HEPATITIS A/B COMBO VACCINE (TWINRIX)
KEY POINTS
Hepatitis A
Hepatitis A is the most commonly indicated vaccine for travel to developing countries, where there may be unsafe food and water due to poor sanitation.
Although children usually have almost uneventful, mild illness with hepatitis A infection, adults may suffer a serious, prolonged course.
Almost everyone who has lived in a developing country without prior vaccination will have acquired hepatitis A virus, and so will have lifelong, natural immunity. This can be verified with a blood test for hepatitis A IgG antibody, making the need for the vaccine unnecessary.
Hepatitis B
Hepatitis B is NOT easily acquired. It is a body fluid/bloodborne virus, and so vaccination is considered in special travel circumstances,
a. When unsafe sex is practiced
b. Where exposure to re-used, blood contaminated medical equipment and blood products for transfusion is possible through local medical care
c. Where work assignment might expose one to wounds and body fluids of co-workers
Blood tests can be done prior to vaccination to see if Hepatitis B vaccine is needed, or if the individual is already immune.
Hepatitis A
Disease: Hepatitis A virus inflames the liver, causing generalized misery for weeks in adults, but usually minor or unnoticeable clinical illness in young people.
1. Flu-like illness (without the respiratory symptoms):
a. Fever
b. Poor appetite
c. Muscle/Joint Aches
d. Abdominal Pain
e. Jaundice (yellow skin/eyes/urine)
2. Incubation: from exposure to illness = 15-50 days (avg = 4 weeks)
a. Illness duration = 1-2 months
b. Only 3-6/1000 cases are fatal.
c. Hepatitis A virus does not cause permanent liver damage.
Distribution:
Worldwide, but most prevalent in developing countries. Risk increases with extended and rural travel.
Transmission:
Person-to-person through fecal-oral route
So, Hepatitis A virus is easily passed through household contacts and public exposure to fecally contaminated food and water, most commonly ice, unpeeled fruits/vegetables, and raw/undercooked shellfish.
Hepatitis A Virus Treatment: None
Prevention:
Chlorinate water.
Boil water or cook over 185°F for 1 minute.
Follow strict water and food restriction and cleanliness during travel.
Avoid uncooked food, salads, puddings, watermelon.
Drink only canned or bottled drinks.
Eat fruits and vegetables you peel yourself.
Use only ice cubes from purified water.
Eat only well-cooked meat and seafood.
Hepatitis A Virus Vaccine
1. Optimally at least 1 month pre-travel
2. 2 doses, 6-12 months apart
3. Lifelong immunity likely
4. Vaccine Targets
a. Travelers to underdeveloped countries
b. Homosexuals
c. Illicit drug users
d. Chronic liver disease patients
e. Households adopting children from countries with prevalent hepatitis A virus
f. Patients who receive blood clotting factor concentrates (hemophiliacs)
g. Children ≥ 1 year old
5. Vaccine Cautions
a. Those with life-threatening reactions to components of some hepatitis A virus vaccine brands: alum, 2-phenoxyethanol
b. Delay vaccination if moderately ill until recovered.
c. Side-Effects: Uncommon and last 1-2 days,
i. Injection site soreness
ii. Headache
iii. Poor appetite
iv. Fatigue
d. Safety in pregnancy has not been proven, but, as a killed vaccine, it is highly unlikely a risk to a fetus.
Hepatitis B
Disease: Inflammation of the liver by hepatitis B virus. Like hepatitis A, adults often (50%) are quite ill, but not children. Unlike hepatitis A, a substantial percentage of hepatitis B virus infections cause chronic disease and/or a lifelong virus carrier state, able to transmit the virus to others.
Acute (short-term) Illness:
a. Fever
b. Poor Appetite
c. Muscle/Joint Aches
d. Abdominal Pain
e. Nausea
f. Diarrhea
g. Jaundice (yellow skin, eyes, urine)
h. Fatigue
i. Average incubation is 90 days (range 60-150 days).
j. Chronic Illness: Cirrhosis (liver damage)
k. Liver cancer
l. Death
m. Chronic Hepatitis B virus carrier (infectious to others)
Prevalence:
Worldwide, but more so in developing countries
Transmission (Sources):
Body Fluids (blood, sexual)
Hepatitis B virus can live on a contaminated object up to 7 days (razor blades, toothbrushes, needles, etc).
Blood transfusion products
Special Risk Groups
Prolonged stay or frequent travelers
New sexual contact(s) during trip
High potential for medical or dental care in local facilities
Travelers with underlying medical illness/conditions (especially liver disease)
Traveling to obtain medical/dental services
Adventure travelers
Travelers using local public transportation extensively
Travelers receiving tattoos, acupuncture, or body-piercing
Healthcare workers
Treatment:
1. Antiviral drugs for Hepatitis B virus
Prevention:
1. Avoid casual (unprotected) sexual contact.
2. Use latex condoms and vaginal spermicidal jelly for intercourse.
3. Never share needles, razors, toothbrushes, or medical equipment, like diabetic blood lancets.
4. Avoid tattoos, body-piercing, acupuncture.
5. Avoid medical/dental care abroad, especially involving needles, IV lines, surgery, blood product transfusions.
6. Hepatitis B Virus Vaccine,
a. The Vaccine
i. 3 doses: day 1, day 30, then 6-12 months after 1st dose (there is an accelerated schedule, also).
ii. Optimally complete first 2 doses a month before travel.
iii. If suffering from a moderately severe illness, delay vaccination until recovered.
iv. Some hepatitis B virus vaccine products can cause reactions in those allergic to neomycin, yeast, aluminum, 2-phenoxyethanol, or formalin.
v. Possible side-effects (all uncommon and brief): Injection site soreness, fever, headache, nausea
vi. Targeted groups,
1. Solid organ transplant candidates
2. HIV positive
3. Mentally retarded who are institutionalized
4. Sexually polygamous
5. Healthcare workers or other jobs with body fluid exposure (first-responders)
6.Diabetics
7. Twinrix: > 18 yrs-old
a. Contraindications: Those with life-threatening reactions to components to: latex, neomycin, yeast, aluminum, 2-phenoxyethanol, or formalin.
How do I schedule an appointment?
Online: Schedule an Appointment.
Call Us: (713) 550-2000 A customer service representative will help you choose an appointment time, and can forward any documents you will need to complete.