Over the past 15 years, the use of hepatitis A and B vaccines as recommended by the Informational Committee on Immunization Practices (ACIP) has resulted in a substantial reduction of cases of both types of viral hepatitis. In the US, an estimated 850,000-2.2 million individuals are chronically infected with the hepatitis B virus and each year, approximately 30,000-50,000 cases of hepatitis A occur. New cases of hepatitis B infection in the United states of america had been decreasing until recently; however, in contempo years, acute cases of hepatitis B have increased and there have been several outbreaks of hepatitis A.

This past year, 2 further concerns became axiomatic: one) under the influence of the national epidemic of opioid corruption, rates of hepatitis B in eye-aged adults actually started to rising and 2) outbreaks of hepatitis A accept occurred in several US cities, often amongst homeless populations.

To help address the challenges surrounding hepatitis A and B in the U.s., the National Foundation for Infectious Diseases (NFID) hosted a webinar* in Oct 2017 and subsequently developed responses to frequently asked questions:

Hepatitis A
Hep A
What is the recommended handling for astute hepatitis A virus?
Unvaccinated individuals who take been exposed recently (within 2 weeks) to hepatitis A virus (HAV) should get hepatitis A vaccine or immune globulin to prevent severe affliction. There is no specific treatment for hepatitis A. Supportive intendance, such as fluids, nutrition, and residue, is also recommended.

How strict is the recommendation to administer the end dose of hepatitis A vaccine at half dozen months? Are there data to support administering a 3rd dose if the 2nd dose is administered within 6 months of the 1st dose?
A decreased immune response may occur when doses are administered earlier than the recommended interval. Doses of any vaccine administered ≥v days earlier than the minimum interval or historic period should not be counted as valid doses and should exist repeated as age advisable. The repeat dose should be spaced later on the invalid dose by the recommended minimum interval. For example, if the first and second doses of hepatitis A vaccine were administered less than 6 months apart, the 2d dose is invalid and should be repeated at least 6 months later the invalid second dose.

Is there a risk of reactivation of hepatitis A post-infection?
Reinfection of hepatitis A does non occur. Protective antibodies (IgG) develop in response to HAV infection and confer lifelong immunity. However, relapsing hepatitis A has been described as an singular complication of hepatitis A virus infection.

Are there any current issues with hepatitis A vaccine supply on a national basis?
Yes, as of Nov 2017, in lite of ongoing outbreaks of hepatitis A amidst adults in several US cities, the demand for developed hepatitis A vaccine has increased substantially over the past 6 months and vaccine supply to meet this unexpected demand in the US has go constrained. The Centers for Disease Command and Prevention (CDC) website provides information on vaccine supply and shortages. Note that current constraints do non apply to the pediatric hepatitis A vaccine supply.

Hepatitis BHep B

Why should infants exist vaccinated against hepatitis B?
Approximately 90% of infants who are infected with hepatitis B develop chronic hepatitis B infection and near i out of 4 infected babies will die of liver failure or liver cancer equally adults. All infants should be vaccinated in the national effort to completely eliminate mother-to-infant transmission of hepatitis B.

What is the recommendation on boosters and titers with hepatitis B for healthcare professionals?
Healthcare professionals (HCPs) who may come up into contact with blood or trunk fluids during their work should exist educated and offered vaccination confronting hepatitis B. Anti-HBs testing should exist performed ane-ii months after assistants of the last dose of the vaccine series. Completely vaccinated HCPs with anti-HBs <10 mIU/mL should receive an boosted dose of hepatitis B vaccine, followed by anti-HBs testing 1-2 months later on. HCPs whose anti-HBs remains <10 mIU/mL should complete the second series (commonly six doses total), followed by repeat anti-HBs testing 1-2 months subsequently the terminal dose. Alternatively, it might be more than applied for very recently vaccinated HCPs with anti-HBs <10 mIU/mL to receive the 2nd complete series (usually 6 doses full), followed by anti-HBs testing 1-2 months after the final dose. CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management contains additional information. Once the vaccination and post-vaccination testing are complete, in that location are no recommendations for farther periodic testing to assess anti-HBs levels and there are no recommendations for routine boosting with hepatitis B vaccine.

For medical workers/students who present without written evidence of hepatitis B vaccine series, is the recommendation to titer or revaccinate (without a titer)?
HCPs defective documentation of hepatitis B vaccination should be considered unvaccinated (when documentation for hepatitis B vaccine doses is lacking) or incompletely vaccinated (when documentation for some hepatitis B vaccine doses is defective) and should receive boosted doses to complete a documented iii-dose hepatitis B vaccine series.

Hepatitis (General)

Why are non-injection drug users at risk for hepatitis?
Individuals that prepare and use not-injection drugs are typically in settings where they may take lapses in personal hygiene which increases the likelihood of disease transmission via shared equipment, drugs, or close personal contact.

If a pediatric patient receives an adult dose of either hepatitis A or B, do they need to be revaccinated?
No, yet if the vaccine serial is not consummate, that individual should receive an age-appropriate dose at the next recommended interval.

*NFID Webinar (CME/CNE): Hepatitis A and B Vaccines: Recommendations and Impact. Presented by Noele P. Nelson, Doc, PhD, MPH, Medical Officer in the Division of Viral Hepatitis at the Centers for Affliction Command and Prevention (CDC). The webinar provides information on the immunogenicity and safety of hepatitis A and B vaccines, current ACIP recommendations, and the touch on of vaccine implementation on the changing epidemiology of hepatitis A and B diseases.

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