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Hepatitis A and Hepatitis A Vaccine. Epidemiology and Prevention of Vaccine-Preventable Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention. Revised March 2008. Note to presenters:

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slide1
Hepatitis A and Hepatitis A Vaccine

Epidemiology and Prevention of Vaccine-Preventable Diseases

National Center for Immunization and Respiratory Diseases

Centers for Disease Control and Prevention

Revised March 2008

slide2

Note to presenters:

Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp

hepatitis a
Hepatitis A
  • Epidemic jaundice described by Hippocrates
  • Differentiated from hepatitis B in 1940s
  • Serologic tests developed in 1970s
  • Vaccines licensed in 1995 and 1996
hepatitis a virus
Hepatitis A Virus
  • Picornavirus (RNA)
  • Humans are only natural host
  • Stable at low pH
  • Inactivated by high temperature (185°F or higher), formalin, chlorine
hepatitis a pathogenesis
Hepatitis A Pathogenesis
  • Entry into mouth
  • Viral replication in the liver
  • Virus present in blood and feces 10-12 days after infection
  • Virus excretion may continue for up to 3 weeks after onset of symptoms
hepatitis a clinical features
Hepatitis A Clinical Features
  • Incubation period 28 days (range 15-50 days)
  • Illness not specific for hepatitis A
  • Likelihood of symptomatic illness directly related to age
  • Children generally asymptomatic, adults symptomatic
hepatitis a epidemiology
Hepatitis A Epidemiology
  • Reservoir Human
  • Transmission Fecal-oral
  • Temporal pattern None
  • Communicability 2 weeks before to 1 week after onset
slide8

Hepatitis A—United States, 1990-2000

Risk Factors

Source: NNDSS/VHSP

hepatitis a vaccines
Hepatitis A Vaccines
  • Inactivated whole virus
  • HAVRIX (GlaxoSmithKline)
  • VAQTA (Merck)
  • Both vaccines approved for persons 12 months of age and older
  • Pediatric (12 months through 18 years) and adult (19 years and older) formulations
hepatitis a vaccine immunogenicity
Hepatitis A Vaccine Immunogenicity
  • Adults
    • >95% seropositive after one dose
    • 100% seropositive after two doses
  • Children (>12 months) and Adolescents
    • >97% seropositive after one
    • 100% seropositive after 2 doses
hepatitis a vaccines1
Hepatitis A Vaccines
  • Adult
    • 1 dose
    • booster dose 6-18 months after first dose
  • Children and Adolescents
    • 1 dose
    • booster dose 6-18 months after first dose
hepatitis a vaccine efficacy
Hepatitis A Vaccine Efficacy
  • HAVRIX
    • 40,000 Thai children 1-16 years of age
    • vaccine efficacy 94%
  • VAQTA
    • 1,000 New York children 2-16 years of age
    • vaccine efficacy 100%
slide16
Hepatitis A Vaccines

Formulation

Pediatric

age

dose

Adult

age

dose

HAVRIX

1-18 yrs

0.5 ml

>18 yrs

1.0 ml

VAQTA

1-18 yrs

0.5 ml

>18 yrs

1.0 ml

acip recommendation for routine hepatitis a vaccination of children
ACIP Recommendation for Routine Hepatitis A Vaccination of Children
  • All children should receive hepatitis A vaccine at 12-23 months of age
  • Vaccination should be integrated into the routine childhood vaccination schedule
  • Children who are not vaccinated by 2 years of age can be vaccinated at subsequent visits

MMWR 2006;55(No.RR-7):1-23

acip recommendation for routine hepatitis a vaccination of children1
ACIP Recommendation for Routine Hepatitis A Vaccination of Children
  • States, counties, and communities with existing hepatitis A vaccination programs for children 2 through 18 years of age should maintain these programs
  • New efforts focused on routine vaccination of children 12 months of age should enhance, not replace ongoing vaccination programs for older children

MMWR 2006;55(No.RR-7):1-23

acip recommendation for routine hepatitis a vaccination of children2
ACIP Recommendation for Routine Hepatitis A Vaccination of Children
  • In areas with without an existing hepatitis A vaccination program catch-up vaccination of unvaccinated children 2 through 18 years of age can be considered

MMWR 2006;55(No.RR-7):1-23

hepatitis a vaccine recommendations
Hepatitis A Vaccine Recommendations
  • International travelers
  • Men who have sex with men
  • Persons who use illegal drugs
  • Persons with occupational risk
  • Persons with chronic liver disease
hepatitis a vaccine international travel
Hepatitis A VaccineInternational Travel
  • The first dose of hepatitis A vaccine should be administered as soon as travel is considered
  • For healthy persons 40 years of age or younger:
    • 1 dose of single-antigen vaccine administered at any time before departure
  • Persons at risk of severe disease from hepatitis A virus planning to travel in 2 weeks or sooner should receive the first dose of vaccine and also can be administered immune globulin

MMWR 2007;56(No.41):1080-4

hepatitis a postexposure prophylaxis
Hepatitis A Postexposure Prophylaxis
  • For healthy persons 12 months through 40 years of age:
    • single-antigen hepatitis A vaccine should be administered as soon as possible after exposure
  • For persons older than 40 years:
    • immune globulin is preferred
    • vaccine can be used if IG cannot be obtained

MMWR 2007;56(No.41):1080-4

hepatitis a vaccine recommendations1
Hepatitis A Vaccine Recommendations
  • Healthcare workers: not routinely recommended
  • Child care centers: not routinely recommended
  • Sewer workers or plumbers: not routinely recommended
  • Food handlers: may be considered based on local circumstances
twinrix
Twinrix
  • Combination hepatitis A vaccine (pediatric dose) and hepatitis B (adult dose)
  • Schedules
    • 0, 1, 6 months, or
    • 0, 7, 21- 30 days and a booster dose at 12 months
  • Approved for persons 18 years of age and older
new twinrix schedule
New Twinrix Schedule
  • Doses at 0, 7, 21- 30 days and a booster dose at 12 months
  • ACIP has no recommendation regarding the new schedule
  • The first 3 doses of the new schedule provide equivalent protection to:
    • the first dose in the standard single-antigen adult hepatitis A vaccine series
    • the first 2 doses in the standard adult hepatitis B vaccine series
new twinrix schedule1
New Twinrix Schedule
  • Seroconversion is nearly 100% after either 3 doses of Twinrix on the new schedule or a single dose of single-antigen adult hepatitis A vaccine
  • No increased benefit of the new schedule for the hepatitis B component compared to administration of 2 hepatitis B vaccine doses 1 to 2 months apart
schedules that include both twinrix and hepatitis a vaccine
Schedules That Include BothTwinrix and Hepatitis A Vaccine
  • Adult formulation single antigen hepatitis A vaccine may be used to complete a schedule begun with Twinrix and vice versa*
  • Acceptable schedules
    • 2 Twinrix and 1 hepatitis A (adult formulation
    • 1 Twinrix and 2 hepatitis A (adult formulation)
  • Maintain spacing recommended for Twinrix

*for persons 19 years of age or older

hepatitis a serologic testing
Hepatitis A Serologic Testing
  • Prevaccination
    • not indicated for children
    • may be considered for some adults and older adolescent
  • Postvaccination
    • not indicated
hepatitis a vaccine adverse reactions
Hepatitis A VaccineAdverse Reactions
  • Local reaction 20%-50%
  • Systemic reactions

(malaise, fatigue) <10%

  • No serious adverse

reactions reported

hepatitis a vaccine contraindications and precautions
Hepatitis A VaccineContraindications and Precautions
  • Severe allergic reaction to a vaccine component or following a prior dose
  • Moderate or severe acute illness
cdc vaccines and immunization contact information
CDC Vaccines and ImmunizationContact Information
  • Telephone 800.CDC.INFO
  • Email nipinfo@cdc.gov
  • Website www.cdc.gov/vaccines