Vaccinations for Hepatitis A and B Discussion

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)

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