Hepatitis A
Hepatitis A is a viral infection that attacks the liver, causing asymptomatic-to-severe illness.Most often, HAV infection produces a self-limited illness that does NOT result in chronic infection or chronic liver disease. Infected adults develop signs and symptoms of illness more often than children. It is usually transmitted from person-to-person by ingestion of contaminated food or water or through direct contact with an infected person. It is estimated that tens of millions of individuals worldwide have experienced hepatitis A viral infection (HAV) each year in developing countries due to poor hygiene standards. The infection causes no clinical signs and symptoms in more than 90% of those infected. Recovery from the infection confers lifelong immunity, and the infection has no special significance to those infected early in life. This HAVRIX (Hepatitis A Vaccine) Package Insert (pdf)
VAQTA (Hepatitis A Vaccine, Inactivated) Package Insert (pdf)
TWINRIX [Hepatitis A & Hepatitis B (Recombinant) Vaccine Package Insert ]
November 2, 2018 - Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel These are recommendations for giving a Hepatitis A vaccine AFTER you have contracted the infection.....
March 14, 2018 - Hepatitis A vaccination coverage among adolescents (13–17 years) in the United States, 2008–2016 "Strengthening the ACIP recommendations for catch-up would likely help improve HepA vaccine series 1 and 2 dose coverage. It is important for physicians to follow the current permissive ACIP recommendations and consider catch-up vaccination of unvaccinated children aged 2–18 years in order to improve population protection from HAV."
March 7, 2018 - The National Vaccine Advisory Committee at 30: Impact and opportunity "Notably, in 1988 ACIP recommended vaccination of all children against 8 diseases (i.e., diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, and Haemophilus influenzae type b), and 30 years later the recommendations cover 16 diseases (i.e., the 8 above plus hepatitis B, hepatitis A, rotavirus, pneumococcal disease, influenza, meningococcal disease, HPV, and varicella). ... Further, despite substantial progress in reducing vaccine-preventable diseases of childhood (due to very high coverage with highly effective vaccines), significant effort remains to achieve the same for adults. NVAC will most likely need to focus on overcoming barriers and facilitating vaccine uptake of recommended vaccines for adults. In addition, vaccine hesitancy and vaccine confidence will likely continue to represent priorities, for which NVAC will likely play a continued role in addressing public and professional concerns."
November 7, 2017 – Immunogenicity of aluminum-adsorbed hepatitis A vaccine (Havrix) administered as a third dose after primary doses of Japanese aluminum-free hepatitis A vaccine (Aimmugen) for Japanese travelers to endemic countries “This vaccine is a lyophilized inactivated aluminum-free hepatitis A vaccine (Aimmugen). The standard schedule of Aimmugen is three doses (at 0, 2–4 weeks, and 6 months). … The three scheduled doses consisting of two doses of Aimmugen plus a third dose with Havrix is more immunogenic than using only two doses of Aimmugen.” Comment: Global is the new keyword for money. GSK will be making profits off Japan, and Havrix does contain aluminum.
March 2017 - Effectiveness of vaccination recommendations versus mandates: Evidence from the hepatitis A vaccine "Using provider-verified immunization data I find that recommendations significantly increased hepatitis A vaccination rates among young children by at least 20 percentage points, while mandates increase rates by another 8 percentage points."
January 9, 2017 - Physician Knowledge and Attitudes about Hepatitis A and Current Practices Regarding Hepatitis A Vaccination Delivery "Gaps in knowledge regarding HAV infection and HepA recommendations and lack of a strong recommendation for routine HepA vaccination of young children among FMDs likely contribute to suboptimal coverage. Closing knowledge gaps and addressing barriers' that prevent all physicians from strongly recommending HepA vaccine' to 1-2-year-olds 'could help increase HepA vaccine coverage and ultimately improve population protection against HAV infection.
January 3, 2017 - A Randomized Controlled Trial to Evaluate a Potential Hepatitis B Booster Vaccination Strategy Using Combined Hepatitis A and B Vaccine[ .] "The adverse events were not statistically different among groups. Combined hepatitis A and B vaccine could stimulate both a high level of anti-HAV and anti-HBs antibodies and not increase adverse events, providing a new choice for hepatitis B booster. The trial was registered with the ClinicalTrial.gov number NCT02445703.
December 23, 2016 - Evidence for Hepatitis A virus endemic circulation in Israel despite universal toddlers' vaccination since 1999 and low clinical incidence in all age groups "The outbreak began among intravenous drug users then spread to the general population. Patients' mean age was 33.2y, 4/75 (5.3%) had been vaccinated and 58/75(77.3%) were hospitalized. No common environmental source was found. HAV was detected in sewage samples: 16/27 (59.2%) from Tel-Aviv; 4/14(28.6%) collected throughout Israel and 6/6 (100%) from Gaza." Comment: This is once again showing the Hepatitis A infection is a sewage/cleanliness issue and unnecessary for children to have two doses in infancy.
May 12, 2015 - Comparison of Immunogenicity Between Inactivated and Live Attenuated Hepatitis A Vaccines Among Young Adults: A 3-Year Follow-up Study "The long-term serial monitoring of immunogenicity induced by 1 dose of inactivated hepatitis A vaccine is needed to determine an effective alternative to a 2-dose schedule."
September 2014 - Impact of environmental factors on the prevalence of autistic disorder after 1979 (pdf) Further, linear regression revealed that Varicella and Hepatitis A immunization coverage was significantly correlated to autistic disorder cases. The software was used to calculate change points. Autistic disorder change points years are coincident with the introduction of vaccines manufactured using human fetal cell lines, containing fetal and 'retroviral contaminants', into childhood vaccine regimens. This pattern was repeated in the US, UK, Western Australia, and Denmark. Thus, rising autistic disorder prevalence is directly related to vaccines manufactured utilizing human fetal cells.
March 2014 - Vaccine Eligibility in Hospitalized Children: Spotlight on a Unique Healthcare Opportunity "One hundred sixty pediatric patients ages 2 months to 17 years (mean age 8 years) were enrolled. Seventy-six percent of patients had documentation of vaccine history, and 92% were documented as receiving all age-appropriate vaccines. Actual immunization records showed that 16% percent of patients were in compliance with Advisory Committee on Immunization Practices (ACIP) guidelines. The most commonly missed vaccine was 'influenza (67%) followed by meningococcal (57%)', hepatitis A (48%), and varicella (38%). Ninety percent of parents were satisfied with the vaccination services their child had received."
January 8, 2014 - Systematic review of human papillomavirus vaccine coadministration "Our review included 9 studies, 4 of quadrivalent HPV vaccine and 5 of bivalent HPV vaccine; coadministered vaccines included: meningococcal conjugate, hepatitis A, hepatitis B, combined hepatitis A and B, tetanus, diphtheria, acellular pertussis (Tdap), and inactivated poliovirus vaccines. Studies varied in methods of data collection and measurement of immunogenicity and safety. An appropriate i'mmune response and an acceptable safety profile was demonstrated when HPV vaccine was coadministered with other vaccines."
December 30, 2013 - Reports to the Vaccine Adverse Event Reporting System after hepatitis A and hepatitis AB vaccines in pregnant women "VAERS received 139 reports of AEs in pregnant women; 7 (5.0%) were serious; No maternal or infant deaths were identified. Sixty-five (46.8%) did not describe an AE. For those women whose gestational age was available, most were vaccinated during the first trimester, 50/60 (83.3%) for Hep A and 18/21 (85.7%) for Hep A/B. The most common pregnancy-specific outcomes following Hep A or Hep A/B vaccinations were spontaneous abortion in 15 (10.8%), elective termination in 10 (7.2%), and pre-term delivery in 7 (5.0%). The most common non-pregnancy specific outcome was urinary tract infection and nausea vomiting with 3 (2.2%) reports each. One case of amelia of the lower extremities was reported in an infant following maternal Hep A immunization."
November 14, 2013 - Motor palsies of cranial nerves (excluding VII) after vaccination: Reports to the US Vaccine Adverse Event Reporting System (full text) Cranial nerve palsies were reported after a wide variety of vaccines (Table 3). Most reports (43; 63%) listed a single vaccine. Among reports listing single vaccines, the most common vaccines were influenza vaccine, human papillomavirus vaccine (HPV), influenza H1N1, and zoster vaccine live. Among reports listing recieving multiple vaccines, the most common vaccines included hepatitis A vaccine; measles, mumps, and rubella (MMR) vaccine live; diphtheria, tetanus and acellular pertussis vaccine (DTaP); Hemophilus influenzae type b vaccine (HiB); and pneumococcal conjugate vaccine 7-valent (Prevnar).
Issue 5 Volume 21, 2011 - Autoimmunity and Hepatitis A Vaccine in Children (pdf) "We found transient ANA positivity in 25% of children after hepatitis A vaccination; just 2 of these children remained positive but there was no evidence of autoimmune disease. However, other factors such as ethnicity and environment may influence the appearance of autoantibodies following vaccination. In conclusion, a larger study is required to examine the relationship between hepatitis A vaccination and autoimmunity development. Clinical evaluation of potential autoimmune side effects and the establishment of appropriate laboratory test protocols are crucial."
July 2011 - Real-life versus package insert: a post-marketing study on adverse-event rates of the virosomal hepatitis A vaccine Epaxal in healthy travelers. "The most common AEs listed in the package insert were reported almost exclusively with solicited questioning. The reporting of local AEs was more likely than that of systemic AEs to be influenced by subjects' sex, age and study center Women reported higher rates of AEs than men. The results highlight the need for detailing the methods of how the vaccine tolerability was reported and assessed."
May 19, 2006 - Prevention of Hepatitis A Through Active or Passive Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP) "An estimated 1.3 million persons in Europe and Asia were vaccinated with HAVRIX before the vaccine's licensure in the United States in 1995. Reports of serious adverse events, received by the vaccine manufacturer included anaphylaxis, Guillain-Barré syndrome, brachial plexus neuropathy, transverse myelitis, multiple sclerosis, encephalopathy, and erythema multiforme (SmithKline Beecham Biologicals, unpublished data, 1995)."
May 25, 2005 - A functional polymorphism in the IL-10 promoter influences the response after vaccination with HBsAg and hepatitis A "In the multiple regression analysis accounting for smoking, gender, body mass index and age, the ACC haplotype (−1082, −819 and −592) had a strong influence on anti-HBs production."
June 21, 2004 - Possible Association of Guillain-Barre Syndrome and Hepatitis A Vaccination (full text) (free registration) "A 1 1/2-year-old previously healthy child was hospitalized for progressive weakness for 5 days. Ten days before admission, he received the first dose of the hepatitis A vaccine (HAVRIX 720). Five days later, he refused to walk, was weak and anorexic and had a low grade fever. No history of febrile illness was reported during the previous month."..."In our patient, the association of Guillain-Barré syndrome with hepatitis A vaccine is supported by temporal proximity of the vaccination with the onset of symptoms, lack of other precipitating factors and the immune-mediated nature of the manifestation."
January 2004- Hepatitis B surface antigenemia following vaccination with a combined vaccine against hepatitis A and B. "We report a case of transient hepatitis B surface antigenemia (HBsAg) following vaccination with a combined vaccine against hepatitis A and B in healthy adults. This phenomenon has been observed following administration of recombinant hepatitis B (monovalent) vaccine, mainly in newborns or dialysis patients."
November 2003 - Neurological adverse event after administration of the hepatitis A vaccine. "A previously healthy, 20-year-old male marine reservist experienced headache, visual disturbance, fatigue, vomiting, and behavioral changes beginning less than 3 hours after receiving the second step of a VAQTA hepatitis A vaccine. The patient was afebrile, and a complete physical examination was normal with the exception of cognition and behavior. Minor inconsistencies in his response to questions rapidly progressed to severe delirium, requiring physical and pharmacologic restraint. Complete blood count; serum levels of electrolytes, calcium, and creatinine; and liver function were normal. The phosphorous level was low at 1.7 mg/dL and corrected with supplementation."..."One possible explanation may be an inadvertent intravascular injection resulting in toxicity from aluminum hydroxyphosphate sulfate (AAHS), a component of the vaccine. Acute toxicity to such a {small amount} of aluminum (0.45 mg) would be unusual, but would be supported by the patient's low phosphorous level. Acute self-limited encephalopathy after the administration of the hepatitis A vaccine is rare; however, health care providers should be aware of this potential adverse reaction."
March 2004 - Effect of maternal antibody on immunogenicity of hepatitis A vaccine in infants. "Passively acquired maternal anti-HAV resulted in a significantly lower final antibody response when infants were administered hepatitis A vaccine at 2, 4, and 6 months of age or at 8 and 10 months of age."
March 2002 - Presence of cytokines in biological preparations. "Among the vaccines examined in this study the highest level of IL-1beta was demonstrated in inactivated hepatitis A vaccine prepared in the green monkey kidney cell line 4647, that of IL-6 in inactivated rabies vaccine produced in Syrian hamster kidney (SHK) cell culture, and that of TNF-alpha in live poliomyelitis vaccine manufactured in VERO cells."