What Hepatitis Vaccines Are Available

Origin Of Antiviral Resistance

The genetic makeup of viruses is constantly changing, which can cause a virus to become resistant to currently available treatments. Viruses can become resistant through spontaneous or intermittent mechanisms throughout the course of an antiviral treatment. Immunocompromised patients, more often than immunocompetent patients, hospitalized with are at the highest risk of developing oseltamivir resistance during treatment. Subsequent to exposure to someone else with the flu, those who received oseltamivir for “post-exposure prophylaxis” are also at higher risk of resistance.

Multiple strains of one virus can be present in the body at one time, and some of these strains may contain mutations that cause antiviral resistance. This effect, called the , results in immense variation in any given sample of virus, and gives the opportunity for natural selection to favor viral strains with the highest fitness every time the virus is spread to a new host. Also, recombination, the joining of two different viral variants, and , the swapping of viral gene segments among viruses in the same cell, play a role in resistance, especially in influenza.

Antiviral resistance has been reported in antivirals for herpes, HIV, hepatitis B and C, and influenza, but antiviral resistance is a possibility for all viruses. Mechanisms of antiviral resistance vary between virus types.

Hepatitis B Vaccine On The Nhs

A hepatitis B-containing vaccine is provided for all babies born in the UK on or after 1 August 2017. This is given as part of the 6-in-1 vaccine.

Hospitals, GP surgeries and sexual health or GUM clinics usually provide the hepatitis B vaccination free of charge for anyone at risk of infection.

GPs are not obliged to provide the hepatitis B vaccine on the NHS if you’re not thought to be at risk.

GPs may charge for the hepatitis B vaccine if you want it as a travel vaccine, or they may refer you to a travel clinic for a private vaccination. The current cost of the vaccine is around £50 a dose.

Is There A Hepatitis C Vaccine

No vaccine exists for hepatitis C right now. While efforts to develop a vaccine for this specific strain are ongoing, it’s proven challenging. That’s because hepatitis C tends to avoid immune responses. In other words, a person can catch hepatitis C repeatedly despite past infection, which is what makes it hard to create a vaccine that works for this virus.

There is an effective treatment for hepatitis C, though, and it involves direct-acting antivirals . Thanks to this treatment, WHO aims to cut 80% of hepatitis C cases worldwide by 2030. Researchers across the globe think that a vaccine is needed to accomplish this goal, so creating one is a high priority.

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Aboriginal And Torres Strait Islander People

Aboriginal and Torres Strait Islander children living in these states and territories are recommended to receive 2 doses of monovalent hepatitis A vaccine:

• the Northern Territory

This is due to the increased risk for hepatitis A in this population.1 See Epidemiology.

These children should receive:

• 1st dose at 18 months of age
• 2nd dose at 4 years of age

Aboriginal and Torres Strait Islander children < 10 years of age who have not received hepatitis A vaccine at the recommended schedule points may need extra doses of vaccine and/or an alternative schedule.

See Catch-up vaccination for more details, including minimum intervals between doses.

Hepatitis A vaccination is recommended for people with chronic liver disease of any aetiology, if they are not immune to hepatitis A.2,3 This includes:

• people with chronic liver disease
• people who have received a liver solid organ transplant
• people with chronic hepatitis B
• people with chronic hepatitis C

2 doses are required, with a recommended interval between doses of 6 months.

People with chronic liver disease should receive the vaccine as early in the course of the disease as possible. Immune responses to vaccination in these people can vary for example:

• people with chronic liver disease of mild to moderate severity mount a good immune response
• people with end-stage liver disease do not respond as well
• liver transplant recipients may not respond at all 4,5

2 doses are required, with a recommended interval between doses of 6 months.

How Are Hepatitis B And C Transmitted

A key difference between hepatitis B and C is the way they are transmitted. Hepatitis B is typically transmitted through the exchange of bodily fluids like blood and semen, while Hepatitis C can only be transmitted through blood-to-blood contact.

This means that needle sharing is a big problem for the spread of both of these viruses, especially since most people are symptomless and dont know that they’re infected.

Hepatitis C is much more limited in how it can be spread. By contrast, hepatitis B can be spread several ways, including:

• Birth: can be transmitted to a newborn during childbirth.
• Sex: can be transmitted to or contracted from a partner through intercourse.
• Sharing Items of Personal Hygiene: can be transmitted to or contracted from anyone through the use of items like razors and toothbrushes.

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How Is It Given

Like most other vaccines, PreHevbrio is injected into your muscle. Its usually given in your upper arm.

PreHevbrio is a three-dose vaccine thats given over a 6-month period. After you get your first shot, you can get your second shot 1 month later. You should get your third shot about 5 months after your second shot.

But, since its so new, PreHevbrio isnt yet incorporated into the CDCs immunization schedules.

Immunization schedules provide advice about which vaccines you should receive. They also tell you when you should receive them.

PreHevbrio will likely be added to these immunization schedules after a CDC expert panel has the chance to meet and talk about the vaccine. It’s expected this will happen in the coming months.

Immunisation Against Hepatitis B For People At Risk

In Victoria free hepatitis B vaccine is provided for people who are at increased risk, including:

• Men who have sex with men.
• People living with HIV.
• People living with hepatitis C.
• Prisoners.
• People no longer in a custodial setting who commenced, but did not complete, a free vaccine course while in custody.
• Aboriginal and Torres Strait Islander people.
• People born in priority hepatitis B endemic countries who arrived in Australia in the last 10 years priority countries include China, Philippines, Malaysia, Vietnam, Afghanistan, Thailand, South Korea, Myanmar , Indonesia, Singapore, Hong Kong, Taiwan and Cambodia.
• Vulnerable citizens people who have experienced hardship that prevented them from accessing the vaccine earlier. Vulnerable citizens are vaccinated based on an individual assessment by an immunisation provider.

Immunisation is also recommended, but not free, for people who are at increased risk including:

If you think you have been exposed to hepatitis B, see a doctor immediately. Your doctor can give you treatment that, in some instances, can greatly reduce your risk of infection with hepatitis B.

Remember that being immunised against hepatitis B does not protect you against HIV, hepatitis C or other diseases spread by blood or bodily fluids. It is important that you take precautions to make sure you are not exposed to these diseases.

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Who Should Have The Hepatitis A Vaccine

People usually advised to have the hepatitis A vaccine include:

• close contacts of someone with hepatitis A
• people planning to travel to or live in parts of the world where hepatitis A is widespread, particularly if sanitation and food hygiene are expected to be poor
• people with any type of long-term liver disease
• men who have sex with other men
• people who inject illegal drugs
• people who may be exposed to hepatitis A through their job this includes sewage workers, people who work for organisations where levels of personal hygiene may be poor, such as a homeless shelter, and people working with monkeys, apes and gorillas

Contact your GP surgery if you think you should have the hepatitis A vaccine or you’re not sure whether you need it.

Babies And Children Can Develop Chronic Hbv

You may be wondering why the recommendations for the HBV vaccine start on the first day of life.

Adults who contract HBV will likely not experience long-term complications from hepatitis B. But the same is not the case for babies. As many as of babies who contract an HBV infection at birth from their mothers become chronically infected with HBV.

Children between the ages of 1 and 5 who get an HBV infection have a 25 percent of people who become chronically infected during childhood will develop liver cancer or cirrhosis. Thats why pediatricians want children to have immunity from HBV from the earliest possible age. Many babies and children exposed to HBV receive post-exposure prophylaxis, which decreases chance of infection.

If youre pregnant, youll most likely have a blood test to see if youre positive for hepatitis B. This allows doctors to find out if theres a chance that you could pass on the virus. These tests are highly sensitive and have a good accuracy rate, but they arent perfect. Additionally, a pregnant person may become infected between the time of the test and giving birth. The first dose of the vaccine given at birth lowers the risk of a newborn baby contracting hepatitis B.

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Types Of Hepatitis A Vaccine

There are 3 main types of hepatitis A vaccination:

• a vaccine for hepatitis A only
• a combined vaccine for hepatitis A and hepatitis B
• a combined vaccine for hepatitis A and typhoid fever

Talk to your GP about which vaccine is most suitable for you. All 3 types are usually available for free on the NHS.

Plan your vaccinations in advance if you’re travelling abroad. They should ideally be started at least 2 or 3 weeks before you leave, although some can be given up to the day of your departure if necessary.

Extra doses of the vaccine are often recommended after 6 to 12 months if you need long-term protection.

You can find more information about the various hepatitis A vaccines on the NHS Fit for Travel website.

Efficacy Of Hepatitis A Vaccines

Randomised controlled trials show that the vaccines have protective efficacy of nearly 100%.28,29 This is supported by the apparent eradication of hepatitis A from Aboriginal and Torres Strait Islander communities in north Queensland and the Northern Territory since the vaccination program started in these regions.15,17,30

A single dose of Hepatitis A vaccine can confer protection for several years. There is evidence to suggest that a single dose of HAV hepatitis A vaccine can be 100% efficacious in preventing hepatitis A infection in seronegative young children in the study period from 6 weeks to 15 months post vaccination.31 Other studies have demonstrated effectiveness of a single dose in preventing hepatitis A infection up to 7 years after vaccination.25,32

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Concurrent Administration Of Vaccines

HB-containing vaccines may be administered concomitantly with other vaccines or with HBIg. Different injection sites and separate needles and syringes must be used for concurrent parenteral injections.

Refer to Timing of Vaccine Administration in Part 1 for additional information about concurrent administration of vaccines.

People Whose Occupation Increases Their Risk Of Acquiring Hepatitis A

People who live or work in rural and remote Aboriginal and Torres Strait Islander communities in the Northern Territory, Queensland, South Australia or Western Australia are recommended to receive hepatitis A vaccine.

2 doses are required, with a recommended interval between doses of 6 months.

People who regularly provide care for Aboriginal and Torres Strait Islander children in the Northern Territory, Queensland, South Australia and Western Australia are recommended to receive hepatitis A vaccine.

2 doses are required, with a recommended interval between doses of 6 months.

Early childhood educators and carers are recommended to receive hepatitis A vaccine.

2 doses are required, with a recommended interval between doses of 6 months.

Carers of people with developmental disabilities are recommended to receive hepatitis A vaccine.

2 doses are required, with a recommended interval between doses of 6 months.

Plumbers and sewage workers are recommended to receive hepatitis A vaccine.

2 doses are required, with a recommended interval between doses of 6 months.

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Value Of Past Studies With Chimpanzees

An important perspective on future research needs for chimpanzees can be gained from an evaluation of the results of previous studies. Over the last 20 years, chimpanzees have been used as experimental models of humans in several research fields, including infectious disease, reproduction, language, and behavior. The contributions with the greatest effect on human health have come from infectious-disease research that focused on the development of vaccines and new classes of therapeutic agents. Instances in which the use of chimpanzees was considered either critical or a prerequisite to introducing an agent into humans include development and safety testing of vaccines for hepatitis B virus and identification of the hepatitis C virus both of which had enormous benefit to humankind and development of novel inhibitors of neutrophil elastase. Those and other examples warrant additional discussion to emphasize the value of chimpanzees as an experimental model of human health problems.

Persons New To Canada

Health care providers who see persons newly arrived in Canada should review the immunization status and update immunization for these individuals, as necessary. In many countries outside of Canada, HB vaccine is in limited use.

All persons from a country that is endemic for HB should be assessed and vaccinated against HB if not immune and not infected. Individuals born in developing countries are more likely to be carriers of HB, necessitating vaccination of their sexual and household contacts based on review of their serologic test results. HB vaccine is recommended for all household contacts whose families have immigrated to Canada from areas in which there is a high prevalence of HB and who may be exposed to HB carriers through their extended families or when visiting their country of origin.

Children adopted from countries in which there is a high prevalence of HB infection should be screened for HBsAg and, if positive, household or close contacts in the adopting family should be immunized before adoption or as soon as possible thereafter. Adults going to pick-up children from these countries should be vaccinated before departure. Refer to Immunization of Persons New to Canada in Part 3 for additional information.

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Hepatitis Vaccine: What You Need To Know

• Warnings

Hepatitis is an inflammatory liver condition. There are five types of viral hepatitis: A, B, C,D, and E. Most cases are caused by a hepatitis virus. The condition can also be a result of excessive alcohol or drug use or a faulty inflammatory immune response that occurs when the immune system mistakes the liver as a threat to the body and begins to attack it.

There are two hepatitis vaccines that can help prevent hepatitis A and B infections. A third vaccine, developed for hepatitis E, is only permitted for use in China. This article discusses the types of hepatitis that can be prevented with a vaccine and what you need to know before getting one.

How Does Prehevbrio Compare To Other Hepatitis B Vaccines

PreHevbrio is the seventh vaccine thats FDA-approved to help prevent hepatitis B. Other hepatitis B vaccines include:

Even though PreHevbrio is the seventh hepatitis B vaccine available in the U.S., its approval is noteworthy. Its the only three-antigen hepatitis B vaccine approved for adults.

Recombivax HB, Engerix-B, and Heplisav-B can also be used by adults, but theyre single-antigen vaccines. For instance, Engerix-B targets small antigens found on the outside of HBV cells. PreHevbrio targets small, medium, and large antigens on these cells.

Twinrix is similar to Engerix-B, but it also provides protection against hepatitis A. But not every adult needs to be vaccinated against hepatitis A.

And like PreHevbrio, Recombivax HV, Engerix-B, and Twinrix are all three-dose vaccines. Heplisav-B is a two-dose vaccine.

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Hepatitis A Vaccine And International Travel

Who should get the hepatitis A vaccine before traveling internationally?

All unvaccinated people, along with those who have never had hepatitis A, should be vaccinated before traveling to countries where hepatitis A is common. Travelers to urban areas, resorts, and luxury hotels in countries where hepatitis A is common are still at risk. International travelers have been infected, even though they regularly washed their hands and were careful about what they drank and ate. Those who are too young or cant get vaccinated because of a previous, life-threatening reaction to the hepatitis A vaccine or vaccine component should receive immune globulin. Travelers to other countries where hepatitis A does not commonly occur are not recommended to receive hepatitis A vaccine before travel.

How soon before travel should I get the hepatitis A vaccine?

You should get the first dose of hepatitis A vaccine as soon as you plan international travel to a country where hepatitis A is common. The vaccine will provide some protection even if you get vaccinated closer to departure. For older adults , people who are immunocompromised, and people with chronic liver disease or other chronic medical conditions the health-care provider may consider, based on several factors, giving an injection of immune globulin at the same time in different limbs.

What should I do if I am traveling internationally but cannot receive hepatitis A vaccine?

Indications For Hepatitis A Vaccine

HepA vaccine also is indicated when any of the following is present:

• A desire for protection from hepatitis A in people not previously vaccinated

• Travel to or work in endemic areas

• Occupational exposure

• Sex between men

• Use of illicit drugs , such as methamphetamine

• Homelessness

• HIV infection in all people 1 year of age

• A chronic liver disorder

• Anticipated close personal contact with an adopted child during the first 60 days after the child’s arrival in the US from an endemic area

• Healthy adults 40 years who have recently been exposed to hepatitis A virus and adults > 40 if hepatitis A immunoglobulin cannot be obtained

• Pregnant women who are identified to be at risk of HAV infection during pregnancy or who are at risk of having a severe outcome resulting from HAV infection

During hepatitis A outbreaks, people 1 year of age who are at risk of HAV infection should be vaccinated.

The combination HepA and HepB vaccine can be used in people 18 years who have indications for either hepatitis A or hepatitis B vaccine and who have not been previously vaccinated with one of the vaccine components.

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