Candidates for Hepatitis A Vaccination

Routine Vaccination

• Children living in areas with high incidence rates of hepatitis A (above the national average). Check with your health department to see if this applies to your area.

High-Risk Populations

• Travelers to developing countries with high rates of hepatitis A, including Mexico
• Men who have sex with men
• Users of illegal drugs
• People who work with hepatitis A virus in research settings
• People who work with infected nonhuman primates
• Recipients of clotting factor concentrates
• People with chronic liver disease (because of risk of fulminant hepatitis A)

source: http://digestive.niddk.nih.gov/ddiseases/pubs/vaccinationshepab/index.htm

Doses and Schedules: Hepatitis A

HAVRIX*
Age	# of Doses	Schedule	Dose
Children age 2 to 18 years	2	0 and 6 to 12 months	720 ELISA units (0.5 mL)
Adults 18 years and older	2	0 and 6 to 12 months	1440 ELISA units (1.0 mL)

* Inactivated vaccine. Manufactured by SmithKline Beecham Biologicals.

VAQTA**
Age	# of Doses	Schedule	Dose
Children age 2 to 17 years	2	0 and 6 to 18 months	25 units (0.5 mL)
Adults 17 years and older	2	0 and 6 months	50 units (1.0 mL)

** Inactivated vaccine. Manufactured by Merck & Company, Inc.

Postexposure Prophylaxis

Immune globulin (IG) can provide temporary immunity to hepatitis A when given within 2 weeks of exposure to the hepatitis A virus. The dose is 0.02 mL/kg injected into the gluteal muscle in adults or the anterolateral thigh muscle in children under 2 years. Concurrent hepatitis A vaccination may also be appropriate in people 2 years and older. IG protects against the hepatitis A virus for 3 to 5 months, depending on dosage.

source: http://digestive.niddk.nih.gov/ddiseases/pubs/vaccinationshepab/index.htm

Candidates for Hepatitis B Vaccination

Routine Vaccination

• All infants, children, and adolescents

High-Risk Populations

• People with multiple sex partners and those who have been recently diagnosed with a sexually transmitted disease
• Sex partners and household contacts of HBV carriers
• Men who have sex with men
• Household contacts of adoptees from countries with high rates of hepatitis B
• Injection drug users
• Travelers to countries with high rates of hepatitis B (staying longer than 6 months)
• People with occupational exposure to blood
• Clients and staff in institutions for the developmentally disabled
• Patients with chronic kidney failure (including those on chronic hemodialysis)
• Patients receiving clotting factor concentrates
• Inmates of long-term correctional facilities

source: http://digestive.niddk.nih.gov/ddiseases/pubs/vaccinationshepab/index.htm

Doses and Schedules: Hepatitis B

Age	# of Doses	Schedule	Dose Recombivax HB*	Dose Energix-B**
Infants with HBsAg-negative mother	3	0 to 2, 1 to 4, and 6 to 18 months	5.0 µg (0.5 mL)	10 µg (0.5 mL)
Infants with HBsAg-positive mother	3	Hepatitis B immune globulin and vaccination within 12 hours of birth, then vaccine at 1 to 2 and 6 months	5.0 µg (0.5 mL)	10 µg (0.5 mL)
Children and adolescents age 1 to 19 years	3	0, 1 to 2, and 4 to 6 months	5.0 µg (0.5 mL)	10 µg (0.5 mL)
Adolescents 11 to 15 years	2	0 and 4 to 6 months	10 µg (1.0 mL)	N/A
Adults 20 years and older	3	0, 1 to 2, and 4 to 6 months	10 µg (1.0 mL)	20 µg (1.0 mL)
Immuno-compromised adults	3	0, 1, and 6 months	40 µg (1.0 mL)	N/A
	4	0, 1, 2, and 6 months	N/A	40 µg (2.0 mL)

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Note: There should be at least 1 month between the first and second doses, at least 2 months between the second and third doses, and at least 4 months between the first and third doses. For infants, the third dose should not be given before 6 months of age.

*Recombinant vaccine. Manufactured by Merck & Company, Inc.
**Recombinant vaccine. Manufactured by SmithKline Beecham Biologicals.

Postexposure Prophylaxis

Prophylactic treatment for exposure to hepatitis B virus involves either hepatitis B immune globulin (HBIG), hepatitis B vaccine, or a combination of both. The HBIG dose equals 0.06 mL/kg. Efficacy ranges from 70 to 95 percent for different types of exposure.

Exposure	Treatment
Perinatal	1 dose of HBIG given with the first hepatitis B vaccine dose.
Percutaneous or permucosal	HBIG and vaccination depending on vaccination and exposure status.
Sexual	HBIG with or without vaccination for exposure to acute hepatitis B; vaccination alone for chronic exposure.
Household contact	HBIG with vaccination for acute hepatitis B in infants under age 12 months; vaccination alone for chronic.

source: http://digestive.niddk.nih.gov/ddiseases/pubs/vaccinationshepab/index.htm

Combination Vaccine

Twinrix* is a vaccine for both hepatitis A and hepatitis B. It combines two FDA-approved vaccines--Havrix, for hepatitis A, and Engerix-B, for hepatitis B. It protects individuals 18 years of age or older against diseases caused by hepatitis A and hepatitis B viruses. The vaccine is recommended for travelers whose occupation or behavior puts them at high risk for exposure to hepatitis B virus, or who are visiting countries with a high or intermediate rate of both hepatitis viruses, as defined by the Centers for Disease Control and Prevention.

Twinrix*
Age	# of Doses	Schedule	Dose
Adults 18 years and older	3	0, 1, and 6 to 12 months	720 ELISA units (Hepatitis A), 20 µg (Hepatitis B) (1.0 mL total)

*Manufactured by SmithKline Beecham Pharmaceuticals.

source: http://digestive.niddk.nih.gov/ddiseases/pubs/vaccinationshepab/index.htm