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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,
- When unsafe sex is practiced
- Where exposure to re-used, blood contaminated medical equipment and blood products for transfusion is possible through local medical care (developing countries)
- 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.
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.
Common Symptoms,
- Flu-like illness (without the respiratory symptoms)
- Fever
- Poor Appetite
- Muscle/Joint Aches
- Abdominal Pain
- Jaundice (yellow eyes/skin/urine)
- Incubation: from exposure to illness = 15-50 days (avg = 4 weeks)
- Illness duration = 1-2 months
- Only 3-6/1000 cases are fatal
- 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:
- Water chlorination
- Boiling water or cooking over 185°F for 1 minute
- Strict water and food restriction during travel
- Avoid uncooked food, salads, pudding, watermelon
- Only canned or bottled drinks
- Fruits and vegetables you peel yourself
- Use only ice cubes from purified water
- Only well-cooked meat and seafood
- Hepatitis A virus Vaccine
- Optimally, at least 1 month pre-travel
- 2 doses, 6-12 months apart
- Lifelong immunity likely
- Combination hepatitis A/B vaccine = Twinrix
- 3 doses: 0, 1, 6 months
- Vaccine Targets
- Travelers to underdeveloped countries
- Homosexuals
- Illicit drug users
- Chronic liver disease patients
- Households adopting children from countries with prevalent hepatitis A virus
- Patients who receive blood clotting factor concentrates (hemophiliacs)
- Hepatitis A vaccine: Children ≥ 1 year-old
- Twinrix: > 18 yrs-old
- Vaccine Cautions
- Those with life-threatening reactions to components of some hepatitis A virus vaccine brands and Twinrix : aluminum, aluminum hydroxide, 2-phenoxyethanol, latex, neomycin, yeast, formalin (check each product for which of these pertain)
- Delay vaccination if moderately ill until recovered.
- Side-Effects: Uncommon and last 1-2 days
- Injection site soreness
- Headache
- Poor appetite
- Fatigue
- Safety in pregnancy has not been proven, but, as a killed vaccine, it is unlikely a risk to a fetus.
Hepatitis B
Disease: Inflammation of the liver by hepatitis B virus (HBV)
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.
Acute (short-term) Illness:
- Fever
- Poor Appetite
- Muscle/Joint Aches
- Abdominal Pain
- Nausea
- Diarrhea
- Jaundice (yellow eyes, skin, urine)
- Fatigue
Chronic Illness:
- Cirrhosis (liver damage)
- Liver cancer
- Death
- Chronic hepatitis B virus carrier (infectious to others)
Average incubation is 90 days (range 60-150 days).
Prevalence: Worldwide, but more so in developing countries
Transmission:
- 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
- Travelers
- Prolonged stay or frequent travel
- New sexual contact(s) during trip
- High potential for medical or dental care in local facilities,
- Travelers with underlying medical illness/conditions
- Traveling to obtain medical/dental services
- Adventure travelers
- Travelers using local public transportation extensively
- Travelers receiving tattoos, acupuncture, or body piercing
- Healthcare workers
Treatment: Antiviral drugs for Hepatitis B virus
Prevention:
- Avoid casual sexual contact.
- Use latex condoms and vaginal spermicidal jelly for intercourse.
- Never share needles, razors, toothbrushes, or medical equipment, like diabetic lancets.
- Avoid tattoos, body-piercing, acupuncture.
- Avoid medical/dental care abroad, especially involving needles, IV lines, surgery, blood product transfusions.
- Hepatitis B virus Vaccine,
- The Vaccine
- 3 doses: day 1, day 30, then 6-12 months after 1st dose
- Optimally, complete first 2 doses a month before travel.
- If suffering from a moderately severe illness, delay vaccination until recovered.
- Some hepatitis B virus vaccine brand products can cause reactions in those allergic to neomycin, yeast, aluminum, 2-phenoxyethanol, or formalin.
- Possible side-effects: Injection site soreness, fever, headache, nausea (all uncommon and brief)
- Combination hepatitis A/B vaccine = Twinrix
- 3 doses: 0, 1, 6 months
- Targeted groups,
- International travelers with recurrent travel or prolonged stays in developing countries
- Households adopting children from high prevalence hep B countries (check hepatitis B virus status of child with blood testing)
- Chronic liver disease patients
- End-stage kidney disease (dialysis)
- Solid organ transplant candidates
- HIV positive
- Mentally retarded who are institutionalized
- Homosexuals
- Sexually polygamous
- Healthcare workers or other jobs with body fluid exposure (first-responders)
- Diabetics
- Twinrix: > 18 yrs-old
- 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.