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Diseases & Vaccines / More Vaccine Preventable Diseases / Hepatitis A / Vaccine

VACCINE: HEPATITIS A

vaccine indication;  rationale for vaccination;  type of vaccine;  composition of the vaccine;  immunogenicity of the vaccine;  efficacy and long-term protection;  candidates for vaccination;  vaccination regimen and route of administration;  side effects and special precautions

1.     Vaccine indication

Hepatitis A vaccine is indicated for the prevention of infection with the hepatitis A virus (HAV) and sequelae associated with infection. The hepatitis A vaccine does not prevent hepatitis caused by other hepatitis agents such as hepatitis B virus, hepatitis C virus, hepatitis D virus, etc

2.     Rationale for vaccination

The primary objective of hepatitis A vaccination is to prevent infection with HAV, and thereby prevent:

• Relapsing hepatitis
• Fulminant hepatitis
• Cholestatic hepatitis
• Renal failure
• Neurologic complications

3.     Type of vaccine

There is only type - inactivated hepatitis A vaccine

4.     Composition of the vaccine

The vaccine is prepared by growth in MRC-5 culture cells and harvested by cell lysis. The virions are concentrated by ultrafiltration and then inactivated by formaldehyde. The vaccine is stored at 2⁰C to 8⁰C, is never frozen and must be protected from light.

5.     Immunogenicity of the vaccine

Hepatitis A vaccine is highly immunogenic with 95% to 100% seroconversion in children 2 years of age and above, 1 month following immunisation with a single dose. Individuals with an underlying chronic condition such as HIV infection and chronic liver disease respond poorly to a standard dose.

6.     Efficacy and long-term protection

Current data indicate that hepatitis A vaccines are highly efficacious in preventing clinically apparent disease. In clinical trial in children aged 1 to 16 years in Thailand, protective efficacy of the vaccine was found to be 94% following two doses of the vaccine given one month apart. Protective antibodies have been shown to persist for 5 to 8 years; however estimates are that the vaccine offers protection for at least 20 years.

7.     Candidates for vaccination

Hepatitis A vaccine is not available as part of the EPI (SA) schedule, however there are persons who are at an increased risk of HAV infection and should be vaccinated. They include the following:

• People living under conditions where sanitation is poor
• Health care workers
• Food handlers
• Recipients of blood or blood products, such as haemophiliacs
• Travellers to HAV endemic countries
• Children in day-care centres, their families, and day-care centre staff

8.     Vaccination regimen and route of administration

• Hepatitis A vaccine is given by intramuscular injection to the  deltoid muscle for children above two years of age and adults
• Two doses of the vaccine are administered at least 6 to 12 months apart for both children and adults

9.     Side effects and special precautions

Hepatitis A vaccine is highly safe. Mild side-effects include soreness at the injection site; fatigue, fever, vomiting and diarrhoea.