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Hepatitis A and Hepatitis A Vaccine

Hepatitis A and Hepatitis A Vaccine. Epidemiology and Prevention of Vaccine-Preventable Diseases National Immunization Program Centers for Disease Control and Prevention. Revised March 2002. Hepatitis A. Epidemic jaundice described by Hippocrates Differentiated from hepatitis B in 1940s

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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 Immunization Program Centers for Disease Control and Prevention Revised March 2002

  2. Hepatitis A • Epidemic jaundice described by Hippocrates • Differentiated from hepatitis B in 1940s • Serologic tests developed in 1970s • Most commonly reported type of hepatitis in the United States

  3. Hepatitis A Virus • Picornavirus (RNA) • Humans are only natural host • Stable at low pH • Inactivated by high temperature, formalin, chlorine

  4. 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

  5. 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

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

  7. Source of Hepatitis A Infection

  8. Vaccine Licensed Hepatitis A – United States, 1966-2001* *2001 provisional data

  9. Hepatitis A Incidence* by Age Group *rate per 100,000 population. 1997 data.

  10. Vaccine Licensed ACIP Recommendation Hepatitis A Incidence - United States and American Indians, 1990-2000 American Indians United States Source: National Notifiable Diseases Surveillance System, CDC

  11. Hepatitis A Vaccines • Inactivated whole virus • HAVRIX (GlaxoSmithKline) • VAQTA (Merck Vaccine Division) • Pediatric and adult formulations • Licensed for persons >2 years

  12. Formulation Pediatric age dose Adult age dose HAVRIX 2-18 yrs 0.5 ml >18 yrs 1.0 ml VAQTA 2-18 yrs 0.5 ml >18 yrs 1.0 ml Hepatitis A Vaccines

  13. Hepatitis A VaccineImmunogenicity • 95% seropositive after one dose • 100% seropositive after two doses • >97% seropositive after one • 100% seropositive after 2 doses Adults Children (>2 years) and Adolescents

  14. Hepatitis A Vaccine Efficacy • 40,000 Thai children 4-15 years • Vaccine efficacy 94% • 1,000 children 2-16 years • Vaccine efficacy 100% GlaxoSmithKline Merck

  15. Hepatitis A Vaccines • 1 dose • Booster dose 6 - 18 months after first dose • 1 dose • Booster dose 6 - 18 months after first dose Adult Children and Adolescent

  16. Hepatitis A Vaccine Recommendations • Children >2 years in states, counties, or communities where the average annual hepatitis A rate during 1987-1997 was >20 per 100,000 population Routine hepatitis A vaccination is recommended for:

  17. Hepatitis A Vaccination StrategiesHigh Incidence States • One or more single age cohorts of children or adolescents • Children in settings such as day care • Children and adolescents in a wide range of ages in a variety of settings, such as when they seek health care for other purposes

  18. Hepatitis A Vaccine Recommendations • Children >2 years in states, counties, or communities where the average annual hepatitis A rate during 1987-1997 was 10 to 20 per 100,000 population Routine hepatitis A vaccination should be considered for:

  19. Hepatitis A Vaccination StrategiesIntermediate Incidence States • Statewide or community-based? • Clustering of high-incidence areas within the state • Feasibility • Impact on incidence

  20. Hepatitis A – High Incidence States

  21. Twinrix • Combination hepatitis B (adult dose) and hepatitis A vaccine (pediatric dose) • Schedule: 0, 1, 6-12 months • Approved for persons >18 years

  22. Hepatitis A VaccineRecommendations • International travelers • Men who have sex with men • Drug users • Persons with occupational risk • Persons with chronic liver disease, including hepatitis C

  23. Hepatitis A VaccineRecommendations • Travelers to high or intermediate risk countries • Protected by 4 weeks after dose • Give concurrent IG for travel in <4 weeks

  24. Hepatitis A VaccineRecommendations • Health care workers: not routinely recommended • Day care centers: not routinely recommended • Food handlers: may be considered based on local circumstances

  25. Hepatitis A Serologic Testing • Not indicated for children • May be considered for some adults and older adolescents • Not indicated Prevaccination Postvaccination

  26. Hepatitis A VaccineAdverse Reactions • Pain at injection site • Systemic reactions uncommon • No serious adverse events reported

  27. Hepatitis A VaccineContraindications and Precautions • Severe allergy to vaccine component or following prior dose • Moderate or severe acute illness

  28. National Immunization Program • Hotline 800.232.2522 • Email nipinfo@cdc.gov • Website www.cdc.gov/nip

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