If I Cant Find My Hepatitis a Immunization Do I Have to Take the Shot Again

Hepatitis A

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

Disease Issues

What is hepatitis A?

Hepatitis A is a liver illness mutual in many parts of the earth and caused by hepatitis A virus (HAV), a picornavirus that causes astute inflammation of the liver. It is not related to the common viruses that crusade hepatitis B or C.

What are the signs and symptoms of hepatitis A?

Illness caused by HAV infection cannot be distinguished from other types of acute viral hepatitis, simply it typically has an abrupt onset that 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, lxx% of infections are asymptomatic. When disease does occur in immature children, it is typically not accompanied by jaundice. In older children and adults, infection typically is symptomatic, with jaundice occurring in more than 70% of patients.

Hepatitis A signs and symptoms normally resolve in 2-iii months, although 10% to 15% of symptomatic people have prolonged illness (commonly referred to as relapsing hepatitis A) lasting up to 6 months and should be considered infectious during that time.

How is HAV transmitted?

Person-to-person spread through the fecal-oral route is the main means of HAV manual. Peak infectivity in infected people occurs during the two week period before the onset of jaundice when the concentration of virus in the stool is highest and most people are no longer infectious one calendar week later jaundice onset. Before routine vaccination of children was recommended, children were a key source of infection because most infected children had no symptoms and could shed virus in stool for weeks or months. Transmission currently occurs primarily among susceptible adults.

Common-source outbreaks and desultory 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 also tin transmit HAV if the temperature during food preparation is inadequate to kill the virus or if food is contaminated after cooking, as occurs in outbreaks associated with infected nutrient handlers. Manual of the virus from infected nutrient handlers to nutrient service institution patrons is rare, bookkeeping for 0.ii% of the about 23,000 outbreak-associated cases of hepatitis A investigated by state health departments during 2016-2019.

Until 2017, Usa incidence rates of hepatitis A were driven by occasional outbreaks, oft linked to viral contamination of imported food. Since 2017, communitywide outbreaks have occurred more oftentimes, predominantly amongst people who are connected by specific risk factors, such as drug use, and their close contacts.

What is the incubation period 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. Peak infectivity occurs during the 2-week menstruation before onset of jaundice or elevation of liver enzymes, when concentration of virus in stool is highest. Concentration of virus in stool declines after jaundice appears, with most people no longer infectious about a week subsequently jaundice appears. Children can shed HAV for longer periods than adults, upwardly to 10 weeks or longer after onset of clinical illness.

How common is HAV infection in the United 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 near 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, large foodborne outbreaks led to an increment 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 and then, persistent person-to-person outbreaks have led to substantial increases in hepatitis A infection, with reported cases increasing by over fifty% from 2018 to 2019. More information regarding ongoing multistate outbreaks can exist found hither: www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm.

Do people die from hepatitis A?

Yes. Decease as a result of fulminant hepatic failure is rare, all the same, older age (over xl years) and preexisting chronic liver disease increases the risk of astringent affliction and decease from hepatitis A. The person-to-person U.Due south. multistate outbreaks that began in 2016 accept disproportionately affected adults with chronic liver disease and other health problems related to drug use and unstable housing. From 2016 through November 2021, CDC received reports of nigh 43,000 cases of acute HAV infection. Of these, approximately 61% have been hospitalized and one% (more than 400 people) take died.

Who is most at risk for acquiring HAV infection?

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

• Travelers to countries that have high or intermediate endemicity of HAV infection • Men who have sex activity with men (MSM) • Users of injection and not-injection drugs (in other words, all who utilise illegal drugs) • People with occupational take a chance of exposure (those who piece of work with HAV-infected not-homo primates or researchers handling hepatitis A virus) • People who anticipate shut contact with an international adoptee coming from a country 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 difficult to maintain • People who are incarcerated

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

People with clotting gene 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 take a chance of HAV infection. Mod blood donor screening and virus reduction steps have drastically reduced that gamble. In addition, more than than fourscore% of people with clotting factor disorders now receive recombinant clotting gene concentrates that are sterilized and have no adventure of HAV transmission. As a result of these factors, people with clotting cistron disorders now take 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 result of poor paw hygiene, close living conditions and diaper use. As fewer children have been institutionalized and equally weather 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 upwardly vaccination of all children through historic period eighteen years.

As a strategy to further reduce the risk of hepatitis A outbreaks and achieve adults in settings with a high proportion of people with risk factors for HAV infection, the current ACIP recommendations suggest considering HepA vaccination of residents and staff in facilities where hygiene is difficult to maintain, such every bit grouping homes for people with developmental disabilities and homeless shelters.

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

No. People with chronic liver disease are non at increased risk for acquiring HAV infection. However, they are at an increased gamble for life-threatening, fulminant (severe and sudden) hepatitis if they become infected with hepatitis A. People considered to have chronic liver affliction include those with hepatitis B or C infection, cirrhosis, fatty liver disease, alcoholic liver disease, and autoimmune hepatitis.

Please talk over the tests normally used to diagnose hepatitis A.

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

• Anti-HAV: Total 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 bracket of anti-HAV. It appears early in the grade of infection, remains detectable for the person's lifetime and provides lifelong protection against disease. 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 recent infection with HAV (six months or less). It is used to diagnose acute (recently acquired) hepatitis A. Because of the risk of fake positive IgM anti-HAV results, people should merely be tested for IgM anti-HAV if they are symptomatic and suspected of having astute hepatitis A illness. • HAV RNA tests also may exist used to diagnose acute infection through the straight 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/disease. To confirm a diagnosis of acute HAV infection, serologic testing for IgM anti-HAV is required. In the bulk of persons, serum IgM anti-HAV becomes detectable v to 10 days before onset of symptoms and lasts about half dozen months. However, there have been reports of persons who test 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 www.cdc.gov/hepatitis/resources/professionals/preparation/serology/training.htm.

Tin HAV be transmitted by blood?

Yeah. 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.east., when HAV is in the donor's blood). Since 2002, tests to detect the presence of hepatitis A virus RNA in donated plasma have drastically reduced the risk of hepatitis A manual 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 catamenia; nevertheless, transmission by human saliva has not been reported.

How common is HAV transmission in hospital settings?

Hospital-acquired HAV infection is rare. In the past, outbreaks were observed in neonatal intensive intendance 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 manual from adult patients to healthcare personnel (HCP) are typically associated with fecal incontinence and inadequate hand hygiene, although the majority of hospitalized patients who take hepatitis A are admitted after onset of jaundice, when they are beyond the point of height infectivity. Transmission in healthcare settings as well has resulted from breakdowns in standard infection command practices and transmission from one healthcare provider to another.

How stable is HAV in the surroundings?

Depending on conditions, HAV can be stable in the surroundings for months; freezing does not inactivate (i.e., render not-infectious) HAV. HAV is inactivated past heating foods to temperatures greater than 185°F (85°C) for 1 minute. In add-on, HAV on surfaces is inactivated past disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (i.e., household bleach) in tap h2o.

Adequately chlorinating water through h2o handling processes and dilution in public water systems kills HAV. Spas and pond pools that are fairly treated are not likely to pose a take chances for HAV outbreaks.

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

No, at that place is no chronic (long-term) infection. Even the small proportion of people who develop relapsing HAV recover after nearly six months. Once yous have had HAV infection and recovered, yous cannot get it again.

Vaccination Recommendations Back to top

What is the best way to prevent HAV infection?

Vaccination with the full series of hepatitis A vaccine (HepA) is the best way to prevent HAV infection. Immune globulin (IG) also tin be used for brusk-term protection in certain situations.

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

Recommended dosages and schedules of hepatitis A vaccines Vaccine Historic period grouping Dose Volume # Doses Schedule Havrix (GSK) 1-18 years 720 El.U.* 0.v ml two 0, 6-12 mos. xix years and older 1440 El.U.* 1.0 ml 2 0, half dozen-12 mos. Vaqta (Merck & Co.) ane-18 years 25 U** 0.v ml 2 0, half-dozen-18 mos. 19 years and older l U** ane.0 ml 2 0, 6-xviii mos.

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

Combination vaccine using hepatitis A and hepatitis B vaccines Vaccine Historic period group Antigens used Volume # Doses Schedule Twinrix (GSK) eighteen years and older Havrix (720 El.U.) combined with Engerix-B (twenty mcg) ane.0 ml 3 0, i, 6 mos. 4 0, 7, 21-30 days, 12 months***

*** Accelerated schedule may exist used for rapid protection prior to travel or for rapid protection of an unexposed but at-risk person who also would benefit from hepatitis B protection. Twinrix is not recommended for use as 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 notice information most vaccine shortages?

For detailed information about HepA shortages, become to CDC'due south website at www.cdc.gov/vaccines/hcp/clinical-resources/shortages.html.

Who is recommended to receive HepA vaccine?

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

• All children at historic period one year (12–23 months) • All children and adolescents age 2 through 18 years who take not previously received HepA should exist vaccinated (i.e., routine take hold of-up vaccination) [2020] • People living with HIV infection [2020] • Travelers age 12 months and older to areas of the world with intermediate or high HAV endemicity. Low endemicity regions include the U.s., Canada, Western Europe, Nihon, New Zealand, and Australia. For more than information, see the CDC travel health website for current data most specific countries at www.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 11 months traveling outside the The states should receive 1 dose when protection against HAV infection is recommended. The travel dose does not count toward the routine HepA serial which should exist initiated at age ane year with the advisable dose and schedule. In these instances, the child volition receive a total of 3 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 60 days following the adoptee's arrival in the U.Due south. • People who work with HAV-infected nonhuman primates or with HAV in a research laboratory setting • People with chronic liver disease (including but non express to people with hepatitis B infection, hepatitis C infection, cirrhosis, fatty 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 risk for HAV infection due to presence of a specific run a risk factor for exposure or at risk for severe outcome from HAV infection (for instance, those with chronic liver disease or with HIV infection). • During an outbreak, any unvaccinated person who is identified as at risk for HAV infection or at risk for severe disease from HAV • Whatsoever person who wishes to be immune to hepatitis A

HepA vaccination is not routinely recommended for healthcare personnel, food handlers, sewage workers, or day care providers because there is no testify 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 almost CDC recommendations for the prevention of hepatitis A, meet the 2020 recommendations of the Informational Commission on Immunization Practices (ACIP): www.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 ii through 18 years not previously vaccinated • [added] All people age 1 year or older living with HIV infection • [added] People identified to be at risk 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 constructive and is recommended for any person who wishes to obtain amnesty.

Which children should exist routinely vaccinated against HAV infection?

All children should receive 2 doses of HepA vaccine beginning at age ane twelvemonth (i.due east., 12–23 months). The 2 doses in the series should exist administered at least half dozen months autonomously. Any kid age 2 through eighteen years not previously vaccinated should exist vaccinated. For a copy of the ACIP recommendations on hepatitis A, go 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 series is at to the lowest degree 6 months. Is this the same as 24 weeks?

No. The minimum interval betwixt dose #i 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 later on the beginning dose. Does it need to be repeated, and if so, when?

Yep. The second dose was given more 4 days earlier the minimum interval of 6 calendar months, so it is considered invalid and should exist repeated. The repeat dose should be administered the proper minimum interval (6 months) later the invalid dose. If this repeat dose is inadvertently given less than half dozen months afterward the invalid dose, information technology does non need to be repeated again as long every bit the interval between the initial HepA vaccine and the nigh contempo dose is at least 6 calendar 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 see the complete PEP recommendations at world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, with special attention to Table 4 on page 19 and Appendix B: Provider Guidance on Risk Assessment for Hepatitis A Postexposure Prophylaxis, outset on page 36.

Good for you people who take completed the HepA vaccination series at whatever time practise not demand additional PEP if they are exposed to HAV. People who have recently been exposed to HAV and who have not received HepA vaccine previously should receive PEP equally soon every bit possible, within ii weeks of exposure.

People age 12 months and older exposed to HAV within the past xiv days and who have non previously completed the HepA vaccine series should receive a single dose of HepA vaccine as soon as possible. In add-on to vaccine, immune globulin (IG; 0.1 mL/kg) may exist administered to people older than age 40 years depending on the providers' risk cess. For long-term immunity, the HepA vaccine series should be completed with a second dose at to the lowest degree half dozen months after the first dose. Yet, the second dose is not necessary for PEP. A second dose should not exist administered sooner than six calendar months after the first dose, regardless of HAV exposure risk.

People age 12 months or older who are immunocompromised or have chronic liver affliction, and who have been exposed to HAV within the by 14 days and have non previously completed the HepA vaccination series, should receive both IG (0.1 mL/kg) and HepA vaccine at the same visit in a unlike anatomic site (for case, separate limbs) as soon as possible later exposure. For long-term amnesty, the HepA vaccination series should be completed with a second dose at least six months afterwards the showtime dose. However, the second dose is not necessary for PEP. A second dose should not exist administered sooner than 6 agenda months afterwards the first dose, regardless of HAV exposure run a risk.

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

Twinrix contains half the amount of hepatitis A antigen as a standard unmarried-dose adult HepA vaccine. Twinrix should not be used for PEP but may exist used to confer protection to at-chance but not 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 as soon as possible and within 2 weeks of exposure. MMR and varicella vaccines should non be administered sooner than 6 months after IG administration in society to avert 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 full anti-HAV or IgG anti-HAV) is not indicated for children because of the low prevalence of infection in children. It also is not routinely recommended for adults but may be considered in some settings to reduce costs associated with vaccinating people who are already allowed. Prevaccination testing should not be used if it poses a barrier to vaccinating susceptible people, especially people who are hard to access.

Prevaccination testing is most likely to be cost-effective for adults who were either born in or lived for long periods of time in areas of the earth with high or intermediate hepatitis A endemicity. When evaluating people from populations with high rates of previous HAV infection, vaccination history also should be obtained, if feasible. If testing or vaccination history is not available, do not postpone vaccinating. There 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 antibody 1 month or more after completing the HepA vaccination series is recommended only for people whose future clinical management depends on knowing their immune condition and for whom revaccination might be indicated, such as 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 adequate immune response (10 mIU/mL or higher), revaccination with a complete series is recommended, followed past a 2nd postvaccination serologic examination. If that second test remains negative, no additional vaccination is recommended; even so, the patient should be counseled on strategies to avert exposure to HAV and the need for IG if an exposure occurs. If vaccination results in seroconversion, bereft information are bachelor to brand recommendations concerning echo testing, booster doses or revaccination.

For Special Groups Back to top

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

ACIP recommends vaccination confronting HAV infection for all previously unvaccinated people who conceptualize having shut personal contact with an international adoptee from a country of high or intermediate endemicity during the first 60 days following the adoptee'southward arrival in the U.South. In addition to the adoptee's new parents and siblings, this group might include grandparents, other household members, regular babysitters and other caregivers. The first dose of HepA should be given to shut contacts as presently as adoption is planned, ideally at least 2 weeks before the arrival of the adoptee. A 2d dose should be given no sooner than six months after the offset dose.

ACIP at present recommends routine hepatitis A vaccination for people experiencing homelessness. Can you provide a definition of "experiencing homelessness"?

The 2020 ACIP recommendations for the prevention of hepatitis A define a person experiencing homelessness every bit i) a person who lacks housing (regardless of whether the person is a member of a family), including a person whose principal residence during the night is a supervised public or private facility (e.g., 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, unmarried-room occupancy facility, abandoned building, vehicle, or any other unstable or nonpermanent situation, or 3) who is "doubled up", a term that refers to a situation where persons are unable to maintain their housing situation and are forced to stay with a serial of friends or extended family members. In addition, previously homeless persons who are to be released from a prison or a hospital might be considered homeless if they practice not have a stable housing situation to which they can return. The instability of a person'due south living arrangements is disquisitional 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 non be able to complete the series or keep upwardly with their records over time. How much of a business 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 x years and can forbid or control outbreaks of hepatitis A. People who are experiencing homelessness may have difficulty protecting themselves from exposure to HAV in other ways because of their living conditions. They should be vaccinated when possible and provided a record of immunization. Reporting the HepA vaccination to a state immunization data system also can facilitate immunization cess at hereafter healthcare encounters.

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

No. A number of studies accept shown that HCP are non at significantly increased risk of HAV infection because of their occupation. Notwithstanding, if HCPs are going to work (or vacation) in a land with a loftier or intermediate endemic rate of HAV infection, they are at gamble of HAV infection and should be 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 exist routinely vaccinated confronting hepatitis A?

No. In the past, outbreaks of hepatitis A occurred amid children in kid care centers, infecting employees of those centers, peculiarly those caring for infants and toddlers. Post-obit widespread adoption of early babyhood vaccination against hepatitis A, outbreaks in kid care centers are at present 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 risk 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 iii serologic surveys conducted amid United States wastewater workers and appropriate comparing populations, no substantial or consistent increase in the prevalence of anti-HAV was identified among wastewater workers. No work-related instances of HAV transmission accept been reported amidst wastewater workers in the United States. In addition, in the United States, outbreaks of hepatitis A caused by flooding, which tin carry raw sewage, have not been reported.

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

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

Why is hepatitis A vaccination recommended (and IG not recommended) for infant travelers age vi through 11 months at risk of exposure to HAV?

Considering 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 11 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 immune globulin (IG) typically used to preclude HAV infection in infants before the kickoff birthday can interfere with the effectiveness of MMR vaccine. An infant who is given IG should not be vaccinated with MMR or varicella vaccines for at to the lowest degree six months later on IG assistants. If an babe age 6 through 11 months is traveling to a destination where protection from infection with HAV is desired, ACIP recommends off-label employ of HepA vaccine (non IG) in addition to MMR. The HepA and MMR doses administered before the start birthday do not count toward the routine vaccination series of either vaccine: these infant travelers will still demand two doses of HepA and 2 doses of MMR when age appropriate.

Can pregnant women receive hepatitis A vaccine?

Yes. The ACIP recommends that meaning women at hazard for HAV infection during pregnancy or at risk for a severe outcome from HAV infection should be vaccinated during pregnancy if not previously vaccinated. Pregnant women should be vaccinated for the aforementioned indications as not-pregnant women. For boosted information, encounter page 20 of the recommendations: world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Administering Vaccines Back to top

By what method should hepatitis A vaccine exist administered?

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

Tin can HepA vaccine be given concurrently with other vaccines?

Aye. Other inactivated and/or live virus vaccines tin can be administered at the aforementioned time as HepA vaccine, just should be given at a different anatomical site, if possible. If given in the aforementioned muscle, separate the injections by a minimum distance of 1 inch.

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

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

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

You practice non need to starting time the series over over again. The immunogenicity of 1 dose of HepA vaccine is 94% to 100%; studies have shown persistent protection from a unmarried dose lasting more than than 10 years. To ensure optimal long-term protection it is important to administrate the second dose.

To consummate a 21-year-old patient's HepA vaccine serial, how many adult doses should I give if the patient received a single dose of pediatric HepA vaccine five years ago?

A person should receive the dosage of HepA vaccine appropriate for their age at the fourth dimension of administration. You should requite the patient one adult dose of HepA to complete the 2-dose series. Information technology is not necessary to restart the vaccine series.

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

In full general, if the error is discovered on the aforementioned clinic mean solar day, you can administer the other "half" of the dose on that aforementioned day. If the fault is discovered later, the dose should not be counted, then the person should exist recalled to the office and given a total age-advisable repeat dose.

If yous requite more an age-appropriate dose (for example, an adult dose of HepA vaccine given to a kid), count the dose as valid and notify the patient/parent most the error. There may exist an increased take a chance of a local agin reaction when more than the recommended dose is given. If the error occurred with the first dose of the series the kid should withal receive the second dose on schedule. Giving a "double" dose for the first dose does not negate the need for a second dose.

Avert such errors by checking the vaccine vial label iii times.

Why does a 15 year erstwhile who weighs 160 pounds receive a pediatric dose of HepA while his 110-pound mother 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 reverberate this historic period-based efficacy data. The same holds true for HepB vaccine. In improver, college response rates are expected in younger people, even if their weights are above the norm.

Could you please provide more data almost Twinrix (the combination hepatitis A and B vaccine) and the 2 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 total Engerix-B developed dose).

In the U.Due south., Twinrix is licensed for use in people who are age 18 years or older. It tin can exist administered to people who are at risk for both hepatitis A and hepatitis B, such as certain international travelers, people with HIV infection, people with chronic liver disease non caused past hepatitis B, men who have sex with men, illegal drug users, or to people who simply desire to be allowed to both diseases. Primary immunization consists of 3 doses given intramuscularly on a 0, ane, and 6 month schedule. In 2007, the FDA besides approved a 4-dose schedule for Twinrix. It consists of 3 doses given within iv weeks, followed past a booster dose at 12 months (0, 7 days, 21–30 days, and 12 months). The 4-dose schedule could do good individuals needing rapid protection from hepatitis A and hepatitis B, such equally people traveling to high-prevalence areas imminently.

Twinrix cannot be used for postexposure prophylaxis.

I have seen adults who accept had one or 2 doses of Twinrix, but we only acquit single-antigen vaccine in our practice. How should we complete their vaccination serial with unmarried-antigen vaccines?

Twinrix is licensed as a iii-dose series for people age 18 years and older. If Twinrix is non available or if you lot cull not to utilise Twinrix to complete the Twinrix serial, you should do the following: If 1 dose of Twinrix was given, complete the series with 2 adult doses of hepatitis B vaccine and 2 adult doses of hepatitis A vaccine. If 2 doses of Twinrix were given, complete the schedule with ane adult dose of hepatitis A vaccine and i adult dose of hepatitis B vaccine.

Some other mode 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 can be substituted for any dose of the hepatitis B series but not for any dose of the hepatitis A serial.

• Any combination of 3 doses of adult hepatitis B or 3 doses of Twinrix is a complete series of hepatitis B vaccine. • 1 dose of Twinrix + ii doses of developed hepatitis A is a consummate series of hepatitis A vaccine. • Two doses of Twinrix + i dose of developed hepatitis A is a complete serial of hepatitis A vaccine.

Nosotros're thinking of using Twinrix and we're wondering whether nosotros can utilise information technology for doses #i and #iii simply and apply single antigen hepatitis B vaccine for dose #2?

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

Immune Globulin Back to top

What is immune globulin (IG)?

Immune globulin (IG, GamaSTAN, Grifols Therapeutics) is a sterile grooming of full-bodied antibodies (i.e., immunoglobulins) made from pooled human plasma processed by cold ethanol fractionation. GamaSTAN is the simply IG product licensed in the United States for the prevention of hepatitis A. Only plasma that has tested negative for hepatitis B surface antigen, antibiotic to human 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 final products examination negative for HCV-RNA by polymerase chain reaction. Anti-HAV concentrations differ among IG lots and decreasing concentrations take been observed over the past 30 years, probably considering 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 change in anti-HAV potency.

How does immune globulin (IG) piece of work?

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

When administered for preexposure prophylaxis, a dose of 0.one mL/kg will provide protection for up to 1 month and a dose of 0.2 mL/kg will provide protection for up to 2 months. If longer term protection is required and vaccination is contraindicated, a dose of 0.2 mL/kg can be repeated every two months. At that place is no maximum number of times the bimonthly doses of IG may be repeated equally long every bit hepatitis A prophylaxis is required.

For postexposure prophylaxis, the recommended dosage is 0.ane mL/kg.

How is IG packaged and how is IG administered?

Intramuscular IG is available in unmarried-use vials (ii mL and 10 mL). Information technology should exist administered intramuscularly, preferably in the anterolateral aspects of the upper thigh and the deltoid muscle of the upper arm. Exercise not use the gluteal region every bit an injection site because of the risk of injury to the sciatic nerve.

Does IG cause 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 not be administered to these people. IG products including GamaSTAN have been associated with the germination of blood clots (thrombosis) later on administration, particularly if the patient has other risk factors for thrombosis. Patients should be counseled nearly this risk.

Tin pregnant or lactating women receive IG?

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

A child in my do was given hepatitis A IG (GamaSTAN, Grifols) when she was ten months onetime afterwards her female parent tested positive for hepatitis A. She'southward scheduled for her 12-month-sometime well-child visit. Will this affect her vaccination schedule?

Yep. IG may be given any time earlier or after inactivated vaccines. However, the antibodies in IG may interfere with the effectiveness of sure live-virus vaccines, such as measles, mumps, and rubella (MMR) and varicella vaccines. CDC recommends waiting at least half-dozen months from the date of IG administration before administering MMR and varicella vaccines.

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

Delight see details of the recommendations for the use of IG for the prevention of hepatitis A provided in Tabular array iv (page nineteen) and Appendices A and B of the 2020 ACIP recommendations for the prevention of hepatitis A infection: world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Beneath is a brief summary of the recommendations:

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

• Infants younger than age half-dozen months and other travelers for whom HepA vaccine is declined or contraindicated • Previously unvaccinated people with chronic liver affliction vaccinated within two weeks of difference may consider IG in addition to vaccination, based upon the clinician's risk assessment • Previously unvaccinated people who are immunocompromised may consider IG in add-on to vaccination, regardless of the timing of vaccination, based upon the clinician's chance assessment • Previously unvaccinated people who are over age forty years and vaccinated within 2 weeks of departure may consider IG in addition to vaccination, based upon the clinician'due south risk cess

Postexposure prophylaxis with IG within 2 weeks after exposure to hepatitis A virus (HAV):

• Infants nether age 12 months • Previously unvaccinated immunocompromised adults (including HIV+), in add-on to vaccination • Previously unvaccinated adults with chronic liver affliction, in addition to vaccination • Previously unvaccinated adults over age 40 years, consider IG in improver to vaccination, based upon clinician risk cess • People with HIV infection, previously vaccinated, consider IG following a high-risk exposure (household or sexual contact), based upon clinician risk assessment

Travel - International Back to meridian

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 world at intermediate or high risk of hepatitis A transmission. Areas of low hazard include the The states, Canada, Nihon, New Zealand, Commonwealth of australia and Western Europe. Visit the CDC's Traveler Health website for more information about specific destinations and electric current outbreaks or travel notices (https://wwwnc.cdc.gov/travel/). When in dubiety, 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 historic period 12 months and older, refer to Appendix A on page 35 of the electric current ACIP recommendations for the prevention of hepatitis A: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Salubrious people age 12 months through 40 years who are planning travel to an expanse with high or intermediate HAV endemicity and have non received HepA vaccine should receive a single dose of HepA vaccine equally presently as travel is considered and should complete the two-does serial co-ordinate to the routine schedule.

People with chronic liver illness likewise as adults older than 40 years of age, immunocompromised persons, and persons with other chronic medical conditions planning to depart to an area with loftier or intermediate HAV endemicity in less than 2 weeks should receive the initial dose of HepA vaccine and may also simultaneously be administered IG at a dissever anatomic injection site (for example in separate limbs).

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

Infants younger than 6 months and travelers who elect not to receive vaccine or for whom vaccine is contraindicated should receive a unmarried 0.one mL/kg dose of IG earlier 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.ii mL/kg dose can be repeated every ii months for travel of more than 2 months duration.

Can Twinrix be used for people planning international travel?

Aye. If time allows, use the standard Twinrix schedule of 3 doses given intramuscularly on a 0, 1, and 6 month schedule. If travel is imminent the accelerated 4-dose Twinrix schedule tin be used, which is 3 doses given on days 0, vii, and 21-30 days and a booster dose at 12 months.

We have an developed patient who received the correct pediatric series of HepA vaccine as a teenager and is at present 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 it actually necessary to vaccinate travelers to Latin America who will be staying in iv-star hotels?

Yes. Information take shown that people acquire HAV infection fifty-fifty in such places as 4-star hotels located in Latin America.

If a traveler received the commencement dose of HepA vaccine more than one year ago and needs to travel abroad imminently, will the traveler need IG in addition to dose #2 prior to leaving?

No. But requite the final dose of HepA vaccine prior to travel.

If an infant younger than age 6 months receives IG earlier travel to a hepatitis A endemic area, will he/she need HepA vaccine before some other trip to a hepatitis A owned area?

Perchance. Since IG protects confronting HAV infection for but 1 to 2 months, depending on the dosage given, additional IG may be needed if the infant is not however age 6 months. Once the child has reached half-dozen months of age, HepA vaccine should exist given.

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

Yeah. ACIP recommends that all children age ane year through 18 years should be vaccinated against hepatitis A. VFC HepA vaccine may be administered to any eligible child, including those recommended for vaccination at 6 through xi months of age every bit a result of travel to an HAV-endemic area.

If a person was born and grew upwardly in a country where HAV infection is endemic (e.thousand., Vietnam, United mexican states) and and so moved to the Usa at age 20, 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 document prior HAV infection, serologic testing for immunity (positive test for full anti-HAV) is the merely way to determine if vaccination is necessary. For people from countries with high rates of HAV infection, such as Vietnam and Mexico, serologic testing might be done to foreclose unnecessary vaccination. The price effectiveness of serologic testing, however, should be balanced against the possibility of delaying needed vaccination while awaiting test results.

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

No, equally long as there are medical records that document that the person was previously infected with HAV (i.eastward., positive examination for total anti-HAV). If there is any doubt that the person actually was infected with HAV, HepA vaccine and/or IG should exist given. The vaccine or IG will not damage a person who is already immune.

Vaccine Condom Back to top

What reactions might occur subsequently assistants of HepA vaccine?

No serious agin events have been attributed definitively to HepA vaccine. Among adults, the most frequently reported side effects are soreness at the site of the injection and headache. In children, the well-nigh frequently reported side effect is soreness at the injection site. The frequency of side furnishings after administration of Twinrix is similar to those reported when the two single-antigen vaccines were administered.

Contraindications and Precautions Back to meridian

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. As with all other vaccines, there is a precaution when giving it to anyone who is moderately or severely sick.

Can pregnant women receive HepA vaccine?

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

Tin lactating women receive HepA vaccine?

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

Tin can HepA vaccine be given to immunocompromised people?

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

If any immunocompromised person has a run a risk factor that places them at increased risk of hepatitis A (due east.g., international travel, drug use), they should be vaccinated with HepA vaccine.

I have a patient on interferon for hepatitis C, but I want to give him HepA vaccine. Is it okay to vaccinate him confronting hepatitis A while he is on interferon?

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

Vaccine Storage and Handling

How should HepA vaccine be stored?

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

Back to acme

santiagoupostaing.blogspot.com

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

Share this post