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Hepatitis A - Management
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Who should be offered vaccination for hepatitis A?
- Pre-exposure vaccination is recommended for:
- Travellers 1 year of age and older travelling to areas where hepatitis A is moderately or highly endemic, particularly if standards of sanitation and food hygiene are likely to be poor, or if visiting friends and relatives.
- For country-by-country recommendations for hepatitis A and other travel vaccines, see www.nathnac.org.
- People with chronic liver disease, including those with chronic hepatitis B or C (vaccination against hepatitis B is also recommended for non-immune people with hepatitis C).
- People with clotting factor disorders (vaccination against hepatitis B is also recommended).
- Men who have sex with men and people whose sexual behaviour is likely to put them at increased risk (vaccination against hepatitis B is also recommended).
- Injecting drug users (vaccination against hepatitis B is also recommended).
- Individuals at occupational risk
- Laboratory workers who may be exposed to hepatitis A in the course of their work (such as in microbiology laboratories and clinical infectious disease units).
- Staff of large residential institutions (where standards of personal hygiene among residents may be poor).
- Sewage workers at risk of repeated exposure to raw sewage.
- People who work with primates that are susceptible to hepatitis A infection.
- People infected with HIV that belong to a group at risk of the infection or its complications.
- For information on how to vaccinate, see Prescribing information.
Basis for recommendation
Travellers 1 year of age and older
- The recommendation to offer vaccination to travellers 1 year of age and older is based on expert opinion in the document from the Department of Health Immunisation against infectious disease (the 'Green Book') [DH, 2009a], a review by the National Travel Health Network and Centre [NaTHNaC, 2009], and a review article [Stauffer et al, 2003].
- Young children rarely become significantly ill from hepatitis A infection, but immunization is considered to be important to protect public health because children are extremely efficient at disease transmission. The risks of disease for children younger than 1 year of age are low, and the vaccines are not licensed for this age group. In young babies, particular care should be taken to prevent exposure to hepatitis A through food and water.
People with chronic liver disease and clotting factor disorders, injecting drug users, and those at occupational risk
- The recommendation to offer vaccination to people with chronic liver disease, clotting factor disorders, injecting drug users, and those at occupational risk is based on expert opinion in the document from the Department of Health Immunisation against infectious disease (the 'Green Book') [DH, 2009a] and a review article [Steele et al, 2009].
Men who have sex with men
- Guidance from the World Health Organization, Department of Health, Health Protection Agency, and National Travel Health Network and Centre recommends pre-exposure vaccination for all men who have sex with men [WHO, 2003; DH, 2009a; HPA, 2009a; NaTHNaC, 2009]. However, the British Association for Sexual Health and HIV (BASHH) recommends that, as current evidence suggests that most men who have sex with men are not at increased risk of hepatitis A infection, universal vaccination in this group cannot be firmly recommended. BASHH suggests that vaccination is offered in large cities, such as central London, where outbreaks have been reported, particularly where there are increased rates of infection [BASHH, 2008].
People infected with HIV
- The recommendation to offer vaccination to people infected with HIV that belong to a group at risk of hepatitis A infection or its complications is based on expert opinion in a British HIV Association guideline for the immunization of HIV-infected adults [Geretti et al, 2008].
Do I need to test for hepatitis A before offering vaccination?
- Consider pre-vaccination testing in people from endemic areas, those with a prior history of hepatitis or jaundice, and in men who have sex with men.
- For information on pre-vaccination testing, see Investigations.
Basis for recommendation
This recommendation is based on expert opinion in the United Kingdom national guideline on the management of the viral hepatitides A, B, and C, produced by the Clinical Effectiveness Group of the British Association for Sexual Health and HIV [BASHH, 2008] and expert opinion in a review article [Steele et al, 2009].
What self-care advice should I provide for travellers to avoid infection with hepatitis A?
- Advise those travelling to countries where hepatitis A is moderately or highly endemic (see www.nathnac.org for this information) to:
- Avoid exposure to hepatitis A through contaminated food and water. In particular, the person should avoid foods grown close to the ground (such as strawberries and salad vegetables) and crustaceans that feed at the bottom of the ocean (such as oysters and clams). For further information, see www.nathnac.org/pro/factsheets/food.htm.
- Thoroughly wash their hands after using the toilet and before food preparation.
Basis for recommendation
Avoidance of contaminated food and water
- Recommendations on avoidance of contaminated food and water and particular foods are based on expert opinion in guidance for the prevention and control of hepatitis A infection from the Health Protection Agency [HPA, 2009a] and a review document produced by the National Travel Health Network and Centre [NaTHNaC, 2009].
Hand washing
- Recommendations on hygiene are based on guidelines from the Health Protection Agency [HPA, 2009a].
Prescriptions
For information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC) (http://emc.medicines.org.uk), or the British National Formulary (BNF) (www.bnf.org).
Hepatitis A vaccine - adults
Age from 16 years onwards
Hepatitis A vaccine (Epaxal)
Epaxal emulsion for injection 0.5ml pre-filled syringes
Give 0.5ml by intramuscular injection.
Supply 1 0.5ml prefilled syringe.
Hepatitis A vaccine (Havrix Monodose)
Havrix Monodose suspension for injection 1ml pre-filled syringes
Give 1ml by intramuscular injection.
Supply 1 1ml prefilled syringe.
Hepatitis A vaccine (Avaxim)
Avaxim suspension for injection 0.5ml pre-filled syringes
Give 0.5ml by intramuscular injection.
Supply 1 0.5ml prefilled syringe.
Hepatitis A vaccine - children
Age from 1 year to 15 years 11 months
Hepatitis A vaccine (Epaxal)
Epaxal emulsion for injection 0.5ml pre-filled syringes
Give 0.5ml by intramuscular injection.
Supply 1 0.5ml prefilled syringe.
Hepatitis A vaccine (Havrix Junior Monodose)
Havrix Junior Monodose suspension for injection 0.5ml pre-filled syringes
Give 0.5ml by intramuscular injection.
Supply 1 0.5ml prefilled syringe.
Age from 1 year to 17 years
Hepatitis A vaccine (Vaqta Paediatric)
VAQTA Paediatric suspension for injection 0.5ml pre-filled syringes
Give 0.5ml by intramuscular injection.
Supply 1 0.5ml prefilled syringe.
Hepatitis A + hepatitis B combined: rapid schedule
Age from 1 year to 15 years 11 months
Hepatitis A + hepatitis B vaccine (Ambirix)
Ambirix vaccine suspension for injection 1ml pre-filled syringes
Give 1ml by intramuscular injection.
Supply 1 1ml prefilled syringe.
Age from 16 years onwards
Hepatitis A + hepatitis B vaccine: rapid schedule
Twinrix Adult suspension for injection 1ml pre-filled syringes
Give 1ml by intramuscular injection. For rapid primary immunization, give 3 doses on days 0, 7, and 21.
Supply 1 1ml prefilled syringe.
Hepatitis A and hepatitis B combined vaccine
Age from 1 year to 15 years 11 months
Hepatitis A + hepatitis B vaccine (Twinrix Paed)
Twinrix Paediatric suspension for injection 0.5ml pre-filled syringes
Give 0.5 ml by intramuscular injection. Give a second dose one month later, then give a third dose 6 months after the first dose.
Supply 1 0.5ml prefilled syringe.
Hepatitis A + hepatitis B vaccine (Ambirix)
Ambirix vaccine suspension for injection 1ml pre-filled syringes
Give 1ml by intramuscular injection.
Supply 1 1ml prefilled syringe.
Age from 16 years onwards
Hepatitis A + hepatitis B vaccine (Twinrix Adult)
Twinrix Adult suspension for injection 1ml pre-filled syringes
Give 1 ml by intramuscular injection. Give a second dose one month later, then give a third dose 6 months after the first dose.
Supply 1 1ml prefilled syringe.
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