ALBERTA IMMUNIZATION POLICY GUIDELINES

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ALBERTA IMMUNIZATION POLICY GUIDELINES

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Hepatitis Vaccines 1. Hepatitis A Vaccines

Refer to the vaccine product monograph and the Canadian Immunization Guide¹ for further information.

Product monographs are available on the Health Canada website:

http://webprod5.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp

Trade Name/

Manufacturer

HAVRIX®² - GlaxoSmithKline Inc.

VAQTA®³ - Merck Frosst Canada Ltd.

Indications for use of

provincially funded vaccine

Individuals 12 months of age and older who meet one or more of the reasons as listed below:

Pre-exposure:

 Individuals with chronic liver disease, including hepatitis B and hepatitis C carriers.

 Individual candidates or recipients of liver transplantation and individuals who have developed chronic graft versus host disease following hematopoietic stem cell transplant.

 Individuals with hemophilia A or B receiving plasma- derived clotting factors.

 Workers involved in hepatitis A virus research.

 Zookeepers, veterinarians and researchers who handle primates.

 Residents of communities with high rates of hepatitis A infection, including inmates of provincial correctional facilities.

 Residents and staff of institutions for the developmentally challenged in which there is evidence of sustained hepatitis A transmission.

 Individuals with lifestyle risks of infection, including people engaging in oral sex or intravenous illicit drug use in unsanitary conditions and males having sexual contact with other males, particularly when there is a likelihood of oral-anal contact.

Pre-immunization serology for anti-HAV (IgG) is recommended for:

 Individuals born prior to 1945^2,3

 Individuals from an endemic country

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Alberta Immunization Policy – Biological Products –Hepatitis

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 Adults diagnosed as hepatitis C positive

 Adults who are diagnosed with hepatitis B Post-exposure:

 Consult with your local public health service area for

immunization that may be recommended following exposure to hepatitis A.

Dose HAVRIX®

0.5 mL - Children/adolescents 12 months up to and including 18 years of age - HAVRIX™ 720 Junior

1.0 mL - Adults from 19 years of age onwards - HAVRIX™

1440 Adult VAQTA®

0.5 mL - Children/adolescents 12 months up to and including 17 years of age

1.0 mL- Adults 18 years of age and older Route Intramuscular injection (IM)

Schedule HAVRIX®

 Dose 1 – day 0

 Dose 2 – 6 to 12 months after dose 1.

VAQTA®

One year up to and including 17 years of age:

 Dose 2 – 6 to 18 months after dose 1.

18 years of age and older:

 Dose 2 – 6 months after dose 1.

General Contraindications  Known severe allergy (anaphylaxis) to any component of the vaccine.

 Anaphylaxis or other severe allergic reaction to a previous dose of hepatitis A-containing vaccine.

Some Possible Adverse Events Following

Immunization

Local reactions:

 Soreness, redness, swelling and induration at the injection site.^2,3

 Local reactions in children occur less frequently than in adults.²

Systemic reactions:

 Headache, irritability, appetite loss, drowsiness, malaise, fatigue, fever, dizziness, rhinitis, respiratory congestion, rash, myalgia, pharyngitis, gastrointestinal symptoms and stiffness.^2,3

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References

1 National Advisory Committee on Immunization. (2012). Canadian immunization guide (Evergreen ed.). Ottawa, ON: Public Health Agency of Canada. Retrieved from www.phac-aspc.gc.ca/publicat/cig-gci/

2 GlaxoSmithKline Inc. (2011, July). HAVRIX®: Hepatitis A vaccine (inactivated).

Product Monograph.

3 Merck Frosst Canada Ltd. (2013, March). VAQTA®: Hepatitis A vaccine, purified inactivated. Product Monograph.

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2. Hepatitis B Vaccines

Trade Names/

Manufacturers

ENGERIX® - B²- GlaxoSmithKline Inc.

RECOMBOVAX HB®³ - Merck Frosst Canada Ltd.

Indications for use of provincially funded vaccine

Pre-exposure:

 Children younger than seven years of age whose families have immigrated to Canada from areas where there are high rates of hepatitis B disease. Contact your local public health service area for more information.

 Students in grade five – routine program.

 Students in grades six through 12 who have not received a series of hepatitis B vaccine.

 Individuals who are workers, volunteers or students (accepted into post-secondary educational program) and who have a reasonable anticipated risk of exposure to blood, bloody body fluids and/or sharps injuries during the course of their work.

 Individuals at risk because of chronic medical conditions including:

o Hemophiliacs and others receiving repeated infusions of blood or blood products. (Hepatitis B vaccine is not provided for parents providing home infusion for their children.)

o People with chronic liver disease who continue to have risk factors for hepatitis B.

o People with renal disease on hemodialysis or peritoneal dialysis, including those who are pre-dialysis.

o Some transplant candidates and recipients.

 Individuals with lifestyle risks of infection.

 Consult with your local public health service area for more information.

Post-exposure:

 Consult with your local public health service area for

immunization that may be recommended following exposure to hepatitis B.

Dose Please refer to Product Monograph and Canadian Immunization Guide for dosing requirements.

Route Intramuscular injection (IM)

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Schedule  Will depend of age of client, the product being

administered and the reason the vaccine is provided.

 Consult with your local public health service area for scheduling information.

 Anaphylaxis or other severe allergic reaction to a previous dose of vaccine containing Hepatitis B antigens.

Immunization

 Redness, pain and swelling at the injection site, usually mild and short-lasting.^2,3

Systemic reactions:

 Irritability, fever, fatigue, headache, appetite loss, nausea, diarrhea, dizziness, pharyngitis, myalgia.^2,3

References

1 National Advisory Committee on Immunization. (2012). Canadian immunization guide (Evergreen ed.). Ottawa, ON: Public Health Agency of Canada. Retrieved from www.phac-aspc.gc.ca/publicat/cig-gci/

2 GlaxoSmithKline Inc. (2011, July). ENGERIX®-B: Hepatitis B vaccine (recombinant). Product Monograph.

3 Merck Frosst Canada Ltd. (2012, May). RECOMBIVAX HB®: Hepatitis B vaccine (recombinant). Product Monograph.

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Alberta Health

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3. Hepatitis A and B Combined Vaccine

Trade Name/Manufacturer TWINRIX® Junior² - GlaxoSmithKline Inc.

Indications for use of provincially funded vaccine

Individuals 12 months of age and older who meet one or more of the reasons as listed below:

Pre-exposure:

 Children 1 year up to and including 18 years of age who are eligible for both hepatitis A and hepatitis B vaccines.

 Children with hemophilia A or B receiving plasma-derived replacement clotting factors

 Children with chronic liver disease, including clients who are anti-HCV positive

 Children with lifestyle risks of infection.

Note:

 TWINRIX® should not be used for children who require double strength hepatitis B vaccine.

 Pre-exposure serology for anti-HAV (IgG) is recommended for some individuals.

Post-exposure:

 TWINRIX® is not recommended for hepatitis A or hepatitis B post-exposure prophylaxis.

Use in children younger than 1 year of age

TWINRIX® Junior is not recommended for children younger than 1 year of age.

Dose 0.5 mL – Pediatric or adolescent (1 year up to and including 18 years of age).

Route Intramuscular injection (IM)

Schedule All individuals 1 year of age and older:

Dose 1 – day 0

Dose 2 – 1 month after dose 1 Dose 3 – 6 months after dose 1

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 Anaphylaxis or other severe allergic reaction to a previous dose of vaccine containing hepatitis A or hepatitis B antigens.

Immunization

 Pain, redness, and swelling at the injection site.² Systemic reactions:

 Appetite loss, irritability, drowsiness, headache, malaise, fatigue, fever, gastrointestinal symptoms and rash.²

References

1 National Advisory Committee on Immunization. (2006). Canadian immunization guide (7^th ed.). Ottawa, ON: Public Health Agency of Canada. Retrieved from www.phac-aspc.gc.ca/publicat/cig-gci/

2 GlaxoSmithKline Inc. (2011, July 12). TWINRIX®: Combined hepatitis A and hepatitis B vaccine. Product Monograph.