Contents

7 Hepatitis A

7.5 Recommended immunisation schedule

7.5.1 Recommendations

Hepatitis A vaccines are not on the Schedule, but are recommended and funded for the high-risk groups in the shaded section of Table 7.1 below. They may also be employer-funded or funded during an outbreak (see section 7.8).

Table 7.1: Hepatitis A vaccine recommendations

Note: Funded conditions are in the shaded rows. See the Pharmaceutical Schedule (www.pharmac.govt.nz) for the number of funded doses and any changes to the funding decisions.

Recommended and funded
Transplant patientsa
Children with chronic liver diseasea
Close contactsb of hepatitis A cases
Recommended but not funded
Adults with chronic liver disease:
  • chronic hepatitis B or C infection
  • ​other chronic liver disease.
Travellers – including occupationalc and recreational travel.
Occupational groupsc exposed to faeces, including:
  • employees of early childhood services, particularly where there are children too young to be toilet trained
  • health care workers exposed to faeces
  • sewerage workers
  • ​those who work with non-human primates (eg, zoos, research laboratories).
Food handlersc during community outbreaks.
Military personnelc who are likely to be deployed to high-risk areas.
a See also sections 4.2 and 4.3.
b Note that only one dose is funded for close contacts. Refer to the Communicable Disease Control Manual6 for a definition of contacts.
c May be employer-funded. See also section 4.6.

Individuals with chronic liver disease

HAV vaccine is recommended and funded for children with chronic liver disease and for children and adults undergoing transplants (see sections 4.2 and 4.3). People with chronic liver disease are not at increased risk for hepatitis A, but acute hepatitis A can have serious or fatal consequences.2

Chronic carriers of hepatitis B and C

Studies have shown that in these individuals, super-infection with HAV leads to increased morbidity and mortality.

Other chronic liver disease

Non-immune individuals who have not been vaccinated should receive HAV vaccine before liver decompensation. It should be given as early as possible before liver transplantation; vaccination may be performed after transplantation, although the response is unlikely to be as good as early in liver disease.7, 8

Travellers

HAV vaccine is recommended (but not funded), and if given prior to departure to the continents and countries specified in section 7.3.1 is likely to provide protection. After one dose in healthy people, protective levels of antibody have been demonstrated by two weeks, and 95–100 percent of people vaccinated will seroconvert by four weeks. Immunoglobulin is no longer available or recommended for pre-travel use.

Certain occupational groups

Immunisation with HAV vaccine is recommended (but not funded) for people in occupational groups exposed to faeces, as listed in Table 7.1 above.

Others at higher risk

Pre-immunisation screening for anti-HAV antibodies is not routinely recommended. There is no danger in vaccinating an already immune person, but some groups with higher probability of prior infection may wish to avoid the expense of vaccination. These include:

Consider HAV vaccine for the following groups:

Routine immunisation for children

HAV vaccine is not routinely recommended and is not on the Schedule for children in New Zealand. It should, however, be considered during community outbreaks (see section 7.8).

7.5.2 Immunisation scheduleTop

Immunisation schedules for HAV-containing vaccines are provided in Table 7.2 below. See the manufacturers’ data sheets for more information.

Table 7.2: Hepatitis A-containing vaccines: by age, dose and schedule

Note: Havrix and Havrix Junior are funded for eligible individualsa (Table 4.1).

Age Vaccine Dose Volume (mL) Number of doses Schedule
Hepatitis A vaccines
1–15 years Havrix Junior 720 EU 0.5 2 0 and 6–12 monthsb
2 years–adult Avaxim 160 antigen units 0.5 2 0 and 6–36 months
≥16 years Havrix 1440 1440 EU 1 2 0 and 6–12 monthsb
Hepatitis A–Hepatitis B combined vaccine
1–15 years Twinrixc 720 EU of HAV and 20 µg of HBsAg 1.0 2 0 and 6–12 months
  Twinrix Juniord 360 EU of HAV and 10 µg of HBsAg 0.5 3 0, 1 and 6 months
≥16 years Twinrix 720 EU of HAV and 20 µg of HBsAg 1.0 3 0, 1 and 6 months; or 0, 7, 21 days plus a booster at 1 year
Hepatitis A–Typhoid combined vaccines
≥15 years Hepatyrix 1440 EU of HAV and 25 µg of Vi 1.0 1 At least 14 days before departure; then boost with HAV vaccine at 6–12 monthse
≥16 years Vivaxim 160 antigen units of HAV and 25 µg of Vi 1.0 1 At least 14 days before departure; then boost with HAV vaccine at 6–12 monthse

Key: EU = enzyme-linked immunosorbent assay (ELISA) units of hepatitis A virus protein; HAV = hepatitis A virus; HBsAg = recombinant hepatitis B surface antigen; Vi = Salmonella typhi polysaccharide

Notes

a Note that two doses of hepatitis vaccine are funded for transplant patients and children with chronic liver disease; one dose is funded for close contacts of hepatitis A cases.
b Even after a longer interval between the 1st and 2nd doses, there is no need to restart the series. A substantial anamnestic response occurs after a 2nd dose given up to 8 years after the initial dose.9
c For children not previously exposed to the hepatitis A or B viruses. Source: GlaxoSmithKline NZ Ltd. 2011. Twinrix and Twinrix Junior New Zealand Data Sheet. URL: http://medsafe.govt.nz/profs/datasheet/t/Twinrixinj.pdf (accessed 28 August 2015.)
d Use when the child is at immediate risk of exposure to hepatitis B (eg, travellers) and did not receive a primary course of hepatitis B vaccine as an infant. Source: GlaxoSmithKline NZ Ltd. 2011. Twinrix and Twinrix Junior New Zealand Data Sheet. URL: http://medsafe.govt.nz/profs/datasheet/t/Twinrixinj.pdf (accessed 28 August 2015.)
e If the individual remains at risk from typhoid fever, a single dose of the typhoid vaccine is recommended every 3 years.