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News : Hep A vaccine shortage - options for staff

PRE-EXPOSURE VACCINATION  

Monovalent adult hepatitis A vaccine is preferred for pre-exposure immunisation. In view of potential stock-outs of adult vaccine and anticipated increased demand PHE is working closely with partners across the health system to secure supplies of hepatitis A vaccine.

In the interim, temporary dose-sparing options were proposed by PHE and agreed by the Joint Committee for Vaccination and Immunisation (JCVI) at the June 2017 meeting.

 Priming of unvaccinated HIV-positive adults:

  • Unvaccinated HIV-positive persons should preferentially receive standard adult antigen content monovalent hepatitis A vaccine as a priming dose because of the poorer response rates to vaccine in this group

        If adult monovalent vaccine is not available, *BASHH/BHIVA advises:

  • CD4 count < 500 cells/μL : two doses of paediatric hepatitis A vaccine
  • CD4 count ≥ 500 cells/μL : single dose of paediatric hepatitis A vaccine

Where adult monovalent hepatitis A vaccine stock is not available:

  • A single dose of paediatric monovalent hepatitis A vaccine can be given to adults off-label as pre-exposure immunisation
  • Where this is not available or where hepatitis B immunisation is also indicated a single dose of adult combination hepatitis A/B vaccine can be given to adults, off-label, as pre-exposure immunisation

For adults already primed with adult hepatitis A vaccine:

  • Paediatric monovalent hepatitis A vaccine or adult combination hepatitis A/B vaccine can be given off-label as the booster dose.
  • The booster dose can be delayed to five years

This advice is supported by immunogenicity data which indicate that the antigen content of a single dose of hepatitis A paediatric monovalent or adult combination hepatitis A/B vaccine is sufficient to confer short term protection to adults. In addition, a WHO review found that protective anti-HAV antibody levels after a single dose of hepatitis A vaccine persist for several years.

Remaining hepatitis A and B doses can be given using either monovalent or combination vaccine.

POST-EXPOSURE VACCINATION

Schedules detailed in the Green Book should be followed. The use of monovalent vaccine is preferred to the combined vaccine.  However, in the context of monovalent adult dose shortage and non availability, the paediatric vaccine (one or two doses) should be used rather than delaying the administration of vaccine given that time is critical following exposure; in the event of paediatric vaccine shortage, the combined vaccine should be used.  

 * British Association for Sexual Health and HIV/British HIV Association