Hepatitis A and the Hepatitis A Vaccine

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					     Hepatitis A and Hepatitis
            A Vaccine

 Epidemiology and Prevention of Vaccine-
          Preventable Diseases

     National Immunization Program
Centers for Disease Control and Prevention

              Revised January 2007
       NOTICE
 Content and order of the slides
in this file may differ from those
presented on the broadcast and
              webcast
       Hepatitis A Virus
• Picornavirus (RNA)
• Humans are only natural host
• Stable at low pH
• Inactivated by high temperature
 (185°F or higher), formalin,
 chlorine
    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 <6 years generally
    asymptomatic; adults usually
    symptomatic
    Hepatitis A Epidemiology
• Reservoir         Human

• Transmission      Fecal-oral


• Temporal pattern None

• Communicability   2 weeks before to
                    1 week after onset
  Hepatitis A—United States, 1990-2000
              Risk Factors
                              Sexual/household
                                     14%                       Int'l travel
                                                                   5%


                                                       MSM
Unknown                                                10%
  45%
                                                                    IDU
                                                                     6%

                                                  Child care
                                                     2%

                                                                  Outbreak
                      Other                                         4%
                       8%
 Source: NNDSS/VHSP                              CC contact
                                                    6%
        Hepatitis A - United States, 1966-2006*


        70000
                                                       Vaccine
        60000                                          Licensed
        50000
Cases




        40000
        30000
        20000
        10000
            0
            1966   1970     1975      1980    1985   1990   1995   2000   2005

                                             Year
            *2006 provisional total
                   Hepatitis A Incidence, 1997

         20
         18
         16
         14
         12
Rate *




         10
          8
          6
          4
          2
          0
                    <5           5-14        15-24      25-39   40+
                                        Age group (yrs)
              *rate per 100,000 population
                    Hepatitis A
High and Intermediate Incidence States, 1999

  >20 per 100,000 population   10-19 per 100,000 population
                                Hepatitis A Incidence By Vaccination
                                 Recommendation Status 1990-2004
                                              Overall
                               35             Vaccine recommended or considered
                                              No recommendation
cases per 100,000 population




                               30

                               25

                               20

                               15

                               10

                               5

                               0
                                1990   1992     1994    1996    1998   2000   2002   2004
                                                         Year
     Hepatitis A Vaccines
• Inactivated whole virus
• HAVRIX (GlaxoSmithKline)
• VAQTA (Merck)
• Pediatric and adult formulations
• Approved for persons 12 months of
 age and older
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
      Hepatitis A Vaccines
• Adult
  –1 dose
  –booster dose 6-18 months after
     first dose
•   Children and Adolescent
    –1 dose
    –booster dose 6-18 months after
     first dose
      Hepatitis A Vaccine
       Minimum Interval

• The minimum interval between the
 first and booster doses of hepatitis A
 vaccine is six calendar months
           Hepatitis A Vaccine
           Recommendations
• 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(RR-7):1-23
               Hepatitis A Vaccine
               Recommendations
•    In areas with an existing hepatitis A
     vaccination program for children 2-18 years
     of age
      – these programs should be maintained
      – new efforts focused on routine
        vaccination of children 12 months of age
        should enhance, not replace ongoing
        vaccination programs
•    In areas without an existing hepatitis A
     vaccination program, catch-up vaccination of
     unvaccinated children 2-18 years of age can
     be considered
    MMWR 2006;55(RR-7):1-23
      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
         Hepatitis A Vaccine
         International Travel
• Protection following hepatitis A
    vaccine might not be complete until
    4 weeks after vaccination
•   For optimal protection immune
    globulin also may be administered
    to persons traveling to a high-risk
    area <4 weeks after the first dose of
    vaccine
•   Children younger than 12 months of
    age should receive IG prior to travel
    to high-risk area
                Twinrix
• Combination hepatitis B (adult dose)
    and hepatitis A vaccine (pediatric
    dose)
•   3 dose schedule at 0, 1, 6-12 months
•   Approved only for persons 18 years
    of age and older
   Schedules That Include Both
 Twinrix 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
         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
       Hepatitis A Vaccine
       Adverse Reactions
• Local reactions         20%-50%

• Systemic reactions
 (malaise, fatigue, low    <10%
 grade fever)

• No serious adverse
 reactions reported
       Hepatitis A Vaccine
Contraindications and Precautions

 • Severe allergic reaction to a
   vaccine component or following
   a prior dose
 • Moderate or severe acute illness
National Immunization Program
            Contact Information



• Telephone        800.CDC.INFO

• Email            nipinfo@cdc.gov

• Website          www.cdc.gov/nip

				
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