Transcript Hepatitis A Vaccination - NYS Conference of Environmental Health

Hepatitis A and B Vaccination and
the New York State Adult
Hepatitis Vaccination Program
Elizabeth Rausch-Phung, MD MPH
Medical Director, NYSDOH Bureau of Immunization
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Hepatitis A Virus (HAV)
• Transmission fecal-oral.
• Symptoms include fatigue, abdominal pain,
jaundice; children often asymptomatic.
• Acute phase only, never chronic, complete
recovery with lifelong immunity within 3-6
months.
• No specific treatment – supportive only.
• Hepatitis A is vaccine preventable!!
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Hepatitis B Virus (HBV)
• Transmitted through blood/body fluids.
• Symptoms similar to HAV; often asymptomatic.
• Acute phase – 90% clear the virus & develop lifelong
immunity.
• 10% develop chronic infection – can lead to cirrhosis
and liver cancer.
• Treatment only for chronic infections on case-by-case
basis.
• ~5000 deaths annually in the U.S. from HBV.
• Hepatitis B is vaccine preventable!!
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Hepatitis A Vaccine
Two inactivated whole virus vaccines available:
• Vaqta ® (Merck) and Havrix ® (GSK)
– Up to age 18: 0.5mL
– Age 19 and over: 1.0mL
Efficacy:
• Highly immunogenic.
– 94% to 100% seroconvert within a month after 2 doses.
• No boosters are currently recommended.
Administration:
• Dose 1 followed by dose 2 at least 6 months after
dose 1.
• If dose 2 is late, it is NOT necessary to repeat dose 1.
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Hepatitis B Vaccine
Two inactivated vaccines available:
• Engerix-B® (GSK) and Recombivax HB® (Merck)
– Up to age 19: 0.5mL
– Age 20 and over: 1.0mL
Efficacy:
• Protection ~ 50% after 1 dose; 85% after 2 doses; 98% after 3
doses.
Administration:
• 0, 1-2 and 4-6 months
– Minimum spacing of 4 weeks between dose 1 and dose 2.
– Minimum 8 weeks between dose 2 and dose 3.
– Minimum of 16 weeks between dose 1 and dose 3.
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Hepatitis A and B Vaccine
• Twinrix ®
– Combination hepatitis A & B vaccine (GSK).
– Approved for persons aged 18 yrs and older in the US.
– Indicated for persons at risk for both hepatitis A and hepatitis B.
• Administered in a 3 dose series at 0, 1 and 6 months
– Dose 1 and dose 2 should be separated by at least 4 weeks.
– Dose 2 and dose 3 should be separated by at least 8 weeks.
– Dose 1 and dose 3 should be separated by at least 6 months.
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Hepatitis A & B Vaccine
Administration
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Hepatitis A Vaccination
• Who should be vaccinated – Adults:
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International travelers,
Men who have sex with men,
Users of either injectable or non-injectable drugs,
Persons with HIV/AIDS,
Persons with chronic liver disease,
Persons with a diagnosis of clotting factor disorder,
and
– Persons with occupational risks.
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Hepatitis B Vaccination
• Who should be vaccinated – Adults:
– Household contacts and sex partners of persons
infected with HBV,
– Persons with > 1 sex partner in 6 months,
– Men who have sex with men,
– Persons seeking evaluation or treatment for an STD,
– Users of injectable drugs,
– Persons with HIV/AIDS,
– Persons with chronic liver disease,
– Persons with end-stage kidney disease, and
– Persons with jobs that expose them to human blood.
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Risk Assessment &
Pre-Vaccination Screening
Three questions that should be asked prior
to hepatitis vaccination:
1. Are you sick today?
2. Do you have any allergies to medications, food
or any vaccine?
3. Have you ever had a serious reaction after
receiving a vaccination?
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Contraindications and
Precautions
• Severe allergic reaction to a vaccine component
or following a prior dose, or
• Moderate or severe acute illness.
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Types of Vaccine Reactions in
Adults
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Local Reaction,
Systemic Reaction,
Allergic Reaction (anaphylactic), and
Post-Vaccination Syncope.
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Local Reactions
• Symptoms include pain, swelling, and redness at the
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injection site.
These reactions occur about 50% of the time.
These reactions occur within a few hours after
vaccination and are mild and self-limited.
If patient has soreness, redness, itching or swelling,
apply a cold compress and give analgesics if necessary.
If patient has slight bleeding, apply adhesive over the
injection site.
If patient continues bleeding, apply gauze pads and firm
pressure; raise bleeding site above level of heart.
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Systemic Reaction
• Fever, malaise, myalgias, headache, loss of
appetite, etc.
• Rarely occur when inactivated vaccines are
used, as in the case with Hepatitis A and B
vaccines.
• Typically mild and self-limited.
• Treat fever, myalgia and/or headache with
analgesics, if necessary.
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Allergic Reaction
(anaphylactic)
• Extremely rare, life-threatening reactions.
• Itching, redness, hives, swelling of lips, face or
throat, wheezing, shortness of breath, shock,
cramping or cardiovascular collapse.
• If itching & swelling confined to injection site,
observe patient for other symptoms.
• Call 911 and seek emergency help if symptoms
are generalized.
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Post-Vaccination Syncope
• Vaccine providers should strongly consider
observing patients for 15 minutes after they are
vaccinated.
– Having patients sit or lie down for 15 minutes
following vaccination could prevent most syncopal
episodes and secondary injuries.
• If syncope develops, patients should be
observed until symptoms resolve.
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Reporting Adverse Reactions
for Hepatitis A & B Vaccination
Vaccine Adverse Events Reporting System (VAERS)
• Adverse events following vaccination may be reported
by providers or the vaccinee.
• For more information and to download report forms:
http://www.vaers.hhs.gov/.
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Vaccination Documentation
• Vaccine Information Statements – It’s a Federal
Law!
• Must be provided with each dose of vaccine.
• Available in many languages.
– www.cdc.gov/vaccines
– www.immunize.org/vis
• Explains benefits and risks of a vaccine.
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Vaccination Documentation
Providers must document:
• Which VIS was given,
• Date of publication of VIS,
• Date VIS was given,
• Name and title of person administering vaccine,
• Date of administration,
• Site of administration, and
• Vaccine manufacturer and lot number.
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Vaccine Storage and
Handling
Hepatitis A and B Vaccines
• When vaccine is received, immediately store
between 2° - 8°C (35° - 46°F).
– Frozen vaccine loses potency and effectiveness.
• Refrigerators for vaccine should be
combination household or stand-alone
commercial style, not dormitory style.
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Vaccine Storage and
Handling
• Food and drink should NOT
be stored in refrigerator.
Ø
• Storage should be in middle
of refrigerator and not in the door.
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Vaccine Storage and
Handling
• Assign a staff member and backup to be in
charge of vaccine storage and handling.
• Keep a thermometer in the refrigerator.
– Check and record the temperature twice a day.
• Keep extra containers of water in the
refrigerator to stabilize temperatures.
Please do not
leave my door
open.
Thank you!
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Vaccine Storage and
Handling
• Rotate vaccine stock using shortest expiration
date first.
• Have a DO NOT UNPLUG sign posted near
refrigerator’s outlet.
• Have a back up plan in event of power outage.
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Don’t Miss An Opportunity
to Vaccinate !!!!!!!!!
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We can prevent this!!!!!
Severe ascites
(abdominal
swelling) in a
woman with chronic
Hepatitis B
infection
Photo courtesy of
Patricia Walker, MD,
Ramsey Clinic
Associates, St. Paul,
MN
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Additional References
NYSDOH Hepatitis Vaccine Information:
http://www.nyhealth.gov/diseases/communicable/hepatitis
/vaccine.htm
CDC: www.cdc.gov/hepatitis
ACIP Recommendations for Hepatitis A Vaccination:
http://www.cdc.gov/vaccines/pubs/ACIP-list.htm#hepa
ACIP Recommendations for Hepatitis B Vaccination:
http://www.cdc.gov/vaccines/pubs/ACIP-list.htm#hepb
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Additional References (con’t)
NYSDOH Immunization Page:
http://www.nyhealth.gov/prevention/immunization/
CDC Vaccine Page: http://www.cdc.gov/vaccines/
Immunization Action Coalition: http://www.immunize.org/
NYSDOH Bureau of Immunization e-mail:
[email protected]
NYSDOH Bureau of Immunization phone: (518) 473-4437
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