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).
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|
|Children with chronic liver diseasea|
|Close contactsb of hepatitis A cases|
|Recommended but not funded|
|Adults with chronic liver disease: |
|Travellers – including occupationalc and recreational travel.|
|Occupational groupsc exposed to faeces, including: |
|Food handlersc during community outbreaks.|
|Military personnelc who are likely to be deployed to high-risk areas.|
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
Studies have shown that in these individuals, super-infection with HAV leads to increased morbidity and mortality.
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
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.
Immunisation with HAV vaccine is recommended (but not funded) for people in occupational groups exposed to faeces, as listed in Table 7.1 above.
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:
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).
Immunisation schedules for HAV-containing vaccines are provided in Table 7.2 below. See the manufacturers’ data sheets for more information.
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