Hepatitis A Vaccine (HepA)

Worldwide, there are an estimated 1.4 million cases of hepatitis A every year.³ 

The word “hepatitis” means “inflammation of the liver”. When someone gets hepatitis, the liver’s ability to function becomes compromised.

If you’ve been walking this planet for the last decade, you may have heard of the term “hepatitis” thrown around followed by a letter. There are actually several different viruses that cause several different types of hepatitis diseases–hepatitis A, B, C, D, E, F (unconfirmed), and possibly G. Some symptoms are similar, however there are different modes of transmission for these viruses and they can affect the liver in different ways. Hepatitis A, hepatitis B (HepB vaccine), and hepatitis C, are the three types you hear about the most often. While the two latter forms more often cause a chronic condition, hepatitis A tends to appear more often as an acute (short-lived) disease.

Hepatitis A, caused by exposure to the hepatitis A virus (HAV), leads to contagious liver disease.

HAV is found in the fecal matter of infected people and gets passed on when someone ingests the infected fecal matter. It may sound unlikely to ingest fecal matter, but the virus is so tiny, even in microscopic amounts of feces there are potentially millions of viral particles. Improper hand washing and/or physical contact, as well as fecal-contaminated objects/food can spread the virus. In fact, it is one of the most frequent causes of food-borne infection.³

The symptoms of hepatitis A tend to appear somewhere from 2-6 weeks after exposure and can last from a few weeks in those who have mild illness, to up to several months in those who have severe illness. And those who develop symptoms are contagious for two weeks before the symptoms appear.

Children under six years old are more often to NOT show symptoms of the disease than adults.³  But, symptom-less people can still spread the virus.

The symptoms of the virus may include any or all of the following, and may begin to appear over several days:

• Flu-like illness: Low-Grade Fever, Fatigue, Loss of appetite, Nausea, Vomiting, Abdominal pain
• Clay-colored bowel movements
• Joint pain
• Severe stomach pains and diarrhea (in children)
• Jaundice (a yellowing of the skin/whites of eyes)/dark urine
  • Only 10% of children under six years will experience jaundice.³ About 70% of older children and adults will experience jaundice.³

Not everyone who is infected will have all of these symptoms.

The symptoms tend to last for under two months, however they may hang around for up to 6 months, and adults who get hepatitis A are often too ill to work for up to a month. Therefore, hepatitis A outbreaks can lead to significant economic and social consequences in communities.

In rare cases, HAV can cause acute liver failure—a loss of liver function that occurs suddenly, and sometimes leads to death (about 3-6 deaths/1,000 cases²). This is more commonly seen in patients over 50 years old and those with chronic liver disease. This requires hospitalization and sometimes a liver transplant.

There is no specific treatment for hepatitis A, and occasionally people need to be treated in the hospital (1 in five people)². Even in the hospital, treatment still remains rest, proper nutrition, and proper fluid intake to replace what is lost from vomiting and diarrhea.

Thankfully, hepatitis A does not become a chronic infection, meaning symptoms will clear up after a few months and do not continue for years or a lifetime. And almost all people who become infected with HAV recover fully.

Proper and frequent hand washing using soap and improved sanitation can help prevent spread of the virus. If you have the hepatitis A, you will want to take steps to reduce the risk of passing the virus on to others. These precautions include avoiding sexual activity, washing hands thoroughly after using the restroom, and not preparing food for others while you’re actively infected.

Of course, the best way to prevent the spread of hepatitis A is to get vaccinated.

The vaccine for HAV is called the hepatitis A vaccine (HepA). It was introduced into the United States in 1995, and dramatically reduced the rate of hepatitis A. The number of cases is currently the lowest it’s been in 40 years.² Before HepA, there were more than 250,000 cases of hepatitis A each year, now there have only been 25,000 cases since 2007.²

HepA is an inactive (killed) vaccine that stimulates the body’s natural immune system. The vaccine is made from smaller pieces of the whole hepatitis A virus.

This vaccine is recommended for all children over a year old, as well as for those in high-risk situations (more on the risk factors later). Several countries including the U.S., Argentina, China, Israel, and Turkey have added the HepA vaccine into their recommended childhood vaccine routines.

It is recommended that children be given the first dose between 12-23 months of age, and the second dose (the booster) six months later. However if the child is not vaccinated by the age of two, he can be vaccinated at any time, as the hepatitis A vaccine series can be started at any time for anyone who is not vaccinated or for those in high risk situations.

Two doses are necessary for longer-lasting protection and the series of two shots should be given six months apart.

Once you have been either exposed to the HAV or given the vaccine, your body will have antibodies to the virus. Protective hepatitis A virus antibodies are seen after one month in nearly 100% of people who have been vaccinated with just a single dose of HepA, and these people are showing protection from the virus as early as two weeks after getting the fist dose.³

Vaccine manufacturers recommend a second dose for longer-term protection of about five to eight years after vaccination.³ Because immunity wanes over time, if you are considered at high risk for contracting the virus, you may want to consider getting vaccinated again.

So, who is considered at high risk, and should consider getting HepA?

• Those who have been exposed to hepatitis A
• Those who are traveling to a country with high prevalence of hepatitis A and who are one year or older
• Children ages 2 through 18 years  who live in communities of high disease incidence
• People engaging in high-risk sexual activity, such as homosexual and bisexual males
• People who use street drugs.
• People with chronic liver disease
• People who are treated with clotting factor concentrates, such as those with hemophilia
• Employees of child day-care centers
• People who work with hepatitis A virus in the laboratory
• Those planning to adopt a child, or care for a newly arriving adopted child, from a country where hepatitis A is common
• Military personnel
• Alaskan Eskimos and Native Americans (cultures who may be exposed to the hepatitis A virus repeatedly due to a high rate of hepatitis A disease)
• Food handlers
• People handling primates

HepA and travel:

The first dose of HepA should be given as soon as travel is planned.

As well as getting the HepA vaccine, your doctor may recommend you get a shot of immune globulin before traveling to countries in Central or South America, parts of the Carribbean, Mexico, and certain parts of Asia (not Japan), Africa, Eastern Europe, the Mediterranean basin, and the Middle East.

Epidemics of hepatitis A occur sporadically in these areas, with a tendency for cyclic recurrences.³

If traveling to one of these high risk places, you can minimize your exposure to HAV by not drinking potentially contaminated water or eating contaminated foods. Foods of high risk are uncooked shellfish, uncooked fruits and vegetables, or those fruits and vegetables not prepared by yourself. You may be at even higher risk if you plan to visit rural areas, trek through back-country areas, or eat/drink in places with poor sanitation.

Developing areas of the world with very poor sanitary conditions and hygienic practices have rates as high as 90% of children under 10 years old infected with HAV.³

Does HepA protect against other forms of hepatitis?

No. HepA will only give protection from the hepatitis A virus. There is a vaccine available for hepatitis B, HepB, which protects from the hepatitis B virus. There is also a combo vaccine that contains both HepA and HepB and can be given to adults over the age of 18. This vaccine is given as a series of three shots over a period of six months. There are no vaccines for the other viruses that cause hepatitis.

Is HepA safe?

HepA has been given to millions of people worldwide, with no serious adverse events reported.³ The risk of HepA causing serious harm, or death, is extremely small, and getting the hepatitis A vaccine is much safer than getting the disease. However, a vaccine is medicine and has the potential to cause side effects.

Most people do not have any side effects.

Like nearly all vaccines, there tends to be soreness at the injection site.

The more common side effects could occur with the vaccine are:

• soreness where the shot was given (about 1 out of 2 adults, and up to 1 out of 6 children)², this may include pain, redness, swelling, or lumps at the injection site.
• Headache (about 1 out of 6 adults and 1 out of 25 children)²
• Loss of appetite (about 1 out of 12 children)²
• Weakness or tiredness (about 1 out of 14 adults)²
• Fever more than 99.5F
• Weight loss

If these problems occur, they usually last 1 or 2 days.

Some more RARE side effects that do not require medical attention:

• Change in color vision
• change in taste
• collection of blood under the skin
• deep, dark purple bruise
• difficulty seeing at night
• difficulty with moving
• dizziness or lightheadedness
• excessive muscle tone
• feeling of constant movement of self or surroundings
• increased sensitivity of the eyes to sunlight
• loss of taste
• muscle tension or tightness
• sensation of spinning
• sleeplessness
• trouble with sleeping
• unable to sleep
• welts

Some more RARE side effects that may require medical attention:

• Arm pain
• bleeding between periods, change in the amount of bleeding during periods, change in the pattern of monthly periods, and/or unusual stopping of menstrual bleeding
• lack or loss of strength
• tenderness or warmth at the injection site
• Body aches or pain
• chills
• congestion
• cough
• difficulty with breathing or swallowing
• dryness or soreness of the throat
• ear congestion
• headache
• hives
• hoarseness
• itching, especially of the feet or hands
• loss of voice
• nasal congestion
• reddening of the skin, especially around the ears
• runny nose
• shortness of breath
• sneezing
• sore throat
• swelling of the eyes, face, or inside of the nose
• swollen, painful, or tender lymph glands in the neck, armpit, or groin
• tender, swollen glands in the neck
• tightness in the chest
• unusual tiredness or weakness (sudden and severe)
• voice changes
• wheezing

Severe reactions include serious allergic reaction, which would occur within a few minutes to a few hours after the injection. This is very rare.² What to do if you think you or your child is having a severe reaction to a vaccine.

It is shown that it is safe to be given HepA at the same time as getting other vaccines with no adverse effects. And, should you happen to get an extra dose of HepA, do not be concerned; it is not harmful to receive more than two doses of the vaccine.²

None of the formulations of this vaccine contain thimerosal (mercury preservative).

It is also important to understand that no vaccine works 100% of the time. It is always possibly, however unlikely, that you may still get hepatitis A even after receiving HepA.

Hep A and pregnancy and breastfeeding:

The HepA injection is a class C drug, meaning there have not been adequate studies in pregnant women and either animal studies have shown adverse effects or there have not been adequate animal studies conducted.

Studies have been conducted to show that HepA poses minimal risk to the child when used during breastfeeding.⁶

Who shouldn’t get this vaccine?

Some people should not get Hep A or should wait to get the vaccine. Those people include:

• Infants under one year (the vaccine is not licensed for children under a year old)
• People who have had a past severe allergic reaction to HepA. (Do not get the following dose.)
• If you have a known severe allergy to latex, alum, 2-phenoxyethanol, or neomycin, talk to your doctor before getting the vaccine.
• If you are moderately or severely ill at the time the vaccine is scheduled to be given, wait until recovered to get the vaccine.
• Talk with your doctor about your options if you have a bleeding disorder such as hemophilia. There may be increased risk of bleeding at the injection site.
• You might want to talk with your doctor before getting the vaccine if you are pregnant. However, because HepA is an inactivated vaccine, the risk to pregnant women and the unborn baby is low.²

The HepA vaccine has been included in the recommended childhood vaccinations for all American children. Please consider that this vaccine has been included to protect your child from getting hepatitis A, a completely preventable disease, and has an immensely high record of safety. Absolutely contact your doctor if you have concerns.

And remember, you and only you have the power to protect your children from deadly diseases!

Interesting hepatitis A-related links:

 What is hepatitis A? Video by Streaming Well

Resources:

1. Melnick, JL. “Properties and Classification of Hepatitis A Virus.” Vaccine. 10 Suppl 1:S24-6. 1992. http://www.ncbi.nlm.nih.gov/pubmed/1335653
2. Centers for Disease Control and Prevention (CDC). www.cdc.gov.
3. World Health Organization (WHO). www.who.int
4. “Hepatitis A Vaccination Should be Part of a Comprehensive Plan for Prevention and Control of Viral Hepatitis.” World Health Organization (WHO) Newsroom. 13 July 2012. http://www.who.int/immunization/newsroom/newsstory_hepa_vaccine_control_viral_hepatitis/en/
5. “Who Position Paper on Hepatitis A Vaccines – June 2012.” Weekly Epidemiological Record. World Health Organization. No. 28-29, 2012, 87, 261-276. 13 July 2012. www.who.int/wer   http://www.who.int/wer/2012/wer8728_29.pdf
6. Mayo Clinic. www.mayoclinic.org
7. Vaccines.gov. U.S. Department of Health and Human Services. www.vaccines.gov
8. MedlinePlus. National Institutes of Health (NIH). U.S. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/medlineplus.html