Vaccinations for Hepatitis A and B

   On this page:

• Candidates for Hepatitis A Vaccination
• Doses and Schedules: Hepatitis A
• Candidates for Hepatitis B Vaccination
• Doses and Schedules: Hepatitis B
• Combination Vaccine
• References

Candidates for Hepatitis A Vaccination

  Routine Vaccination

• Children living in areas with high incidence rates of hepatitis A (above the national average). Check with your health department to see if this applies to your area.

  High-Risk Populations

• Travelers to developing countries with high rates of hepatitis A, including Mexico
• Men who have sex with men
• Users of illegal drugs
• People who work with hepatitis A virus in research settings
• People who work with infected nonhuman primates
• Recipients of clotting factor concentrates
• People with chronic liver disease (because of risk of fulminant hepatitis A)

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Doses and Schedules: Hepatitis A

  Postexposure Prophylaxis

Immune globulin (IG) can provide temporary immunity to hepatitis A when given within 2 weeks of exposure to the hepatitis A virus. The dose is 0.02 mL/kg injected into the gluteal muscle in adults or the anterolateral thigh muscle in children under 2 years. Concurrent hepatitis A vaccination may also be appropriate in people 2 years and older. IG protects against the hepatitis A virus for 3 to 5 months, depending on dosage.

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Candidates for Hepatitis B Vaccination

  Routine Vaccination

• All infants, children, and adolescents

  High-Risk Populations

• People with multiple sex partners and those who have been recently diagnosed with a sexually transmitted disease
• Sex partners and household contacts of HBV carriers
• Men who have sex with men
• Household contacts of adoptees from countries with high rates of hepatitis B
• Injection drug users
• Travelers to countries with high rates of hepatitis B (staying longer than 6 months)
• People with occupational exposure to blood
• Clients and staff in institutions for the developmentally disabled
• Patients with chronic kidney failure (including those on chronic hemodialysis)
• Patients receiving clotting factor concentrates
• Inmates of long-term correctional facilities

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Doses and Schedules: Hepatitis B

Age	# of     Doses	Schedule	Dose   Recombivax HB*	Dose Energix-B**
Infants with HBsAg-negative mother	3	0 to 2, 1 to 4, and 6 to 18 months	5.0 µg (0.5 mL)	10 µg (0.5 mL)
Infants with HBsAg-positive mother	3	Hepatitis B immune globulin and vaccination within 12 hours of birth, then vaccine at 1 to 2 and 6 months	5.0 µg (0.5 mL)	10 µg (0.5 mL)
Children and adolescents age 1 to 19 years	3	0, 1 to 2, and 4 to 6 months	5.0 µg (0.5 mL)	10 µg (0.5 mL)
Adolescents 11 to 15 years	2	0 and 4 to 6 months	10 µg (1.0 mL)	N/A
Adults 20 years and older	3	0, 1 to 2, and 4 to 6 months	10 µg (1.0 mL)	20 µg (1.0 mL)
Immuno-compromised adults	3	0, 1, and 6 months	40 µg (1.0 mL)	N/A
	4	0, 1, 2, and 6 months	N/A	40 µg (2.0 mL)

Note: There should be at least 1 month between the first and second doses, at least 2 months between the second and third doses, and at least 4 months between the first and third doses. For infants, the third dose should not be given before 6 months of age.

*Recombinant vaccine. Manufactured by Merck & Company, Inc.
**Recombinant vaccine. Manufactured by SmithKline Beecham Biologicals.

  Postexposure Prophylaxis

Prophylactic treatment for exposure to hepatitis B virus involves either hepatitis B immune globulin (HBIG), hepatitis B vaccine, or a combination of both. The HBIG dose equals 0.06 mL/kg. Efficacy ranges from 70 to 95 percent for different types of exposure.

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Combination Vaccine

Twinrix* is a vaccine for both hepatitis A and hepatitis B. It combines two FDA-approved vaccines—Havrix, for hepatitis A, and Engerix-B, for hepatitis B. It protects individuals 18 years of age or older against diseases caused by hepatitis A and hepatitis B viruses. The vaccine is recommended for travelers whose occupation or behavior puts them at high risk for exposure to hepatitis B virus, or who are visiting countries with a high or intermediate rate of both hepatitis viruses, as defined by the Centers for Disease Control and Prevention.

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References

Centers for Disease Control and Prevention. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report. 1999;48(RR-12).

Centers for Disease Control and Prevention. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report. 1991;40(RR-13).

Food and Drug Administration. 2001. New Combination Vaccine Approved for Protection Against Two Hepatitis Viruses. FDA Talk Paper. Available at: www.fda.gov/bbs/topics/ANSWERS/2001/ANS01084.html. Accessed February 9, 2004.

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National Digestive Diseases Information Clearinghouse

2 Information Way
Bethesda, MD 20892–3570
Email: http://digestive.niddk.nih.gov/about/contact.htm

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.

NIH Publication No. 05–4332
November 2004

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