hepatitis A vaccination

Last edited 04/2019

Hepatitis A is more common in countries outside Northern and Western Europe, North America, Australia and New Zealand

Travel abroad is a common factor in sporadic cases in the UK

• highest risk areas for UK travellers are the Indian subcontinent and the Far East, but the risk extends to Eastern Europe
  
  
• are two products for immunisation against hepatitis A
• an immunoglobulin provides rapid but temporary immunity
• vaccine confers active immunity but response is not immediate
  • vaccines are available as either monovalent, or combined with either typhoid or hepatitis B
    • Hepatitis A monovalent vaccines and those combined with either typhoid or hepatitis B do not contain thiomersal - vaccines are inactivated, do not contain live organisms and cannot cause the diseases against which they protect
      
      
• monovalent vaccines
  • currently there are four monovalent inactivated hepatitis A vaccines (which can be used interchangeably)
  • seroprotective levels of neutralising antibody may not be detected for 12-15 days following administration (2)
  • gives protection for at least one year.
  • if a patient is staying abroad for long periods or likely to travel repeatedly then a booster dose (usually given 6-12 months later - the exact time varies with product) will give protection for beyond 10 years
    
    
• combined vaccination (hepatitis A + B or hepatitis A + typhoid)
  • may be used when protection against both diseases are required

Human normal immunoglobulin

• Human normal immunoglobulin (HNIG) is prepared from pooled plasma derived from blood donations
• use of HNIG should be limited to situations where it may have a definite advantage over vaccine
• HNIG can provide immediate protection, although antibody levels are lower than those eventually produced by hepatitis A vaccine
• because of a theoretical risk of transmission of vCJD from plasma products, HNIG used in the UK is now prepared from plasma sourced from outside the UK, and supplies are scarce

Reinforcing immunisation

• a booster dose of hepatitis A vaccine should be given at six to 12 months after the initial dose - results in a substantial increase in the antibody titre and will give immunity beyond ten years, however, effective protection beyond ten years cannot be assured until this booster is given
• until further evidence is available on persistence of protective immunity, a further booster at 25 years is indicated for those at ongoing risk

Reference:

• (1) Department of Health (DH) 2019. Immunisation against infectious disease - "The Green Book". Chapter 17 - hepatitis A  
• (2) Health Protection Agency (HPA) 2009. Guidance for the prevention and control of hepatitis A infection