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Hepatitis A and Hepatitis A Vaccine

Hepatitis A and Hepatitis A Vaccine. Epidemiology and Prevention of Vaccine-Preventable Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention. Revised March 2008. Note to presenters:

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Hepatitis A and Hepatitis A Vaccine

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  1. Hepatitis A and Hepatitis A Vaccine Epidemiology and Prevention of Vaccine-Preventable Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Revised March 2008

  2. Note to presenters: Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp

  3. Hepatitis A • Epidemic jaundice described by Hippocrates • Differentiated from hepatitis B in 1940s • Serologic tests developed in 1970s • Vaccines licensed in 1995 and 1996

  4. Hepatitis A Virus • Picornavirus (RNA) • Humans are only natural host • Stable at low pH • Inactivated by high temperature (185°F or higher), formalin, chlorine

  5. Hepatitis A Pathogenesis • Entry into mouth • Viral replication in the liver • Virus present in blood and feces 10-12 days after infection • Virus excretion may continue for up to 3 weeks after onset of symptoms

  6. Hepatitis A Clinical Features • Incubation period 28 days (range 15-50 days) • Illness not specific for hepatitis A • Likelihood of symptomatic illness directly related to age • Children generally asymptomatic, adults symptomatic

  7. Hepatitis A Epidemiology • Reservoir Human • Transmission Fecal-oral • Temporal pattern None • Communicability 2 weeks before to 1 week after onset

  8. Hepatitis A—United States, 1990-2000 Risk Factors Source: NNDSS/VHSP

  9. Hepatitis A - United States, 1966-2006 Vaccine Licensed Year

  10. Hepatitis A Incidence By Age Group, 1990-2004 Year

  11. Hepatitis A Incidence By Vaccination Recommendation Status 1990-2004 Year

  12. Hepatitis A Vaccines • Inactivated whole virus • HAVRIX (GlaxoSmithKline) • VAQTA (Merck) • Both vaccines approved for persons 12 months of age and older • Pediatric (12 months through 18 years) and adult (19 years and older) formulations

  13. Hepatitis A Vaccine Immunogenicity • Adults • >95% seropositive after one dose • 100% seropositive after two doses • Children (>12 months) and Adolescents • >97% seropositive after one • 100% seropositive after 2 doses

  14. Hepatitis A Vaccines • Adult • 1 dose • booster dose 6-18 months after first dose • Children and Adolescents • 1 dose • booster dose 6-18 months after first dose

  15. Hepatitis A Vaccine Efficacy • HAVRIX • 40,000 Thai children 1-16 years of age • vaccine efficacy 94% • VAQTA • 1,000 New York children 2-16 years of age • vaccine efficacy 100%

  16. Hepatitis A Vaccines Formulation Pediatric age dose Adult age dose HAVRIX 1-18 yrs 0.5 ml >18 yrs 1.0 ml VAQTA 1-18 yrs 0.5 ml >18 yrs 1.0 ml

  17. ACIP Recommendation for Routine Hepatitis A Vaccination of Children • All children should receive hepatitis A vaccine at 12-23 months of age • Vaccination should be integrated into the routine childhood vaccination schedule • Children who are not vaccinated by 2 years of age can be vaccinated at subsequent visits MMWR 2006;55(No.RR-7):1-23

  18. ACIP Recommendation for Routine Hepatitis A Vaccination of Children • States, counties, and communities with existing hepatitis A vaccination programs for children 2 through 18 years of age should maintain these programs • New efforts focused on routine vaccination of children 12 months of age should enhance, not replace ongoing vaccination programs for older children MMWR 2006;55(No.RR-7):1-23

  19. ACIP Recommendation for Routine Hepatitis A Vaccination of Children • In areas with without an existing hepatitis A vaccination program catch-up vaccination of unvaccinated children 2 through 18 years of age can be considered MMWR 2006;55(No.RR-7):1-23

  20. Hepatitis A Vaccine Recommendations • International travelers • Men who have sex with men • Persons who use illegal drugs • Persons with occupational risk • Persons with chronic liver disease

  21. Hepatitis A VaccineInternational Travel • The first dose of hepatitis A vaccine should be administered as soon as travel is considered • For healthy persons 40 years of age or younger: • 1 dose of single-antigen vaccine administered at any time before departure • Persons at risk of severe disease from hepatitis A virus planning to travel in 2 weeks or sooner should receive the first dose of vaccine and also can be administered immune globulin MMWR 2007;56(No.41):1080-4

  22. Hepatitis A Postexposure Prophylaxis • For healthy persons 12 months through 40 years of age: • single-antigen hepatitis A vaccine should be administered as soon as possible after exposure • For persons older than 40 years: • immune globulin is preferred • vaccine can be used if IG cannot be obtained MMWR 2007;56(No.41):1080-4

  23. Hepatitis A Vaccine Recommendations • Healthcare workers: not routinely recommended • Child care centers: not routinely recommended • Sewer workers or plumbers: not routinely recommended • Food handlers: may be considered based on local circumstances

  24. Twinrix • Combination hepatitis A vaccine (pediatric dose) and hepatitis B (adult dose) • Schedules • 0, 1, 6 months, or • 0, 7, 21- 30 days and a booster dose at 12 months • Approved for persons 18 years of age and older

  25. New Twinrix Schedule • Doses at 0, 7, 21- 30 days and a booster dose at 12 months • ACIP has no recommendation regarding the new schedule • The first 3 doses of the new schedule provide equivalent protection to: • the first dose in the standard single-antigen adult hepatitis A vaccine series • the first 2 doses in the standard adult hepatitis B vaccine series

  26. New Twinrix Schedule • Seroconversion is nearly 100% after either 3 doses of Twinrix on the new schedule or a single dose of single-antigen adult hepatitis A vaccine • No increased benefit of the new schedule for the hepatitis B component compared to administration of 2 hepatitis B vaccine doses 1 to 2 months apart

  27. Schedules That Include BothTwinrix and Hepatitis A Vaccine • Adult formulation single antigen hepatitis A vaccine may be used to complete a schedule begun with Twinrix and vice versa* • Acceptable schedules • 2 Twinrix and 1 hepatitis A (adult formulation • 1 Twinrix and 2 hepatitis A (adult formulation) • Maintain spacing recommended for Twinrix *for persons 19 years of age or older

  28. Hepatitis A Serologic Testing • Prevaccination • not indicated for children • may be considered for some adults and older adolescent • Postvaccination • not indicated

  29. Hepatitis A VaccineAdverse Reactions • Local reaction 20%-50% • Systemic reactions (malaise, fatigue) <10% • No serious adverse reactions reported

  30. Hepatitis A VaccineContraindications and Precautions • Severe allergic reaction to a vaccine component or following a prior dose • Moderate or severe acute illness

  31. CDC Vaccines and ImmunizationContact Information • Telephone 800.CDC.INFO • Email nipinfo@cdc.gov • Website www.cdc.gov/vaccines

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