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Hepatitis A virus vaccination

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Hepatitis A is more common in countries outside Northern and Western Europe, North America, Australia and New Zealand

Travel abroad is a common factor in sporadic cases in the UK

  • highest risk areas for UK travellers are the Indian subcontinent and the Far East, but the risk extends to Eastern Europe

  • are two products for immunisation against hepatitis A
    • an immunoglobulin provides rapid but temporary immunity
    • vaccine confers active immunity but response is not immediate
      • vaccines are available as either monovalent, or combined with either typhoid or hepatitis B
        • Hepatitis A monovalent vaccines and those combined with either typhoid or hepatitis B do not contain thiomersal - vaccines are inactivated, do not contain live organisms and cannot cause the diseases against which they protect

  • monovalent vaccines
    • currently there are four monovalent inactivated hepatitis A vaccines (which can be used interchangeably)
    • seroprotective levels of neutralising antibody may not be detected for 12-15 days following administration (2)
    • gives protection for at least one year.
    • if a patient is staying abroad for long periods or likely to travel repeatedly then a booster dose (usually given 6-12 months later - the exact time varies with product) will give protection for beyond 10 years

  • combined vaccination (hepatitis A + B or hepatitis A + typhoid)
    • may be used when protection against both diseases are required

Human normal immunoglobulin

  • Human normal immunoglobulin (HNIG) is prepared from pooled plasma derived from blood donations
  • use of HNIG should be limited to situations where it may have a definite advantage over vaccine
  • HNIG can provide immediate protection, although antibody levels are lower than those eventually produced by hepatitis A vaccine
  • because of a theoretical risk of transmission of vCJD from plasma products, HNIG used in the UK is now prepared from plasma sourced from outside the UK, and supplies are scarce

Reinforcing immunisation

  • a booster dose of hepatitis A vaccine should be given at six to 12 months after the initial dose - results in a substantial increase in the antibody titre and will give immunity beyond ten years, however, effective protection beyond ten years cannot be assured until this booster is given
  • until further evidence is available on persistence of protective immunity, a further booster at 25 years is indicated for those at ongoing risk

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