Hepatitis A Vaccine : Schedule,Cirrhosis,HCV Carriers,Booster,WHO Position

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Immunization and Vaccination

Hepatitis A Vaccine

Immunization and Vaccination

BCG Vaccine

Chickenpox or Varicella Vaccine

DPT Vaccine

Frequently asked questions on immunization

Hepatitis A Vaccine

Hepatitis B Vaccine

Hib Vaccine

Human Papillomavirus vaccine

Immunization Schedule

Influenza vaccine

Measles Vaccine

Meningococcal vaccine

Polio Vaccine

VACCINE REMINDER

Get the Vaccine Schedule for your child."

Today's Poll

Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

No, it should be used only after drug sensitivity report

Yes, under guidance of an infectious disease expert

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Results

HEPATITIS - A VACCINE - LATEST UPDATES

Live Hepatitis A vaccine is now available that is to be given subcutaneously after 1 year of age. The international vaccine was first developed by Dr Mao, the main inventor of the vaccine in the year 1987 and introduced in China in 1992. Till date over 120 million people have been administered the vaccine successfully in China. This new generation vaccine offers long term protection and convenience of a single dose administration for both adults and children. There is no need for a booster dose with this vaccine. The vaccine is now available in India and is packaged as a vial of the freeze-dried, live attenuated lyophilised vaccine along with 1 ml of diluent for a single dose.

Accelerated Schedule: A randomized multicentric study from Germany conducted that accelerated schedule (Combined Hepatitis A & B at 0, 7, 21 days or Hepatitis A on day 0 and Hepatitis B vaccine on D0, D7 and D21 with booster at 12 months) provides a good immune response against Hepatitis A & B antigens and is suitable for last minute immunization.

A study from Israel reported that rectal immunization might be highly effective way of inducing both local and systemic immunity to Hepatitis-A virus (In animal model).

Hepatitis A Vaccine and Cirrhosis: Study from USA suggest that seroconversion after Hepatitis A vaccination was significantly less in decompensated liver disease and the presence of advanced disease (Child - Pugh Class B/C). These findings indicate that the response to Hepatitis A vaccination in chronic liver diseases is optimal when targeted to patients before the development of hepatic decompensation.

Hepatitis A Vaccination and HCV carriers: Recent study suggested that Hepatitis A vaccination should be considered in all patients positive for HCV infection.

Hepatitis A Vaccination - whether booster in needed? Data have shown that after a full primary immunization course protective antibodies persist for more than 10 years in healthy individuals and underlying immune memory provides protection far beyond the duration of anti HAV Antibodies. So it can be concluded that there is no evidence to lend support to HAV booster vaccination after a full primary vaccination course in healthy individuals. However for special patient groups further research is needed.

Post exposure prophylaxis: Study from Italy showed that post exposure administration of currently available immunoglobulin is effective in preventing Hepatitis A infection and disease. Active immunization with Hepatitis A vaccine to secondary contacts of exposed subjects should be offered.

Mother to Newborn transmission: Unlike Hepatitis B, mother infected with Hepatitis A rarely transmits the disease to their newborns

With the availability of vaccine, it is pertinent to consider its use in the effective control of the disease. However with the varied epidemiological patterns and economical constraints in different countries, it does not seem to be possible to evolve universal policy for immunization. Though universal immunization may be the most effective way of control, the same is not practical for many countries.

WHO position on Hepatitis A Vaccines

The currently available vaccines against Hepatitis A are all of known good quality and in line with the WHO recommendations.
They are licensed for use in children more than one year of age because of interference by passively acquired maternal antibodies in children less than one year.
In countries where Hepatitis A is highly endemic, exposure to Hepatitis A is almost universal before the age of 10 years. In such countries, clinical Hepatitis A is usually a minor public health problem, and large-scale immunization efforts against this disease should not be undertaken.

References :-

Ren A, Feng F; Ma J; Xu Y; Liu C. Immunogenicity and safety of a new inactivated hepatitis A vaccine in young adults: a comparative study. Chin Med J (Engl) 2002;115(10):1483-5.
Guptan RC, Thakur V, Safary A; Sarin SK. Immunogenicity and reactogenicity of a combined high dose hepatitis A and hepatitis B vaccine, compared to that of Twinrix in healthy Indian children. Vaccine 2002;20(16):2102-6.
Arankalle VA, Chadha MS. Who should receive hepatitis A vaccine? J Viral Hepat 2003;10(3):157-8.
Mitchell LA, Galun E. Rectal immunization of mice with hepatitis A vaccine induces stronger systemic and local immune responses than parenteral immunization. Vaccine 2003;21(13-14):1527-38.
Arguedas MR, Johnson A, Eloubeidi MA, Fallon MB. Immunogenicity of hepatitis A vaccination in decompensated cirrhotic patients. Hepatology 2001;34(1):28-31.
Core information for the development of Immunization Policy. WHO- Vaccines and Biologicals. 2002 Update
Sans M, Escorza S, Villagrasa D et al. Carriers of hepatitis C: should they all be vaccinated for hepatitis A? Aten Primaria 2002;30(2):80-4.
Nothdurft HD, Dietrich M, Zuckerman JN et al. A new accelerated vaccination schedule for rapid protection against hepatitis A and B. Vaccine 2002;20(7-8):1157-62.
Van Damme P, Banatvala J, Fay O et al. Hepatitis A booster vaccination: is there a need? Lancet 2003;362(9389):1065-71.
Taliani G, Gaeta GB. Hepatitis A: post-exposure prophylaxis. Vaccine 2003;21(19-20):2234-7.