaccine or for whom vaccine is contraindicated should receive a single 0.ane mL/kg dose of IG before travel when protection against HAV is recommended. If travel is for more than than 1 month, a dose of 0.two mL/kg should be administered. A 0.2 mL/kg dose can be repeated every 2 months for travel of more than two months duration.

Can Twinrix be used for people planning international travel?

Yes. If time allows, use the standard Twinrix schedule of 3 doses given intramuscularly on a 0, 1, and 6 calendar month schedule. If travel is imminent the accelerated four-dose Twinrix schedule can exist used, which is iii doses given on days 0, 7, and 21-30 days and a booster dose at 12 months.

We accept an adult patient who received the correct pediatric series of HepA vaccine as a teenager and is now traveling abroad. Does the patient need an adult booster?

No. There is no recommendation for a booster dose of HepA if a patient has completed the 2-dose series at any age.

Is information technology really necessary to vaccinate travelers to Latin America who will be staying in 4-star hotels?

Yes. Information have shown that people acquire HAV infection fifty-fifty in such places as four-star hotels located in Latin America.

If a traveler received the beginning dose of HepA vaccine more than ane year ago and needs to travel abroad imminently, will the traveler need IG in addition to dose #ii prior to leaving?

No. Just give the terminal dose of HepA vaccine prior to travel.

If an baby younger than historic period vi months receives IG before travel to a hepatitis A endemic area, will he/she need HepA vaccine before another trip to a hepatitis A endemic area?

Possibly. Since IG protects confronting HAV infection for only 1 to 2 months, depending on the dosage given, additional IG may be needed if the infant is not withal age half dozen months. Once the child has reached six months of age, HepA vaccine should exist given.

Can VFC-eligible children who travel to HAV-owned areas receive HepA vaccine under the VFC programme?

Yes. ACIP recommends that all children age 1 year through eighteen years should be vaccinated against hepatitis A. VFC HepA vaccine may be administered to any eligible child, including those recommended for vaccination at vi through 11 months of age equally a consequence of travel to an HAV-endemic surface area.

If a person was built-in and grew up in a state where HAV infection is owned (due east.g., Vietnam, Mexico) and so moved to the United States at age xx, should that person receive HepA vaccine before returning to visit his/her homeland?

It depends on whether that person has a history of HAV infection. Unless there are medical records that certificate prior HAV infection, serologic testing for amnesty (positive examination for total anti-HAV) is the only way to make up one's mind if vaccination is necessary. For people from countries with high rates of HAV infection, such every bit Vietnam and Mexico, serologic testing might be done to prevent unnecessary vaccination. The cost effectiveness of serologic testing, however, should exist balanced against the possibility of delaying needed vaccination while awaiting test results.

If a person has had HAV infection, should they notwithstanding receive the vaccine if planning international travel?

No, as long as there are medical records that document that the person was previously infected with HAV (i.due east., positive test for full anti-HAV). If at that place is whatever doubt that the person really was infected with HAV, HepA vaccine and/or IG should be given. The vaccine or IG will not damage a person who is already immune.

Vaccine Safe Back to pinnacle

What reactions might occur afterward assistants of HepA vaccine?

No serious adverse events have been attributed definitively to HepA vaccine. Among adults, the virtually often reported side effects are soreness at the site of the injection and headache. In children, the most oft reported side effect is soreness at the injection site. The frequency of side effects subsequently administration of Twinrix is like to those reported when the two single-antigen vaccines were administered.

Contraindications and Precautions Back to top

What contraindications and precautions should be followed when administering HepA vaccine?

Hepatitis A vaccine is contraindicated for people with a history of a severe allergic reaction to a previous dose of HepA vaccine or to a vaccine component. Equally with all other vaccines, at that place is a precaution when giving it to anyone who is moderately or severely ill.

Tin can significant women receive HepA vaccine?

Yes. ACIP recommends that meaning women at risk for HAV infection during pregnancy or at risk for a severe upshot from HAV infection should be vaccinated during pregnancy if non previously vaccinated. Pregnant women should exist vaccinated for the aforementioned indications every bit non-pregnant women. For boosted details, see page 20 of the current ACIP recommendations: world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Can lactating women receive HepA vaccine?

Yes. HepA vaccine is an inactivated vaccine and poses no harm to the nursing infant.

Tin can HepA vaccine exist given to immunocompromised people?

Yes. All people age 1 twelvemonth or older living with HIV infection should exist vaccinated against hepatitis A if they have not been vaccinated, regardless of their CD4+ count.

If any immunocompromised person has a risk gene that places them at increased run a risk of hepatitis A (e.k., international travel, drug use), they should exist vaccinated with HepA vaccine.

I accept a patient on interferon for hepatitis C, just I want to give him HepA vaccine. Is information technology okay to vaccinate him against hepatitis A while he is on interferon?

Yes. HepA vaccine should be given to all susceptible patients with chronic liver affliction. HepA vaccine is very immunogenic.

Vaccine Storage and Handling

How should HepA vaccine be stored?

All hepatitis A-containing vaccine should exist stored at refrigerator temperature at 2°C to eight°C (36°F to 46°F). The vaccine must not be frozen. Whatever vaccine exposed to freezing temperature should non exist used. Do not use these or any other vaccines later the expiration date shown on the packaging. Whatever vaccine administered after its expiration date is not valid and should be repeated.

Back to top

cruzthispered.blogspot.com

Source: https://www.immunize.org/askexperts/experts_hepa.asp

Share this post