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Immunogenicity of Hepatitis A vaccine:

HAV vaccines produced from a single HAV strain provides protection against all HAV strains, this is because of the genetic similarity of human HAV isolates. After administrating of Immunoglobulin, Anti HAV concentration of 10-20 mIU / ml is accepted as protective, but natural infection provides concentration 100-300 fold higher. After 2nd and 3rd dose of HAV vaccine similar concentration as natural infection is achieved. Single dose gives protective level of Anti HAV antibodies up to 1 year in 95 % of vaccines. Seropositivity is seen as soon as 15 days after the first dose of the vaccine in 70-98 % but almost 100 % at 4-8 weeks. Peak anti HAV level tends to be minimally lower in adults above 40 years as also in HIV positive persons and immunocompromised host due to any other reasons like chronic renal failure or chronic liver disease. This is the reason that HAV vaccine should be administered early after the diagnosis of CRF or CLD is made, because these patients show poor response to this vaccine when the disease is in advanced stage.

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)

Doses and Schedules: Hepatitis A

Hepatitis A Vaccine 1
Age # Of Doses Schedule Dose
Children age 2to 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)

Hepatitis A Vaccine 2
Age # Of Doses Schedule Dose
Children age 2to 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)

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 less than 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.

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 adoptee 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

Doses and Schedules: Hepatitis B

Hepatitis A Vaccine 2
Age # Of Doses Schedule Dose Recombivax HB* DoseEnergix-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

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 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.

Combination Vaccine

Available is a vaccine for both hepatitis A and hepatitis B. It combines two FDA-approved vaccines—one for hepatitis A and another 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.

Combination vaccine for Hepatitis A and B
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)

As per the manufacturer’s recommendation Twinrix can be given to children above 2 years of age as three doses at 0,1 and 6 month interval. And the vaccine constitutes 360 ELISA units of HAV, 10 µg in total 0.5 mL.