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Hepatitis A
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Rebecca Pierce-Williams, Neil Silverman, Steven K. Herrine, Danielle Tholey
The best method for preventing HAV is through vaccination. As of 2020, according to the US Centers for Disease Control and Prevention, vaccination is recommended during pregnancy if a patient is at risk for HAV exposure, or at risk of severe illness (See section “Risk Factors/Associations”) [15]. Havrix (Glaxo Smith Kline) and Vaqta (Merck) are single-antigen inactive vaccines given through intramuscular (IM) injection, on a 2-dose schedule (see Table 31.1). Combination hepatitis A and B vaccination Twinrix (Glaxo Smith Kline) can also be given if also non-immune to hepatitis B virus. Dosing and schedules for those >18 years of age can be found in Table 31.1. Duration of immunity after vaccination (or infection) is unknown and may be lifelong [15].
Viral Hepatitis
Published in Thomas T. Yoshikawa, Shobita Rajagopalan, Antibiotic Therapy for Geriatric Patients, 2005
Abbasi J. Akhtar, Made Sutjita
Currently available recombinant hepatitis B vaccines include Energix-B and Recombivax HB. More recently, Twinrix, a combined HAV and HBV vaccine, has also become available (32). Three doses of vaccines are administered intramuscularly into deltoid muscle over a 6-month period. Antibodies are produced against HBsAg, and anti-HBs titers of lOmlU/mL or higher are considered protective for a period of 15-20 years or more. Elderly patients and immunocompromised patients may have suboptimal response to vaccination and a second vaccination series may be helpful (33). Hepatitis B immunoglobulin (HBIG) 0.04-0.07 mL/kg should be given along with the first dose of vaccine in cases of postexposure prophylaxis (34).
Serum vaccine antibody concentrations in adults exposed to per- and polyfluoroalkyl substances: A birth cohort in the Faroe Islands
Published in Journal of Immunotoxicology, 2021
Yu-Hsuan Shih, Annelise J. Blomberg, Marie-Abèle Bind, Dorte Holm, Flemming Nielsen, Carsten Heilmann, Pál Weihe, Philippe Grandjean
The current study population is a subset of a birth cohort (N = 1,022) recruited from the three Faroese hospitals from 1986 to 1987 (Grandjean et al. 1992). Subjects enrolled in this cohort were singleton births born at or close to term. A cord-blood sample was collected at birth. Follow-up clinical examinations, including standard questionnaires and blood sample collection, were conducted among 90% of the cohort members at age 7 years, 87% at age 14 years, and 84% at age 22 years. In 2014 and 2015, all cohort members (96% eligible) were invited back for a 28-year examination that included an optional vaccination trial. The vaccination and blood sampling schedule is shown in Figure 1. A booster vaccination against diphtheria and tetanus and vaccination against hepatitis type A and B (Twinrix) were offered. Standard Twinrix administration includes three doses; the second dose 1 mo after the first, and the final dose 5 mo after the second. Diphtheria and tetanus booster vaccines were given on the same day as the first Twinrix dose. A baseline blood sample was collected on the day of the first dose, and a follow-up sample was collected when the subjects returned for the last dose of Twinrix. Both blood samples were obtained immediately preceding vaccine administration. Subjects who were vaccinated against diphtheria and tetanus only returned for follow-up blood sample collection about 6 mo after the first visit (n = 125; median: 183 days).
Efficacy, safety, and formulation issues of the combined vaccines
Published in Expert Review of Vaccines, 2020
Combined vaccines are produced by different manufacturers and are available in various formulations and types. These variations, in addition to the biological nature of the vaccines, raise important challenges in terms of the efficacy and safety of the combined vaccines in comparison with the same monovalent vaccines. For example, a temporary resurgence of Haemophilus influenzae type b (Hib) disease has occurred in the Alaskan young infants when the routine immunization of the disease has been switched from the PRP-OMP (polyribosylribitol phosphate Neisseria meningitidis outer-membrane protein) vaccine to the DTP-HbOC (combination of diphtheria-tetanus-whole-cell pertussis antigens along with Hib oligosaccharide CRM197) vaccine. Most interestingly, opposite immunologic response has also been reported for the hepatitis A and B combined vaccines, even from one manufacturer (GlaxoSmithKline). While, TwinrixTM is highly immunogenic and produces suitable immune responses, however, low or lack of antibody production against the hepatitis B virus (HBV) has been seen after AmbirixTM administration [4,5]. Such non-negligible reports alongside the vaccine hesitancy phenomenon in different parts of the world can seriously damage the public trust and confidence in the vaccines, which are important factors in eliminating or reducing the burden of infectious diseases [6–9].
Challenges in adult vaccination
Published in Annals of Medicine, 2018
Eduardo de Gomensoro, Giuseppe Del Giudice, T. Mark Doherty
In vaccination against hepatitis A and B, use of a combination vaccine such as Twinrix (GSK) facilitates coverage in adults not adequately covered in earlier immunization schedules. Clinical data has shown that Twinrix provides high and persistent immunogenicity against both diseases similar to that of monovalent vaccines [41,42]. However, some age-related differences are seen. While data shows similar rates of seroconversion against hepatitis A in adults >40 years compared with younger subjects, differences are seen for responses against hepatitis B, where slightly lower rates of sero-protection (92–93% versus 96.6%) and lower antibody titres are observed. In addition, rates are lower in adults >50 years compared to those aged between 41 and 50 [41,43,44].