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.
Who Should Not Receive Hepatitis A Vaccine
There are a very few situations where the hepatitis A vaccine is not recommended. They include:
- If you have an illness causing a high temperature. In this situation, it is best to postpone vaccination until after you have fully recovered from the illness.
- If you have had an allergic reaction to the vaccine or to any of its components in the past.
- One type of vaccine should not be given to anyone who is known to be allergic to eggs.
- Children under the age of 1 year. However, the risk of hepatitis A in children under the age of 1 year is very low. The hepatitis A vaccine is not licensed for this age group.
The vaccine may be given if you are pregnant or breastfeeding and vaccination against hepatitis A is thought to be necessary.
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?
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How Does Hepatitis A Spread
Contaminated food or water is the most common source of hepatitis A infection. Contamination can happen at any point in the food growing, processing or cooking process. Travelers are at an increased risk. Take extra precautions in developing countries with poor sanitary conditions.
It is possible for the disease to spread through close contact with an infected person. This includes sex or caring for an infected person.
Vaccination is the best form of protection.
How And When Do Doctors Give Vaccines
For the hepatitis A vaccine:
You should get two doses, given as shots, 6 months apart for complete protection. The virus in the vaccine is killed .
Children should get the first dose between 12 and 23 months of age. Children older than age 2 can get the first dose at their next doctorâs visit.
If you need the vaccine because of upcoming travel, get it at least 1 month before you go.
For the hepatitis B vaccine:
For long-lasting immunity, you need three to four doses, depending on which type of vaccine is used. You get them as shots.
Children should get their first dose at birth and complete the series by age 6 months. Usually, the baby would get a second dose at 1 month old and the third dose at 6 months.
Babies born to women who have hepatitis B need a shot of hep B antibodies, as well as their first hep B vaccine shot, when theyâre born. They will also need follow-up blood tests to make sure theyâre OK.
Catch-up vaccinations are recommended for children and teens who were never vaccinated or who did not get all three shots.
If you’re an adult who wants to be vaccinated, you should talk about it with your doctor or pharmacist. If you are considering both vaccines, ask your doctor about vaccines that combine hep A and B.
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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.
Should I Get The Hepatitis A Vaccine
Hepatitis A vaccination is recommended for:
- Travelers to countries that have high rates of hepatitis A
- Family members or caregivers of a recent adoptee from countries where hepatitis A is common
- Men who have sex with men
- People who use injection and non-injection drugs
- People with chronic liver diseases, such as hepatitis B or hepatitis C
- People who are teated with clotting-factor concentrates
- People who work with hepatitis A infected animals or in a hepatitis A research laboratory
- People who are experiencing homelessness
- People age 40 and older at increased risk for hepatitis A infection, or who are at increased risk for severe disease from hepatitis A infection who also have other risk factors
- People age 19 or older at increased risk for hepatitis A infection, or who are at increased risk for severe disease from hepatitis A infection who also have other risk factors
Health care providers recommend that all children receive a hepatitis A vaccination at around 1 year of age, but many adults have never received the vaccine because it only became available in 1995.
Health care personnel and patients with the following conditions should discuss the hepatitis A vaccination with their health care provider: pregnancy, immunocompromising conditions, HIV infection, heart disease, chronic lung disease, chronic alcoholism, asplenia, kidney failure.
You should NOT get the hepatitis A vaccination or you should wait, if you:
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How And When Should You Receive The Hepatitis A Vaccine
You receive the injection of the hepatitis A vaccine in the muscle of your upper arm. Start the vaccine series when you are at risk of infection and at least one month before traveling. You need two doses six to twelve months apart.
There are also combination vaccines for adults that protect against both hepatitis A and hepatitis B. However, these have a different dosing schedule. Ask your doctor for details. You might prefer this option if, for example, you are traveling to countries with high rates of both diseases.
People At High Risk For Hepatitis A
Some people are more likely than others to get hepatitis A. The following groups of people may be at an increased risk of hepatitis A and should get the vaccine:
- People who are homeless
- People who use drugs, either injection or non-injection
- Men who have sex with men
- People in jail or prison
- People who recently got out of jail or prison
- People who are exposed to a hepatitis A outbreak
- People who travel to countries with high rates of hepatitis A
- This includes countries in Central and South America, Asia , Africa, Eastern Europe, and Mexico. If you plan to go to one of these areas you should get your first dose of hepatitis A vaccine at least four weeks before you travel.
If you are traveling:
- Start the hepatitis A vaccine series at least four weeks before you travel.
- Babies aged six months and older should get the hepatitis A vaccine before any travel outside of the U.S.
- For more information, see Health for Travelers and Immunizations for Travelers.
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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.
Common And Local Adverse Events
HA vaccine is well tolerated. Reactions are generally mild and transient, and are usually limited to soreness and redness at the injection site. Other less frequent reactions include headache, irritability, malaise, fever, fatigue and gastrointestinal symptoms. Injection site reactions occur less frequently in children than in adults as do mild, systemic events . No significant difference in reactions is evident between initial and subsequent doses of vaccine or in the presence of pre-existing immunity.
Refer to Hepatitis B Vaccine in Part 4 for information about HAHB vaccine.
Injection site reactions following receipt of standard human Ig include tenderness, erythema and stiffness of local muscles, which may persist for several hours. Mild fever or malaise may occasionally occur.
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How Is Hepatitis A Spread
The hepatitis A virus is found in the bowel movements of infected persons. People with hepatitis A infection who use the bathroom without proper hand washing can pass the virus on to others through food preparation or other hand-to-mouth contact. The disease can also be spread by sexual contact, or sharing of equipment used in illegal drug use, such as needles or pipes.
Hepatitis A can also be spread by drinking contaminated water, or by eating raw or under-cooked shellfish, such as crabs, clams, oysters or mussels that have been contaminated with sewage.
Are There Any Adults Who Should Not Get The Vaccine
Do not get the hepatitis vaccine if you:
- Have ever had a severe allergic reaction to a hepatitis A vaccine or to any vaccine component hepatitis A vaccines contain alum and some contain 2-phenoxyethanol.
- Are ill, unless it is a mild illness
- Are pregnant, unless you are at greater risk for contracting hepatitis A
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What You Need To Know
1. What is hepatitis A?
Hepatitis A is a serious liver disease caused by the hepatitis A virus . HAV is found in the stool of persons with hepatitis A. It is usually spread by close personal contact and sometimes by eating food or drinking water containing HAV.
Hepatitis A can cause:
- severe stomach pains and diarrhea
People with hepatitis A often have to be hospitalized .
Sometimes, people die as a result of hepatitis A .
A person who has hepatitis A can easily pass the disease to others within the same household.
Hepatitis A vaccine can prevent hepatitis A.
2. Who should get hepatitis A vaccine and when?
Some people should be routinely vaccinated with hepatitis A vaccine:
- All children 1 year of age.
- Persons 1 year of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A, such as those located in Central or South America, Mexico, Asia , Africa, and eastern Europe. For more information see www.cdc.gov/travel.
- Children and adolescents through 18 years of age who live in states or communities where routine vaccination has been implemented because of high disease incidence.
- Men who have sex with men.
- Persons who use street drugs.
- Persons with chronic liver disease.
- Persons who are treated with clotting factor concentrates.
- Persons who work with HAV-infected primates or who work with HAV in research laboratories.
Other people might get hepatitis A vaccine in special situations:
5. How can I learn more?
What Is The Hepatitis A Vaccine
Hepatitis A vaccination provides the best form of protection against the virus. Most vaccinations come in two doses given six months apart. Most children are vaccinated around one-year-old.
Studies indicate the vaccine protects for 40 years or more.
Immune globulin is an alternative to hepatitis A vaccination that provides short-term protection for travellers. This is also offered at Passport Health locations across North America.
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Should Pregnant Or Breast
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.
Who Should Get A Hepatitis A Vaccine
The hepatitis A vaccine is recommended for everyone over the age of 1 year. The PHAC highly recommends vaccination for individuals in the following groups:
- Work or travel to countries with hepatitis A
- Live in an area where hepatitis A is present
- Are homosexual and identify as male
- Use street drugs
- Work with hepatitis A samples or patients
Many older adults have not been vaccinated against hepatitis A. Make sure youre protected with a visit to Passport Health.
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Hepatitis A Vaccine Needed
Is it ok to go to major areas like San Jose, Arenal, and Manuel Antonio without Hepatitis A vaccine. We are leaving in one week and I’ve been told it is too close to departure to have the vaccine be effective. Is it dumb to risk going without the vaccine? Can you eat fruit, lettuce, non-bottle water, ice, etc.? Please advise, anyone.
We stayed near the San Jose airport, Arenal, Mal Pais and the Osa. We did not get any special vaccines or malaria medicine for the trip.
With the exception of Bosque del Cabo in the Osa, we were told on check-in at all of the hotels we stayed at that the water was potable. We ate fruit, salads, ice, ceviche just about everywhere but we did mainly eat at our hotels or at restaurants widely recommended
Having said all that, however, I had a bit of the “traveler’s stomach” on the day we came home and for a day after. Nothing that couldn’t be handled with a little Immodium AD but I’m glad I’d packed some!
Taking malaria pills depends on where you are going. Good DEET based mosquito repellent is more important for Malaria and Dengue.
Before Taking This Medicine
Hepatitis A and B vaccine will not protect you against infection with hepatitis C or E, or other viruses that affect the liver. It will also not protect you from hepatitis A or B if you are already infected with the virus, even if you do not yet show symptoms.
You should not receive this vaccine if you are allergic to yeast or neomycin, or if you have ever had a life-threatening allergic reaction to any vaccine containing hepatitis A or hepatitis B.
Before receiving this vaccine, tell the doctor if you have:
an allergy to latex rubber or
a weak immune system caused by disease, bone marrow transplant, or by using certain medicines or receiving cancer treatments.
You can still receive a vaccine if you have a minor cold. In the case of a more severe illness with a fever or any type of infection, wait until you get better before receiving this vaccine.
FDA pregnancy category C. Tell your doctor if you are pregnant. It is not known whether hepatitis A and B vaccine will harm an unborn baby. However, not vaccinating the mother could be harmful to the baby if the mother becomes infected with a disease that this vaccine could prevent. Your doctor will decide whether you should receive this vaccine, especially if you have a high risk of infection with hepatitis.
If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of this vaccine on the baby.
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