Hepatitis A is an infection of the liver caused by the hepatitis A virus.
Hepatitis A occurs worldwide, mostly in countries where sanitation is poor. It is one of the most frequent causes of foodborne infections. It is now rare in Northern and Western Europe, North America, Japan, New Zealand and Australia. Most cases imported into Britain have been contracted in the Indian sub-continent. Outbreaks of hepatitis A infection can occur sporadically and can be explosive.
Hepatitis A is transmitted by ingesting food or water that has been contaminated with faeces.
It can also be spread directly from an infected individual through poor personal hygiene, such as lack of hand washing.The hepatitis A virus can persist in the environment and can withstand food production processes.
Symptoms can vary from mild disease to severe disease. The disease is more likely to be severe in older adults and people with pre-existing liver disease.
The incubation period is around 14-28 days. The virus is found in faeces during this time.
Symptoms include mild fever, nausea/vomiting, diarrhoea and abdominal pain. Jaundice may also occur. Infection with hepatitis A results in lifelong immunity.
There is no specific treatment available for Hepatitis A.
It is important to observe food and water hygiene while travelling. This includes only drinking bottled water, not using ice, avoiding salads and only eating food that is piping hot when served.
There is a very safe and effective vaccine against Hepatitis A.
The Hepatitis A Vaccine
Hepatitis A vaccine is an inactivated vaccine containing dead virus. It cannot cause disease in the vaccinated individual and nor is the vaccinated individual infectious.
It should be considered for individuals aged 1 years and over travelling to or going to reside in countries where hepatitis A infection is prevalent.
1. Adult Schedule
|Vaccine Brand||Age||Method of Administration||Number of Doses||Interval Between Doses|
|Avaxim||From 16 years||Intramuscular injection to the deltoid muscle||2||2nd dose should be given ideally 6-12 months after first.|
The 2nd dose can be given up to 3 years after the 1st dose.
|Havrix Monodose||From 16 years||Intramuscular injection to the deltoid muscle||2||2nd dose should be given 6-12 months after first. |
The 2nd dose can be given up to 5 years after the 1st dose.
|Vaqta Adult||From 18 years||Intramuscular injection to the deltoid muscle||2||2nd dose should be given 6-12 months after first.|
The first dose should be given ideally 2 weeks before travel to the risk area.
2. Children’s Schedule
|Vaccine Brand||Age Range||Method of Administration||Number of Doses||Interval Between Doses|
|Vaqta Paediatric||1-17 years||Intramuscular Injection to the thigh or deltoid muscle||2||The 2nd dose should be given 6-12 months after the first dose.|
|Havrix Junior Monodose||1-15 years||Intramuscular injection to the thigh or deltoid muscle||2||The 2nd dose should be given 6-12 months after the first dose.|
Further single booster doses are required after 25 years for ongoing travel risk.
Combined Hepatitis A and Typhoid Vaccine
The combined vaccine contains inactivated Hepatitis A virus and Typhoid protein and can be given to travellers requiring protection against both diseases. The combined vaccines cannot be used in children under 15 years of age.
|Vaccine Brand||Age||Method of Administration||Number of doses|
|Viatim||From 16 years||Intramuscular injection to the deltoid muscle||1|
|Hepatyrix||From 15 years||Intramuscular injection to the deltoid muscle||1|
Booster doses Following receipt of combined Hepatitis A and Typhoid Vaccine
Hepatitis A-a single dose of Hepatitis A vaccine 6-12 months after administration of the combined vaccine provides protection for 25 years.
Typhoid-a single dose of Typhoid vaccine 3 years after administration of the combined vaccine.
The vaccine should not be given in the following circumstances:
- To infants under 1 year of age.
- There is a history of severe allergic reaction to previous dose of the vaccine or any of the components of the vaccine.
- There is a history of severe allergic reaction to formaldehyde (a preservative) or neomycin (an antibiotic).
- In illnesses with high fever (greater than 38.5 degrees Celsius).
The syringe plunger stopper and tip cap contain dry natural latex rubber that may cause allergic reaction in those that are extremely hypersensitive to latex (history of anaphylaxis reaction).
There is no evidence of harm from vaccinating pregnant women with inactivated vaccines. Therefore, the hepatitis A vaccine can be given during pregnancy if there is significant risk of exposure to the infection.
There is no evidence of harm from vaccinating breast feeding mothers with inactivated vaccines. Therefore, the hepatitis A vaccine can be given while breast feeding if there is significant risk of exposure to the infection.
Common Side Effects
- Localised injection site reactions-pain, redness
- Fever, headache, muscle ache, loss of appetite can occur, but are not common.
Interactions with Other Vaccines
The hepatitis A vaccine does not interact with other vaccines and can be given at the same time or any time before or after other vaccines including:
- Typhoid-injection or oral vaccine
- Hepatitis B vaccine
- Diphtheria, Tetanus and Polio vaccine
- Rabies vaccine
- Yellow fever
- Oral Cholera vaccine
- Japanese encephalitis vaccine
- MMR combined vaccine and other vaccines in the routine UK immunisation schedule
Frequently Asked Questions
1) What does the Hepatitis A vaccine contain?
The common Hepatitis A vaccines contain:
- Medium 199 Hanks -a complex mixture of amino acids (including phenylalanine), mineral salts, vitamins and other components.
- Water for injections
- Hydrochloric acid and sodium hydroxide for pH adjustment
- Traces amounts of neomycin (an antibiotic) and formaldehyde (a preservative) may be found in the vaccines.
None of the hepatitis A vaccines contain:
- Thiomersal (mercury)
2) Can I still get the Hepatitis A vaccine if I am travelling in less than 2 weeks.
The hepatitis A vaccine can be given any time before travel up to the day of departure. This is because the incubation periods of the infection is 14-28 days and you would have immunity by the time the infection develops.
3) Can I get my second dose of hepatitis A vaccine if I had my first dose many years ago?
Studies have shown that the immune boosting effects of the Hepatitis A vaccine can occur even when the second dose is given several years after the first dose. Therefore, you do not need to start the course again and can receive your second dose several years later if required for travel.
Additionally, the manufacturer’s advise that for:
- Havrix Monodose vaccine-the second dose can be given yup to 5 years after the 1st dose.
- Avaxim-the second dose can be given 3 years after the 1st dose.
4) What if I am unwell on the day of the vaccination, should I still attend?
If you do not have a high fever, then the vaccine can be given. If you have a fever, then it is best to postpone the vaccination until you have recovered. The decision to vaccinate in minor illnesses would depend on the assessment by the clinician on the day.
5) Can the hepatitis A vaccine be given to babies?
The vaccine can only be given to infants over 1 year of age. Babies under 1 year cannot have the vaccine. If you are travelling with an infant under 1 year of age, discuss with your CityDoc clinician who will advise you on measures to prevent the disease.
6) Can I have the Hepatitis A and Typhoid combined vaccines?
The combined hepatitis A/typhoid vaccine (Viatim or Hepatyrix) can be given to individuals above 16 years of age, provided stocks are available. Children under 16 years, can only be given the separate vaccines.
7) Can Hepatitis A be given to people with chronic liver disease?
The vaccine can be given to anyone with chronic or severe disease of the liver. Indeed, hepatitis A is more likely to cause severe illness in those who have pre-existing liver disease and thus, vaccination is recommended. The vaccine is inactivated and cannot cause liver disease.
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