II. Indications
- Also administer Hepatitis A Vaccine if not contraindicated
- Exceptions: Age <6 months (preexposure) or age <12 months (postexposure)
- High Risk Indications for Preexposure or Postexposure Prophylaxis
- Patient age <6 months (pre-exposure) or <1 year old (postexposure)
- Age over 40 years old
- Serious comorbidity
- Immunocompromised
- Chronic Liver Disease
- Severe allergy to Hepatitis A Vaccine or other contraindication
- Preexposure Travel to endemic areas Indications
- Give with Hepatitis A Vaccine if travel within next 4 weeks to endemic region
- Age under 6 months or Vaccine otherwise contraindicated
- Age over 6 months AND other high risk indications above (give Immunoglobulin AND Hepatitis A Vaccine)
- Postexposure (within 2 weeks to household or institutional contact or contaminated food) Indications
- Age under 12 months or Vaccine otherwise contraindicated
- Age over 12 months AND other high risk indications above (give Immunoglobulin AND Hepatitis A Vaccine)
- Not necessary for casual work contacts
III. Epidemiology
- Hepatitis A is the most frequent Vaccine preventable disease in travelers
IV. Protocol
- Dose 0.1 to 0.2 ml/kg IM
- Use higher dose (0.2 ml/kg) for travel in next 1-2 months
- Provides up to 3 months of protection from Hepatitis A Virus
V. Preparation
- Immunoglobulin from pooled human plasma
- Considered safe from transmission of contagious disease
- Viruses inactivated
- Tested for Hepatitis B, Hepatitis C and HIV
VI. Contraindications
- IgA Deficiency
- Not contraindicated in pregnancy or Lactation
VII. Efficacy
- Pre-exposure before travel
- Prevents infection in up to 85%
- Post-exposure (if given within 2 weeks of exposure)
- Prevents infection in up to 89%
VIII. Adverse Effects
- Hypersenstivity reaction
- Thrombosis risk
IX. Drug Interactions: Live Attenuated Vaccines
- Immunoglobulin decreases immunogenicity
- Delay MMR Vaccine and Varicella Vaccine for 2 weeks before and 6 months after Immunoglobulin