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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 |
| |
4 |
|
|
|
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. |