Hepatitis A
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Hepatitis A virus
hepatitis a

Hepatitis A is a serious liver disease caused by the hepatitis A virus (HAV). HAV is transmitted mainly via the fecal-oral route by person-to-person contact or ingestion of contaminated food or water. Symptoms of illness generally begin about 28 days after infection. Hepatitis A virus can be spread to others starting about two weeks before symptoms begin until about one week after symptom onset.

About 70% of infected children younger than 6 years of age will not have any symptoms. Infection in older children and adults is usually symptomatic and includes fever, malaise, nausea, abdominal discomfort, dark urine, and jaundice. There is no specific treatment for hepatitis A and most people recover within two months after symptoms begin. However, 10% to 15% of people will have prolonged symptoms and a small number will develop fulminant hepatitis A.

About the Vaccine

There are two hepatitis A vaccines: Havrix and Vaqta. Both are inactivated whole-virus vaccines. They are available in both adult and pediatric formulations. The pediatric formulations are approved for persons 12 months through 18 years of age. The adult formulations are approved for persons 19 years and older.

Hepatitis A vaccine is also available as a combination vaccine called Twinrix. Twinrix contains both hepatitis A and hepatitis B vaccines. Twinrix is licensed only for use in persons 18 years of age and older.



Hepatitis A Vaccines Licensed for use in the US

Product: Havrix® (Hepatitis A)
Manufacturer: GlaxoSmithKline
Year licensed: 1995
Product Insert

Product Name: Vaqta® (Hepatitis A)
Manufacturer: Merck & Co
Year licensed: 1996
Product Insert

Product Name: Twinrix® (Hepatitis A and Hepatitis B)
Manufacturer: GlaxoSmithKline
Year licensed: 2001
Product Insert

Indications Contraindications and precautions
Child
  • All children should receive hepatitis A vaccine at 1 year of age (i.e., 12-23 months). Vaccination should be completed according to the licensed schedules and integrated into the routine childhood vaccination schedule. Children who are not vaccinated by age 2 years can be vaccinated at subsequent visits.
Adult

Older children and adults who did not receive hepatitis A vaccine in childhood and who fall into one or more of the following groups:

  • military personnel
  • persons traveling to or working in countries with high or intermediate prevalence of hepatitis A, such as those located in Central or South America, Mexico, Asia (except Japan), Africa, and eastern Europe
  • men who have sex with men
  • persons who use illegal drugs
  • persons with chronic liver disease
  • persons being treated with clotting factor concentrates
  • persons who have an occupational risk for exposure, such as those working with HAV in research laboratories or with HAV-infected primates
  • persons who anticipate close personal contact with an international adoptee from a country with high or intermediate levels of hepatitis A during the first 50 days following the adoptee's arrival in the United States
  • People who have had a severe allergic reaction to a previous dose of hepatitis A vaccine or a hepatitis A vaccine component.* If you are administering Twinrix, also check for a history of severe allergic reaction to a previous dose of hepatitis B or hepatitis B vaccine components.
  • People who are moderately or severely ill should wait until recovery before receiving any vaccine. Minor illnesses, such as a cold, are not a contraindication.
  • Pregnancy is a precaution to hepatitis A vaccine.
Child (1 through 18 years of age)
Vaccine Dose Volume Doses Schedule
Havrix 720 EL.Units 0.5 mL 2 0, 6-12 months
Vaqta 25 Units 0.5 mL 2 0, 6-18 months
Adult (19 years and older)
Vaccine Dose Volume Doses Schedule
Havrix 1440 EL.Units 1 mL 2 0, 6-12 months
Vaqta 50 Units 1 mL 2 0, 6-18 months
Twinrix' 720 EL.Units (hepatitis A) and 20 mcg (hepatitis B) 1 mL 3 0, 1, 6 months or
0, 7, and 21 to 31 days with a booster dose at 12 months (if an accelerated schedule is necessary)

' Twinrix is approved for use in persons 18 years of age and older

Hepatitis A Vaccine Side Effects*
  • Swelling, pain, or redness at the injection site in about 1 out of 2 adults and 1 out of 6 children.
  • Headache in about 1 out of 6 adults and 1 out of 25 children.
  • Loss of appetite in about 1 out of 12 children.
  • Fatigue, malaise or low-grade fever in fewer than 10% of recipients.
  • Severe allergic reaction (very rare).

Notes:
*When hepatitis A antigens are given in combination with other antigens in one vaccine, the other antigens in the vaccine may cause other side effects. For more information about these possible side effects, go to the Hepatitis B.

Product Name Supplied Storage and Handling
Havrix
GlaxoSmithKline
In pediatric doses of 0.5 mL single dose vials (10 per package) and 0.5 mL single dose prefilled syringes (5 or 10 per package). In adult doses of 1 ml single dose vials (10 per package)and 1 mL single dose prefilled syringes (5 per package). Store refrigerated between 2° to 8°C (35° to 46°F). Do not freeze. Discard if vaccine has been frozen.

Havrix is a sterile slightly opaque, white suspension. Shake vial/syringe well before administering. Thorough agitation is needed to maintain suspension of the vaccine.
Vaqta
Merck & Co.
In pediatric doses of 0.5 mL single dose vials (10 per package) and 0.5 mL single dose prefilled syringes (10 per package). In adult doses of 1 ml single dose vials (1 or 6 per package)and 1 mL single dose prefilled syringes (6 per package) Store refrigerated between 2° to 8°C (35° to 46°F). Do not freeze. Discard if vaccine has been frozen.

Vaqta is a sterile slightly opaque, white suspension. Shake vial/syringe well before administering. Thorough agitation is needed to maintain suspension of the vaccine.
Twinrix
GlaxoSmithKline
1 mL single dose vials (10 per package) and 1 mL single dose prefilled syringes (1, 5, or 10 per package) Store refrigerated between 2° to 8°C (35° to 46°F). Do not freeze. Discard if vaccine has been frozen.

Twinrix is a sterile white, cloudy suspension. Shake vial/syringe well before administering. Thorough agitation is needed to maintain suspension of the vaccine. 
MSMR August 2012: Hospitalizations for Hepatitis A, B, and C, Active Component, U.S. Armed Forces,1991-2011
Healthcare professionals are invited to join us as we acknowledge Hepatitis Awareness and discuss "2014 Hepatitis A Vaccine Updates". COL Susan Fraser, MD, Chief, Infectious Disease Clinic will provides information on clinical features, ACIP recommendations, policy updates and issues/challenges. (Recorded on 21 May 2014)
You Call the Shots is an interactive, web-based immunization training course. It consists of a series of modules that discuss vaccine-preventable diseases and explain the latest recommendations for vaccine use. Each module provides learning opportunities, self-test practice questions,reference and resource materials, and an extensive glossary. The course is available free of charge on the CDC Vaccines and Immunizations website.
Author: Chu
DoD Instruction 6025.19
GENADMIN PDF 21 Jun 13
III MEF FORCE HEALTH PROTECTION (FHP) REQUIREMENTS 2014
MSMR August 2012: Hospitalizations for Hepatitis A, B, and C, Active Component, U.S. Armed Forces,1991-2011
MMWR 09 Dec 05
Notice to Readers: FDA Approval of Havrix® (Hepatitis A Vaccine, Inactivated) for Persons Aged 1--18 Years
National Foundation for Infectious Diseases
Recommendations of the Defense Health Board (DHB)
Recommendations of the Armed Forces Epidemiological Board (AFEB)
Recommendations of the Armed Forces Epidemiological Board (AFEB)
Recommendations of the Armed Forces Epidemiological Board (AFEB)
Vaqta (Merck) 01 Feb 14
Package Insert - Vaccine
Package Insert - Vaccine
Package Insert - Vaccine
VIS
Vaccine Information Statement (Interim)