Wednesday, May 22, 2024

Is There A Vaccine For Hepatitis A

Should Pregnant Or Breast

Hepatitis A Outbreak Reported In Nashville Amid Concerns Of Vaccine Shortage

The safety of hepatitis A vaccination during pregnancy has not been determined however, because hepatitis A vaccine is produced from inactivated virus, the risk to the developing fetus is probably low. The risk associated with hepatitis A vaccine should be discussed with your health care provider to determine if vaccination is right for you.

Guidance On Reporting Adverse Events Following Immunization

Vaccine providers are asked to report, through local public health officials, any serious or unexpected adverse event temporally related to vaccination. An unexpected AEFI is an event that is not listed in available product information but may be due to the immunization, or a change in the frequency of a known AEFI.

Refer to Reporting Adverse Events Following Immunization in Canada and Vaccine Safety and Pharmacovigilance in Part 2 for additional information about AEFI reporting.

Enhancing Healthcare Team Outcomes

Vaccination providers, including the pharmacist and nurse practitioner, commonly encounter persons who do not have adequate immunization documentation. Only written, dated records should be used as evidence of vaccination. If records are not available, these patients should receive their age-appropriate vaccination schedule or have serologic testing to determine immunity. However, not all commercially available serologic tests are sensitive enough for the detection of vaccine-induced immunity.

Vaccination administration should be as close to the recommended intervals as possible. An interruption in the vaccination schedule does not require restarting the entire hepatitis A vaccine series or the addition of extra doses.

Only severe allergy to a prior HAV is a valid contraindication to vaccination. Misperceptions by healthcare providers result in missed opportunities to administer recommended vaccinations and should be avoided. Routine physical examinations are not necessary for vaccinating persons who appear to be healthy.

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Antibody Response Following Hepa Vaccination

HepA vaccination induces immune protection by both cellular and humoral pathways. Geometric mean concentration and seroconversion rate of anti-HAV is the most widely used indicators to evaluate the immunogenicity of HepA. Anti-HAV could be detected by enzyme-linked immunosorbent assays and microparticle enzyme immunoassay , and the sensitivity differs by the detection method., The minimal protective level of anti-HAV IgG was unknown until now. Serological cutoffs for seroconversion rate differed widely between studies . Seroconversion of anti-HAV could be achieved after two doses of HepA-I among almost all children regardless of the manufacture of the vaccine.,,,,- The anti-HAV seroconversion rate could reach approximately 95% at 1430 d after the first dose of HepA-I,,,,, and the second-dose could greatly elevate the anti-HAV level postvaccination.,, A similar seroconversion rate after one-dose vaccination was reported between HepA-I and HepA-L among children and adults,,, and GMC was much higher after two doses of HepA-I compared with one-dose of HepA-I or HepA-L. The nature of the prompt immune response after HepA vaccination is important for its use for PEP.

Dose And Administration Of Hepatitis A Vaccine

Hepatitis A vaccines could soon be in short supply in ...

The HepA vaccine dose is 0.5 mL IM up to age 18 years or 1 mL IM for adults .

Children are given a 2-dose series typically at age 12 to 23 months and 6 to 18 months after the 1st dose.

Adults are given the vaccine in a 2-dose series at 0 and 6 to 12 months or 0 and 6 to 18 months .

Or adults may be given the combination HepA and HepB vaccine on a 3-dose schedule: at 0, 1, and 6 months. The 1st and 2nd doses should be separated by 4 weeks, and the 2nd and 3rd doses should be separated by 5 months. Alternatively, the vaccine may be given on an accelerated 4-dose schedule: on days 0, 7, and 21 to 30, followed by a booster 12 months after the 1st dose.

As soon as an adoption of a child from an endemic area is planned, close contacts should be given the 1st dose of the 2-dose HepA vaccine series, ideally 2 weeks before the adopted child arrives.

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Administration Of Hepatitis A Vaccine

HepA-I is licensed for intramuscular administration in a 2-dose schedule with a flexible interval between the first dose and the second dose . The timing of the second dose is not critical and a similar anti-HAV titer could be achieved after a two-dose HepA interval schedules of 6 months, 12 months or 18 months. High immunogenicity could be detected even if the interval between the two doses of HepA-I was up to 2 y. For consideration of cost, a single-dose HepA-I schedule has been integrated in the routine universal vaccination of children in Argentina, Brazil, Chile, Paraguay, Colombia and Tunisia. Compared with HepA-I, which is used widely throughout, HepA-L is mainly used in China and India and is administered as a single subcutaneous dose. Although a high seroconversion rate could be elicited after single-dose HepA-I or HepA-L, the immunity duration after one-dose HepA might be shorter compared with the two-dose schedule.

Mrna Covid Shots May Increase Autoimmune Diseases

Reports continue to increase of autoimmune diseases, including Guillain-Barré syndrome and primary biliary cholangitis, which destroys the bile ducts, occurring following COVID-19 injections.11 In another example of vaccine-induced autoimmunity, cases of immune thrombocytopenia that developed days after COVID-19 injection have also been reported to the Vaccine Adverse Event Reporting System .12

It is speculated that SARS-CoV-2 can disturb self-tolerance and trigger autoimmune responses through cross-reactivity with host cells and that the COVID-19 mRNA vaccines may trigger the same response, researchers from Ireland explained.13

They also reported the cause of autoimmune hepatitis that developed after a COVID-19 injection in a 71-year-old woman with no risk factors for autoimmune disease. She noticed jaundice four days after the shot and had markedly abnormal liver function tests. The researchers raised the possibility that this is a case of vaccine-related drug-induced liver injury and, like the other teams that reported similar cases, noted:14

These findings raise the question as to whether COVID-19 mRNA vaccination can, through activation of the innate immune system and subsequent non-specific activation of autoreactive lymphocytes, lead to the development of autoimmune diseases including AIH or trigger a drug-induced liver injury with features of AIH.

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Scientific Study Confirms Vaccine

Despite the potential risk of autoimmune hepatitis and liver damage, governments around the world continue to claim these injections are “safe and effective.”

RIO DE JANEIRO, BRAZIL Yet another side effect of a Covid jab severe hepatitis. A recent study in the peer-reviewed Journal of Hepatology has provided conclusive evidence of vaccine-induced immune-mediated hepatitis with a rapid onset of liver injury after the first Moderna dose.

Its no longer a coincidence but is now confirmed by the case study published in October.

The UK researchers concluded that inadvertent re-exposure led to worsening liver injury with deranged synthetic function.

They noted that the mRNA vaccine pathway triggers pro-inflammatory cytokines including interferon and cross-reactivity has been illustrated between the antibodies against the spike protein and self-antigens.

Despite the potential risk of autoimmune hepatitis and liver damage, the federal government claims these experimental injections are safe and effective.

The Journal of Hepatology stated:

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How Can I Contract Hepatitis A

Demand for Hepatitis A vaccine skyrockets

You can contract the hepatitis A virus by eating food or drinking beverages that have been contaminated by human fecal waste.

Resort activities that may put you at risk for hepatitis A include:

Eating food handled by an infected worker who did not wash his/her hands properly after using the washroom

Eating raw or undercooked seafood and shellfish that lived in sewage-polluted water

Eating salads or produce rinsed in contaminated water

Drinking contaminated water or drinks with contaminated ice

Bathing, showering, or swimming in contaminated water

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Factors Associated With Immunogenicity Of Hepa

Several factors could influence the antibody response post-HepA. First, the dosage of HepA plays an important role in the immunogenicity of HepA. In the early day of HepA-L manufacturing, the dose of HepA-L was 105.05.5 TCID50 and the seroconversion proportion postvaccination was 3040% , when the dose was increased to 106.52 TCID50, 106.83 TCID50 and 107.0 TCID50, the seroconversion increased to 90.4%, 94.8% and 97.5%, respectively. Now the dose of HepA-L is required to be above 106.5 TCID50 according to the Chinese Pharmacopoeia. A similar trend could be found for HepA-I. Second, the immunogenicity of HepA is found to decrease with age., Anti-HAV following HepA vaccination is much lower among vaccinees aged > 40 y when compared with younger adults,, which is the main reason why immunoglobulin instead of HepA is recommended for elderly persons for PEP during hepatitis A outbreaks in some countries. Third, obesity and smoking are reported to decrease the antibody response to HepA. In addition, maternal anti-HAV is another factor influencing the antibody response post-HepA, which lasts for 12 months in infants and might reduce the immunogenicity of HepA. Interference with the antibody response is more obvious among infants whose mothers have immunity after natural infection . Finally, according to previous studies, the immunogenicity of HepA is consistent across ethnic groups and races.,

Liver Anatomy And Function

Main Function of the Liver

The liver is an essential organ that has many functions in the body. The liver plays an important role in detoxifying the body by converting ammonia, a byproduct of metabolism in the body, into urea that is excreted in the urine by the kidneys. The liver also breaks down medications and drugs, including alcohol, and is responsible for breaking down insulin and other hormones in the body. The liver also stores vitamins and chemicals that the body requires as building blocks.

Many different disease processes can occur in the liver, including infections such as hepatitis, cirrhosis , cancers, and damage by medications or toxins.

Symptoms of liver disease can include:

  • Jaundice

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Who Should Get Hepatitis Vaccinations

Since the vaccines were first developed, the hepatitis A and B vaccines have become part of the regular childhood immunization schedule. They are not considered a routine adult immunization.

“When we’re talking about adults, I would say yes, get the vaccine if they fit into one of these risk factors” says Poland. “If they don’t fit into the risk factors, their risk is so low that there’s no compelling reason to do it.”

People at risk for hepatitis A include:

  • Anyone traveling to or working in areas where hepatitis A is more widespread.
  • People whose work puts them in potential contact with hepatitis A, such as those who work with the hepatitis A virus in research labs
  • People who are treated with clotting-factor concentrates
  • People who have chronic liver disease
  • People who use recreational drugs, injected or not
  • Men who have sex with men

People at risk for hepatitis B include:

  • Anyone traveling to or working in areas where hepatitis B is more widespread.
  • Health care workers and other people whose job exposes them to human blood
  • People with HIV infection, end-stage kidney disease, or chronic liver disease
  • People who live with someone with hepatitis B
  • People who inject street drugs
  • Sexually active people who have had more than one partner
  • Anyone who has had an STD
  • Men who have sex with men
  • Sex partners of people with hepatitis B

In Case Of Contact With An Infected Persons Blood Sperm Or Vaginal Secretions

Children and staff at school to be given Hepatitis A vaccine

Consult a health-care professional or call Info-Santé 811 immediately if:

  • You have come into contact with the blood, sperm or vaginal secretions of a person who could be infected with the hepatitis B virus. You may have to receive preventive treatment that protects you from catching hepatitis B. This treatment is called post-exposure prophylaxis. It must be administered as soon as possible after contact

Consult a health-care professional if:

  • You have come into contact with the blood of someone who could be infected with the hepatitis C virus. You can get tested and receive appropriate care, as needed

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How Is Hepatitis Contracted

There are various ways of contracting hepatitis, depending on the type. Contracting a viral form of hepatitis depends on the mode of transmission, which the table above shows.

A person may sometimes contract hepatitis nonvirally. In autoimmune hepatitis, the immune system attacks the liver cells. Ingesting substances that contain toxins, such as alcohol, can also induce some types of hepatitis.

A doctor may use a blood test to diagnose viral hepatitis.

A healthcare professional will check a persons blood for:

  • HAV-specific immunoglobulin G antibodies to diagnose HAV
  • the surface antigen HBsAg to diagnose HBV
  • anti-HCV antibodies to diagnose HCV
  • high immunoglobulin G and anti-HDV immunoglobulin M levels to diagnose HDV
  • virusspecific IgM antibodies to identify HEV

To autoimmune hepatitis, a doctor may consider:

  • symptoms

What Medications Are Available To Treat Hepatitis C

Many medications can treat and cure hepatitis C. The first medication for hepatitis C was interferon alfa-2b, but other medications are now available too.

Oral antiviral medications called direct acting antivirals were first introduced in 2011. Theyre now first-choice medications to treat hepatitis C, but the best DAA to treat hepatitis C depends on the person. Before choosing and starting a DAA, your healthcare provider will consider your medical history, take blood work, and assess how well your liver and kidneys are working.

Choosing a DAA can depend on the HCV genotype that you have. While determining if you have hepatitis C, your healthcare provider may run tests to determine your HCV genotype. But, this isnt necessary for all people some DAAs can treat many identified genotypes. The CDC recommends that people should be tested for their HCV genotype if they have cirrhosis or were previously treated unsuccessfully for hepatitis C.

DAA medications are often taken for 8 to 12 weeks when treating an acute infection, but this timeframe can vary. Recommended DAAs available to treat hepatitis C include:

If DAA medications cant be used, other medications are available. Medications like pegylated interferon , interferon , and ribavirin may be considered. The best medication to treat hepatitis C varies by person, so your healthcare provider can talk with you about which medication may be best for you.

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Interchangeability Of Hepatitis A Vaccines

Vaccine manufacturers use slightly different methods to produce the vaccines and quantify the hepatitis A virusantigen content. All monovalent hepatitis A vaccines that are given as a 2-dose course are interchangeable. See Table. Recommended doses and schedules for monovalent hepatitis A vaccines.

Schedules that mix combination hepatitis A/hepatitis B vaccines with monovalent vaccines are not routinely recommended.

An adult dose of Twinrix 720/20 contains half the hepatitis A antigen content of an adult dose of Havrix adult vaccine. These vaccines are therefore not interchangeable.

The only absolute contraindications to hepatitis A vaccines are:

  • anaphylaxis after a previous dose of any hepatitis A vaccine
  • anaphylaxis after any component of a hepatitis A vaccine

Combination hepatitis A/hepatitis B vaccines are contraindicated in people with a history of anaphylaxis to yeast.

Persons With Inadequate Immunization Records

Hepatitis A vaccine in short supply after restaurant scare

Children and adults lacking adequate documentation of immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors. HA vaccine may be given, if indicated, regardless of possible previous receipt of the vaccine or pre-existing immunity, because adverse events associated with repeated immunization have not been demonstrated.

Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information about vaccination of people with inadequate immunization records.

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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.

Who Should Be Immunised Against Hepatitis A

Travellers to countries outside Western Europe, North America and Australasia should consider being immunised. The highest-risk areas include the Indian subcontinent , Africa, parts of the Far East , South and Central America and the Middle East. Vaccination is generally recommended for anyone over the age of 1 year. Your doctor or practice nurse can advise if you should be immunised against hepatitis A for your travel destination.

You can find out if immunisation against hepatitis A is recommended for any countries you are planning to visit from the NHS website Fitfortravel.

Close contacts of someone with hepatitis A. Occasional outbreaks of hepatitis A occur in the UK within families or in institutions. Close contacts of someone found to have hepatitis A infection may be offered vaccination. This only happens rarely. The most important measure for anybody with hepatitis A is good personal hygiene. In particular, washing hands after going to the toilet or before eating.

People with chronic liver disease. If you have a persistent liver disease it is suggested that you have the hepatitis A vaccine. Hepatitis A infection is not more common in those with chronic liver disease but, if infection does occur, it can cause a more serious illness.

People exposed to hepatitis A at work. For example, laboratory workers who are exposed to hepatitis A during their work and sewage workers are advised to be immunised against hepatitis A.

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