Hepatitis A

Transmission

Hepatitis A is caused by the virus Hepatovirus and transmitted by the faecal-oral route or person-to-person. This could be through contaminated food or drink, particularly shellfish that feed on waters polluted with sewage, and unwashed salads/ vegetables/fruits — food handlers can contaminate food also, through virus shedding, if good personal hygiene is not observed.

Vaccination schedule — Hepatitis A only

Brand Vaccine information Primary course Booster
Avaxim

 

  • Inactivated, adsorbed
  • Licensed from 16 years of age
  • Single dose
  • Effective after two weeks
  • Single dose — preferably between 6–12 months but can be up to 36 months after primary course
  • Effective immediately — can last over ten years. A further booster may be given after 25 years for on-going risk
Epaxal
  • Inactivated, virosome
  • Licensed from one year of age
  • Single dose
  • Effective immediately if concomitantly given with human gamma globulin
  • Lasts up to 12 months
  • Single dose — preferably between 6–12 months but can be up to ten years after primary course
  • Mathematic modelling estimates the booster to last at least 30 years
Havrix Monodose
  • Inactivated, adsorbed
  • Licensed from 16 years of age
  • Single dose
  • Effective after two-to-four weeks
  • Lasts up to 12 months
  • Single dose — preferably between 6–12 months
  • Some individuals show antibody response if booster is given up to three years after initial vaccination
  • Effective four weeks after booster dose if administered between 6–12 months — lasts over ten years; a further booster may be given after 25 years for on-going risk
Havrix Junior Monodose
  • Inactivated, adsorbed
  • Licensed for 1–15 years of age
VAQTA Adult
  • Inactivated, adsorbed
  • Licensed from 18 years of age
  • Single dose
  • Effective after two-to-four weeks
  • VAQTA Adult lasts up to 18 months
  • Single dose — after 6–18 months
  • Lasts for at least six years for VAQTA Adult and for at least ten years for VAQTA Paediatric — mathematic modelling predictions for both state antibodies may persist up to 25 years
VAQTA Paediatric
  • Inactivated, adsorbed
  • Licensed from 1–17 years of age

Vaccination schedule — Hepatitis A and typhoid combined

Brand Vaccine information Primary course Booster
Hepatyrix

 

  • Inactivated, adsorbed
  • Licensed from 15 years of age
  • Single dose
  • Effective after two weeks
  • Hepatitis A protection lasts up to 12 months
For hepatitis A:

  • Dose of an inactivated hepatitis A vaccine between 6–12 months
  • Lasts for at least 10 years

For typhoid:

  • Dose of Vi polysaccharide vaccine every three years, or, Hepatyrix if hepatitis A revaccination required
ViATIM
  • Inactivated, adsorbed
  • Licensed from 16 years of age
  • Single dose
  • Effective after two weeks
For hepatitis A:

  • Dose of monovalent hepatitis A vaccine between 6–12 months but can be within 36 months, or, ViATIM if typhoid revaccination required

For typhoid:

 

  • Dose of ViATIM at 36 months
  • Lasts for at least ten years

 

The information below is based on Public Health England recommendations; individual Summaries of Product Characteristics should be referred to for manufacturer recommendations regarding individual brands.

Acute illness

If a patient is suffering from an acute illness, immunisation should be postponed until they have recovered. Patients with minor infections without fever or systemic upset do not need to postpone their vaccination schedule.

Administration with other vaccines

Hepatitis A vaccine can be given at the same time as other vaccines such as hepatitis B, MMR, MenC, tetanus/diphtheria/inactivated polio vaccine (TdIPV) and other travel vaccines as long as they are administered at different sites.

Immunocompromised patients

Hepatitis A vaccine can be given to patients who are immunocompromised if they are travelling to an area of risk, however it may not be as effective. Specialist advice may be required and the importance of good personal, food and water hygiene measures while in risk areas should be emphasised.

Pregnancy and breast-feeding

No harmful effects due to hepatitis A vaccination during pregnancy or breast-feeding have been reported so it may be given when clinically indicated.