II. Indications
- All children as Primary Series at age 1 year
- Children are reservoir for Hepatitis A (May erradicate Hepatitis A from population)
- Travelers to endemic Hepatitis A areas
- All regions outside United States, Western Europe, New Zealand, Australia, Japan and Canada
- Close contact with international adoptee
- Food handlers
- Workers with primates
- Day care workers or children
- Occupational exposure or other exposure to those at high risk for Hepatitis A
- Illicit Drug use
- Homosexual male
- Homelessness
- High risk of Hepatitis A complication
- Chronic Liver Disease
- Age over 40 years
- HIV Infection
- Patients living in endemic regions of United States or in regions of outbreaks
- Cases in which cohort is no longer at high risk to require Hepatitis A Vaccine
- Clotting Factor disorder (transfusion risk)
III. Preparation
- See Twinrix (combination with Hepatitis B Vaccine)
- Hepatitis A Vaccine (Havrix, Vaqta)
IV. Dosing: Havrix or Vaqta
- Start Vaccine at least 4 weeks before departure
- Give Hepatitis A Immunoglobulin if less than 4 weeks before departure
- See Hepatitis A Immunoglobulin for other indications
- Give Hepatitis A Immunoglobulin if less than 4 weeks before departure
- Infants (>12 month)
- May also administer to ages 6-12 months for international travel to endemic regions
- Dose 1: 0.5 ml IM at month 0, after age 12 months (or after 6 months old, before travel to endemic region)
- Dose 2: 0.5 ml IM at month 6-12, at least 6 months after first dose
- Children (ages 1 to 18 years)
- Dose 1: 0.5 ml IM at month 0 (U.S. Primary Series administers at age 12 months)
- Dose 2: 0.5 ml IM at month 6-12 (U.S. Primary Series administers at age 18-24 months)
- Adult (ages 19 years and older)
- Dose 1: 1 ml IM at month 0
- Dose 2: 1 ml IM at month 6-12
V. Dosing: Indications for administering Immoglobulin in impending out of country travel
- Age under 1 year old (Immunoglobulin Alone)
- Serious comorbidity (Vaccine and Immunoglobulin)
- Age over 40 years old (Vaccine and immoglobulin)
VI. Precautions
- Safe in HIV
- Safe in Pregnancy
- Not indicated for under age 1 years
- Use Hepatitis A Immunoglobulin for exposure
VII. Adverse Effects
- Purpura (ages 7 to 17 years old)
VIII. Efficacy
- Protective antibodies after dose 1
- Two weeks: 37% of patients
- Four weeks: >90% of patients
- Twenty-six weeks: 100% of patients
- Long-term protection occurs with dose 2
- Protection lasts at least 20 years after series
- Hepatitis A Incidence reduced 95% since Vaccine introduction
IX. Resources
- CDC Immunization Schedules (last accessed 10/28/2020)