Article: Vaccinations for Hepatitis A and B

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

schedule for hepatitis A: Havrix">
HAVRIX*

Age # of Doses Schedule Dose

Children age 2
to 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)

* Inactivated vaccine. Manufactured by SmithKline Beecham Biologicals.

schedule for hepatitis A: Vaqta">
VAQTA**

Age # of Doses Schedule Dose

Children age 2
to 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)

** Inactivated vaccine. Manufactured by Merck & Company, Inc.

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 under 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 adoptees 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 B depending on age, number of doses, and dose.">
Age     # of
    Doses
Schedule   Dose
  Recombivax HB*
Dose
Energix-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
Immuno-comprimised adults 4 0, 1, 2, and 6 months N/A 40 µg
(2.0 mL)

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 either 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.

prophylactic treatment">
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

Twinrix* is a vaccine for both hepatitis A and hepatitis B. It combines two FDA-approved vaccines--Havrix, for hepatitis A, and Engerix-B, 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.

schedule for hepatitis A: Twinrix">
Twinrix*

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)

*Manufactured by SmithKline Beecham Pharmaceuticals.

References

Centers for Disease Control and Prevention. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report. 1999;48(RR-12).

Centers for Disease Control and Prevention. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report. 1991;40(RR-13).

Food and Drug Administration. 2001. New Combination Vaccine Approved for Protection Against Two Hepatitis Viruses. FDA Talk Paper. Available at: www.fda.gov/bbs/topics/ANSWERS/2001/ANS01084.html. Accessed February 9, 2004.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, this does not mean or imply that the product is unsatisfactory.


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Email: nddic@info.niddk.nih.gov

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts.

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NIH Publication No. 04-425
February 2004


Source: National Institute of Diabetes and Digestive and Kidney Diseases
Cache Date: December 10, 2004

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