Hepatitis A Vaccine : Types,Schedule,Storage,Side effects,Contraindications

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

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HEPATITIS - A VACCINE - LATEST UPDATES

Q. Which are the hepatitis -A vaccines available?
A. There are 2 types of Hepatitis A vaccines available. Killed inactivated vaccine contains HM 175 strains of Hepatitis A virus grown on human diploid cell culture originally obtained from the fecal sample of patients from Melbourne, Australia. A new freeze dried live attenuated vaccine is now available that is made from master seen virus , the H2 attenuated strain of HAV cultured in human diploid cells. 5 vaccines are available currently- Biovac A (Internationally - Zhepu), Havrix, Avaxim, Vaqta and Epaxal. Only the first 3 brands are available in India .

BIOVAC A is single dose of 1.0 ml to be administered subcutaneously .

Havirix is available in two forms for pediatric use, as 360 EU per dose in 0.5 ml ready to use suspension, and 720 EU per dose in 0.5 ml suspension. Adult vial contains 1440 EU in 1.0 ml volume.

Vaqta is available for pediatric use containing 25 U/ dose and adult dose containing 50 U/dose.

Pediatric use means till 19 years of age and adult dose > 19 years of age.

Q. What is the schedule of giving Hepatitis A vaccine?
A. The dose and schedule differ with the 3 vaccines.

BIOVAC A is single dose to be administered subcutaneously in a child above 1 year of age.

Havirix in children can be given in 2 schedules. First schedule consists of 3 doses of 360 EU at 0, 1 and 6-12 months and second schedule of 2 doses of 720 EU at 0 and 6 - 12 months. It is to be given intramuscularly in the deltoid region.

Vaqta in children is given as 2 doses of 25 U at 0 and 6- 12 months.It is to be given intramuscularly in the deltoid region.

Q. How are the Hepatitis - A vaccines stored?
A. The vaccines are stored at 2-8⁰ C in refrigerator.

Q. What are the side effects of hepatitis - A vaccine?
A. The side effects of Hepatitis A vaccines are very rare and mild. Local side effects seen include redness, swelling and pain at injection site. They usually subside in 72 hours. Systemic side effects like mild fever, headache, malaise, arthralgia and gastrointestinal disorders may be seen.

Q. When is Hepatitis A vaccine contraindicated?
A. Patients known to have hypersensitivity to the vaccine or any component of the formulation should not be given the vaccine. It is also contraindicated during pregnancy and in patients with fever. Live vaccine should be avoided in immunocompromised patients. Patients with history of anaphylaxis to vaccines should avoid the vaccine.

Q. What is the efficacy of each vaccine?
A. Among the killed vaccine it is found that antibody titres rise by 2nd week after first dose in over 85% of children and in 95% of children by the end of the first month. After the second dose (in 3 dose schedule), 97% have protective titres and after the third dose, 100% have protective titres. One year after completion of vaccination the titres fall gradually however Kinetic models developed have suggested that titres are likely to remain in protective range for at least 20 years after vaccination.

Live vaccine: A study in 3089 adult healthy individuals suggested that seroconversion occurs in 2-5 weeks after the injection and was seen in 95.6% of individuals. Another study in 3031 children aged 6 to 9 years found the seroconversion rate to be 97.5% after 4 weeks of inoculation. The protective efficacy of this vaccine was found to be 94.47% in randomised and controlled trials in 12036 children.

Q. Who should be receive Hepatitis A Vaccine?
A. Though Hepatitis-A is a self limiting disease, there is no effective treatment. In addition there is occasional mortality due to fulminant hepatitis especially in adolescent and adults.Thus primary immunization may be recommended for pre-exposure prophylaxis in individuals who are at increased risk of the infection such as :-

Foreign traveller : Those staying in low endemic areas for Hepatitis A do not develop natural immunity till adulthood. Such persons are at risk of developing Hepatitis A when they visit an area with high endemicity. If such a person is going to stay for <3 months, Hepatitis A immunoglobulin can be enough to prevent hepatitis-A. If the stay is going to be prolonged it is better to give the vaccine.
Patients with chronic liver disease who may be at increased risk of fulminant hepatitis A.
During epidemics: Whenever there is an outbreak of Hepatitis A in a community
IV drug abusers
Those who have occupation hazards like staff working in laboratories, food handlers, health personnel, zoo keepers, veterinarians, emergency relief workers and members of armed forces.
Those who work in day-care centers or schools or institutionalized children etc.

Children from a higher socio-economic group who may not have had natural infection may be given the Hepatitis A vaccine.

Q. Can hepatitis-A vaccine be given along with other vaccines?
A. Yes, hepatitis-A vaccine can be given along with any other vaccine provided one uses separate syringes and separate sites for different vaccines.

Last created on 23-02-2001
Last updated on 01-12-2004

How to cite this url

Dr.Shah N.Hepatitis A Vaccine.Pediatric Oncall [serial online] 2004 [cited 2004 December 1];1. Available from: