General term for Inflammatory condition of the liver Most commonly the result of a viral infection 5 unrelated hepatotropic viruses hepatitis A B C D and E All of the hepatitis viruses cause acute ID: 1047125
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1. Hepatitis vaccines
2. HepatitisGeneral term for Inflammatory condition of the liverMost commonly the result of a viral infection 5 unrelated hepatotropic viruses (hepatitis A, B, C, D, and E)All of the hepatitis viruses cause acute hepatitis. There is no specific treatment for acute hepatitis Every 30 seconds, a person dies due to a hepatitis-related illness.
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5. These outcomes are all preventable by early childhood immunization for Hep B
6. World Hepatitis DayIn 2008, the first community-led World Hepatitis Day was celebrated.Observed each year on 28 July to raise awareness of viral hepatitisBirth day of Nobel Laureate Baruch Samuel Blumberg Discovered the hepatitis B virus (HBV) Developed a diagnostic test Developed a vaccine for the virus.
7. ‘’Hepatitis Can’t Wait”Theme of World Hepatitis Day 2021Specifically aims to increase early testing and treatment to reduce the risk of liver cancer. WHO : eliminate viral hepatitis as a public health threat by 203042 per cent of children globally have access to the birth dose of the hepatitis B vaccine
8. Hepatitis A virusRelatively benign infection in young children. s 85% of children below 2 years and 50% of those between 2 years and 5 years infected with HAV may have no symptoms at all 70–95% of adults with hepatitis A are symptomatic with a mortality of 1%. The disease severity increases irrespective of age, in those with underlying chronic liver disease.
9. HAV TRANSMISSION
10. VACCINE FACTS The first hepatitis A vaccine was approved in Europe in 1991 It is on the World Health Organization's List of Essential Medicines.Can be used as post exposure prophylaxis
11. Indian Burden :HAVA highly endemic country, is now shifting to intermediate endemicitySusceptibility in 30–40% of adolescents and adults belonging to the high socioeconomic class with regional differences Seropositivity in Kerala being lower than other states)Studies also show a reduction in cord blood seropositivity (indicative of young adult seronegativity) for HAV over the years.
12. Individual Use: RECOMMENDATIONSPatients with chronic liver disease.Carriers of hepatitis B and hepatitis CCongenital or acquired immunodeficiencyTransplant recipientsAdolescents seronegative for HAV who are leaving home for residential schoolsTravelers to countries with high endemicity for hepatitis AHousehold contacts of patients with acute HAV infection within 10 days of onset of illness in the index case.
13. TYPES OF VACCINESHM 175/ GBM strains formalin inactivated and adjuvanted with aluminum hydroxideA liposomal adjuvanted hepatitis A vaccine derived from the RG-SB strainCombination of hepatitis A and hepatitis B vaccines is also availableCombinations of hepatitis A vaccine with Vi-polysaccharide vaccines are available internationally though not in India.
14. LIVE ATTENUATED HEPATITIS A VACCINEH2 strain of the virus attenuated after serial passage in Human Diploid Cell (KMB 17 cell line ) subcutaneous ROUTE Single dose of live- attenuated vaccine is well tolerated and provides long-term immunogenicity 100% efficacy for preexposure prophylaxis and 95% efficacy for postexposure prophylaxis.does not provide postexposure protection against HAV infection during the outbreak.
15. SCHEDULE : INACTIVATEDTwo doses of inactivated hepatitis A vaccine Administer the second dose 6–18 months after the first.Minimum age for giving hepatitis A vaccine is 12 months.ROUTE :IM
16. SAFETY PROFILEAdverse reactions are minor and usually include local pain and swellingExcellent overall safety profileMay be safely given with other childhood vaccines Interchange of brands is permitted though not routinely recommended.
17. EFFICACY OF VACCINEEffective in around 95% of cases Immunity lasts for at least twenty years and possibly a person's entire life (anamnestic response )
18. LOWER VACCINE EFFICACYElderlyImmunocompromisedChronic liver diseaseTransplant recipients Preexisting maternal antibodies.
19. Screening for Hepatitis A AntibodiesPrevaccination screening for hepatitis A antibody in children more than 10 years of agecost of screening to identify those susceptible to get hepatitis A infection is lower than the cost of vaccine
20. HEPATITIS B VACCINEAll of the hepatitis viruses cause acute hepatitis; HBV frequently cause chronic hepatitis. Younger the age of acquisition of HBV infection, higher the chances of becoming a chronic carrier. HCC is the most common type of primary liver cancer.
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22. HEPATITIS B IN INDIAPrevalence of hepatitis B surface antigen (HBsAg) is 3–4.2% Over 40 million HBV carriersHigh prevalence rate in the tribal population. Every year over 115 000 Indians die of hepatitis B related complicationHepatitis B seropositivity was 2.9% amongst pregnant women in India.India introduced HB vaccine in the Universal Immunization Program (UIP) on a pilot basis in 14 cities and 33 districts in 2002–2003 and the entire country in 2011–2012
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24. HBV TRANSMISSIONPercutaneous (through the skin), mucosal, or non-intact skin exposure to infectious blood or body fluids.HBV is concentrated most highly in blood, detected in saliva, tears, and bile. Semen and vaginal secretions are infectious Cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid are also considered potentially infectious.
25. Not efficient vehicles of transmissionUrine,feces, vomitusNasopharyngeal washings, sputumsweat …………………….. unless they contain blood HBV infection is not a contraindication to breastfeeding.
26. UNIVERSAL HEPATITIS B VACCINATIONWHO has recommended universal hepatitis B vaccination.All national programs should include a monovalent hepatitis B vaccine birth doseSafe and effective vaccines against hepatitis B have been available since 1982Current vaccine extremely safe and well tolerated.The primary three-dose vaccine series induces protective antibody concentrations in >95% of healthy infants, children, and young adults.
27. HEPATITIS B VACCINEActive substance : the viral surface protein HBsAg (hepatitis B surface antigen Recombinant technology in yeast and adjuvanted with aluminum salts T-cell dependent vaccine(immune memory)Available as Monovalent formulations for birth doses or for vaccination of older persons at riskAvailable as single and multidose vials Pentavalent/Hexavalent formulation
28. VACCINE: HEP B :DOSE & ROUTEDOSEChildren and adolescents (aged less than 18 years) : 0.5 mL/10 μg 18 years and older : 1 mL/20 μg. ROUTEIntramuscularly in the deltoid/anterolateral thigh. STORAGEShould be stored at 2–8°C. Relatively heat-stable Should not be frozen; frozen vaccine should be discarded
29. SCHEDULE0-1-6 schedule is the preferred schedule(two priming doses administered 1 month apart)Longer intervals between the last two doses result in higher final antibody concentrations. The primary three-dose hepatitis B vaccination series for monovalent vaccines: monovalent birth dose followed by either two doses of monovalent or hepatitis B-containing combination vaccine Four doses of hepatitis B vaccine may be given for programmatic reasons The additional dose is not harmful.
30. OTHER SCHEDULESSchedules are very flexible NO ADDITIONAL VISITS NEEDED for immunization. • Birth, 6, and 14 weeks • Birth, 6 weeks, 6 months • Birth, 6 weeks, 10 weeks, 14 weeks.None of the above schedules needs a booster.
31. BIRTH DOSEDelay in administration of the birth dose to infants of chronically infected mothers increases the risk of perinatal HBV transmission.The birth dose can reduce perinatal transmission by 18–40%.90% of those who are infected at birth go on to become chronic carriers 25% of chronic carriers will die of chronic liver disease as adults. Pregnant women encouraged to opt for HBsAg screening. If the mother is known to be HBsAg negative, routine schedule.
32. IMMUNIZATION OF PRETERM INFANTSPreterm infants and low-birth weight infants with birth weight< 2,000 grams have a decreased response to hepatitis B vaccinesGreater than 2,000 g: As for full-term infantsLess than 2,000 g:Mother HBsAg negative: Dose 1 at 30 days of age, dose 2 and 3 as per schedule adopted for full-term infants.
33. Catch-up Vaccination0-1-6 schedule should be offered to all children/adolescents not been previously vaccinated with hepatitis B vaccinePrevaccination screening for HBsAg should be done in contacts of HBsAg positive patient.
34. HIGH RISK INDIVIDUALSSeroconversion rates lower in elderly the immunocompromised chronic renal failure. Anti-HBs levels should be checked periodicallyBooster vaccination given whenever levels drop to below protective levelsFour doses at 0,1, 2, and 12 months of double dose may be given in these patients.
35. HEALTHCARE WORKERSRoutinely offer Vaccine to persons in high -risk settings that includes health care workers, public safety workers, trainees in blood or blood-contaminated body fluid.Medical students and trainees SHOULD be offered the vaccine, as exposure is more common during the training period.0, 1, and 6 months schedule PREFERREDAn accelerated schedule may be required as dose 1 of the series at any visit, dose 2 at least 4 weeks after dose 1 and dose 3 at least 8 weeks after dose 2 and at least 16 weeks after dose Postvaccination testing should be done 1–2 months after the last dose of vaccine
36. NON RESPONDERSAnti-HBs concentration of 10 mIU/mL measured 1–3 months after administration of the last dose of the primary vaccination series is a reliable correlate of protection All infants born to HBsAg positive mothers should be tested for HBsAg and anti-HBsAg antibodies at the age of 9–15 monthsAnti-HBs concentration of <10 mIU/Ml…NON RESPONDERSShould be tested for hepatitis B carrier status. If found to be negative, the same three-dose schedule should be repeatedFollowing exposure to hepatitis B in patients who are nonresponders , two doses of HBIg 1 month apart are indicated.
37. Management of an Infant Born to Hepatitis B Positive MotherMother’s HBsAg status is not known: hepatitis B vaccination should begin ASAPHBIg along with hepatitis B vaccine within 12 hours of birth( using two separate syringes and separate sites for injection.)HBIg may be given up to 7 days of birth but the efficacy of HBIg after 48 hours is not known. Three more doses of Hepatitis B vaccine should be administered at 6–10–14 weeks as part of combination vaccine. If HBIg is not available (or is unaffordable), hepatitis B vaccine may be given at 0, 1 and 2 months with an additional dose between 9 months and 12 months.
38. Efficacy of prophylaxis Both HBIg and hepatitis B vaccine is 85–95% Hepatitis B vaccine alone (first dose at birth) is 70–75%. All infants born to HBsAg positive mothers should be tested for HBsAg and anti-HBsAg antibodies at the age of 9–15 months to identify carriers/nonresponders.
39. INTERACTIONSdo not interfere with the immune response to any other vaccine and vice versa. immune responses and safety of hepatitis B-containing combination vaccines are comparable to those observed when the vaccines are administered separately
40. HEPATITIS B IMMUNOGLOBULINprovides passive immunity along with hepatitis B vaccine in management of perinatal/occupational/sexual exposures to hepatitis B Dose of in neonates/infants 0.5 mL. never be given intravenously HBIg should be stored at 2–8°C and should not be frozen. following exposure to hepatitis B in patients who are nonresponders to hepatitis , two doses of HBIg 1 month apart are indicated.
41. Routine testing for anti-HBsAg levels 1 month after completion of the immunization scheduleRecommended in children born to HBsAg positive mothers health care workers comorbidities. Antibody titers greater than 10 mIU/mL signify a response and are considered protective.For immunocompetent HCP, periodic testing or periodic boosting is not needed.
42. HEPATITIS B BRANDS IN INDIABevac - Bio E [Vaccine, Hepatitis B] Biovac- B - Wockhardt [Vaccine, Hepatitis B] Engerix-B - GSK [Vaccine, Hepatitis B] Enivac-HB - Panacea [Vaccine, Hepatitis B] Genevac-B - Serum Institute [Vaccine, Hepatitis B] HB-Vac - Zydus (Biogen) [Vaccine, Hepatitis B]51 Brands of Hepatitis B (recombinant) vaccine listedMost brands cost range from Rs 35 to 300