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hepatitis A vaccine (Harvix, VAQTA)

Indications: - active immunization of persons >= 2 years of age against hepatitis A a) persons (including military) traveling to or working in countries where hepatitis A is endemic (South Asia, Africa, South American, Central America, including Mexico) [2] 1] >= 1 month prior to departure to endemic area [2]* 2] NOT needed for travel to Canada, western Europe, Australia, New Zealand, Japan [4] b) sexually active homosexual & bisexual men c) illicit drug users d) persons with chronic liver disease e) patients with clotting factor disorders [2] - those that receive clotting factor concentrates f) persons with occupational risk - laboratory workers who handle hepatitis A virus g) routine vaccination of children prevents outbreaks [3] & may confer herd immunity on the population [5] h) all toddlers age 12-23 months [7] i) homeless j) incarceration [10] k) HIV1 infection l) exposure to hepatitis A (within 2 weeks) [2] Limitations: 1) may not prevent hepatitis A infection in patients who have unrecognized hepatitis A infection at the time of vaccination 2) may not prevent infection in patients who do not achieve protective antibody titers 3) the lowest protective titer has not been established * should be given with immune globulin to persons travelling within 2 weeks [2]; immune globulin alone no longer recommended [2] * hepatitis A immune globulin* not necessary before travel to endemic area or post-exposure in healthy person < 40 years [2,11] - administer single dose of hepatitis A vaccine with booster as scheduled Contraindications: - hypersensitivity to any component of the vaccine Caution: 1) do not inject in gluteal region, response may be suboptimal 2) shake vial or syringe well before use pregnancy-category C safety in lactation ? Dosage: Primary immunization:* - Harvix: - Children 2-18 years: 720 ELU (0.5 mL) IM in deltoid - Adults > 18 years: 1440 ELU (1 mL) IM in deltoid - VAQTA: - Children 2-17 years: 25 units (0.5 mL) - Adults >= 18 years: 50 units (1 mL) * 90% effective within 2-4 weeks Booster: - recommended at any time between 6-12 months after primary immunization Injection: - Harvix: - 720 ELU/0.5 mL (0.5 mL vial) - 1440 ELU/mL (1 mL vial, 1 mL syringe) - VAQTA: - 25 units/0.5 mL (0.5 mL vial, 0.5 mL syringe) - 50 units/1 mL (1 mL vial, 1 mL syringe) - combined hepatitis A & B vaccine: 0, 7 & 21-30 days - booster required at 12 months to ensure long-term protection [2] Pharmacokinetics: - protective antibodies develop in ~100% of health patients within 2-4 weeks [2] - elimination: liver Adverse effects: - most common (1-10%) - headache, fatigue, fever (rare), transient abnormal LFTs, inflammation at injection site - thrombocytopenic purpura in children age 7-17 years of age [8] Note: 1) may be administered concomitantly with immune globulin, although titer is likely to be lower than if vaccine is given alone 2) may be administered concomitantly with hepatitis B vaccine Twinrix is combined hepatitis A/ hepatitis B vaccine

Related

hepatitis A infection hepatitis A virus (HAV)

General

vaccine

References

  1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Journal Watch 22(3):25, 2002 Averhoff et al JAMA 286:2968, 2001
  4. Prescriber's Letter 9(7):40 2002
  5. Wasley A, Samandari T, Bell BP. Incidence of hepatitis A in the United States in the era of vaccination. JAMA. 2005 Jul 13;294(2):194-201. PMID: 16014593
  6. Prescriber's Letter 13(2): 2006 Detail-Document#: 220203 (subscription needed) http://www.prescribersletter.com
  7. Prescriber's Letter 14(9): 2007 Immunization Update 2007 Detail-Document#: 230923 (subscription needed) http://www.prescribersletter.com
  8. Maglione MA et al Safety of Vaccines Used for Routine Immunization of US Children: A Systematic Review. Pediatrics; published online July 1, 2014 PMID: 25086160 http://pediatrics.aappublications.org/content/early/2014/06/26/peds.2014-1079.full.pdf+html - Byington CL Vaccines: Can Transparency Increase Confidence and Reduce Hesitancy? Pediatrics; published online July 1, 2014 PMID: 25086161 http://pediatrics.aappublications.org/content/early/2014/06/26/peds.2014-1494.full.pdf+html
  9. Doshani M, Weng M, Moore KL, Romero JR, Nelson NP. Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness. MMWR Morb Mortal Wkly Rep 2019;68:153-156 https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a6.htm
  10. CDC Health Alert. March 25, 2019 Update: Widespread Outbreaks of Hepatitis A among People Who Use Drugs and People Experiencing Homelessness across the United States. https://emergency.cdc.gov/han/han00418.asp
  11. Nelson NP, Link-Gelles R, Hofmeister MG et al Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel. MMWR Morb Mortal Wkly Rep. 2018 Nov 2;67(43):1216-1220. PMID: 30383742 PMCID: PMC6319798 Free PMC article
  12. Department of Veterans Affairs, VA National Formulary

Component-of

hepatitis a vaccine/hepatitis b vaccine (Twinrix) hepatitis a vaccine/hepatitis b vaccine (Twinrix)