The underestimated risk of hepatitis A and hepatitis B: benefits of an accelerated vaccination schedule

Abstract

Hepatitis A virus (HAV) and hepatitis B virus (HBV) are vaccine-preventable. Current recommendations advocate vaccination of non-immune adults at risk of exposure, including travelers to HAV or HBV endemic areas, individuals with high risk of contracting a sexually transmitted infection, and some correctional facility inmates. We review the use of an accelerated schedule to administer the combination hepatitis A and hepatitis B vaccine (Twinrix). Administering three doses over three weeks and a fourth at 12 months provides rapid initial protection of most individuals for whom the standard 6-month vaccination schedule would not be suitable, including last-minute travelers and short-term correctional facility inmates. Furthermore, we consider the role of a universal vaccination strategy in preventing the spread of HAV and HBV.

Effects of a Nurse-Managed Program on Hepatitis A and B Vaccine Completion Among Homeless Adults

“…These specific subgroups include the young and newly homeless persons and those who were least likely to seek substance use programs. Finally, considering accelerated time sequence HAV/HBV vaccine series may also be helpful (Keystone & Hershey, 2008). …”

United Kingdom National Guideline on the Management of the viral hepatitides A, B and C 2015

“…Test for response (anti-HBs >10 IU/l, ideally >100 IU/l) 4-12 weeks after the last dose (1A). 59,[97][98][99][100][101][102]108,109 Only 80% of ultra-rapid vaccine recipients will have detectable anti-HBs antibodies at this stage (see 'Sexual and other contacts' above). If someone is at high risk of acquiring infection and are in the 20% without an early antibody response, consider further booster doses (1C).…”

“…[112][113][114][115] 3.9.5 Table: Vaccination schedules for hepatitis B using monovalent vaccine or combined AþB vaccine. [41][42][43]59,[96][97][98][99][100][101][102][103][104][105][106] . It is probable that booster doses of vaccine are not required for at least 15 years in immunocompetent children and adults who have responded to an initial vaccine course, (1B) 102,116-119 although in those vaccinated in infancy 10% will be non-immune and show no immunological memory after 18 years.…”

Survival of hepatitis A virus on various food-contact surfaces during 28 days of storage at room temperature

“…The incidence of HAV cases in developed countries has significantly decreased, due to the availability of vaccine and improvements in sanitation and living conditions (Normann et al, 2008). Nevertheless, international travelers are still at risk of infection, particularly in developing countries; infection risk depends on the period of stay, living environment and the incidence of HAV infection in the area visited (Keystone & Hershey, 2008). HAV is contagious and resistant to heat and disinfection agents (Koopmans & Duizer, 2004).…”