Hepatitis A and Hepatitis B Vaccine

What are Hepatitis A and Hepatitis B and what are the complications of having these diseases?

Hepatitis A and B are two of several types of Hepatitis virus that attack the liver. Both Hepatitis A and Hepatitis B are vaccine preventable diseases.

Hepatitis A is most commonly spread by contact with the feces of an infected person either directly (person to person, sexual activity, contaminated environment or objects) or indirectly through consuming food or water. Food and water may become contaminated due to lack of handwashing, failure to wash produce, or from handling of food by an infected person. Transmission through infected blood or blood products has also been reported.

Symptoms of Hepatitis A illness appear several days to weeks after infection but the infected person is able to spread the disease two weeks before the onset of symptoms. Symptoms include fever, fatigue, nausea and vomiting, loss of appetite, stomach or joint pain, and jaundice (yellowing of skin and white part of eyes).

Hepatitis B is spread from person to person through contact with infected blood and body fluids in one of the following ways:

• through a break in skin or directly in a mucous membrane (e.g. mouth);
• by sharing a toothbrush, razor or needle, and particularly by sharing of needles while injecting drugs;
• during sexual intercourse; or
• during birth from an infected mother to her baby.

Hepatitis B can be mild or may not cause any symptoms and some people do not know they have this illness. Other people are very sick with fever, fatigue, loss of appetite, nausea and vomiting, stomach or joint pain, and jaundice. Hepatitis B infection over the course of many years can result in serious liver problems including cirrhosis of the liver and liver cancer.

What are the contents of the combined Hepatitis A and B vaccine?

It is a combined vaccine formulated from purified, inactivated Hepatitis A and Hepatitis B viruses identical to those used for the preparation of the separate Hepatitis A and B vaccines. The vaccine contains traces of non-medicinal ingredients that keep the vaccine sterile, stable and help it to be more effective. All vaccine contents are licensed for use in Canada by the Biologics and Genetics Therapies Directorate within Health Canada. A complete listing of products contained in the vaccine is available from the public health nurse.

What are the possible reactions from the vaccine and how should they be managed?

The most serious but rare side effect is a severe allergic reaction (anaphylaxis), which can be life threatening and usually occurs within 15 to 20 minutes of receiving the vaccine. Procedures are in place for the nurse to respond quickly to anaphylaxis by administering adrenaline.

The most common side effects of the vaccine include:

• Localized swelling, redness, itching, warmth and/or tenderness/pain at the injection site; and/or
• Mild headache, tiredness and irritability have been reported.

It is not necessary to give acetaminophen after every immunization. If discomfort or fever occurs acetaminophen can relieve these symptoms.

• Please remain in the waiting room for 15 minutes after immunization.
• See a doctor or seek medical attention if any serious side effect occurs.
• Report serious reactions to the public health nurse.

When should the Hepatitis A and B vaccine not be given?

• Persons who have had an anaphylactic (severe or life threatening) reaction to any of the contents of this vaccine should not receive this vaccine.
• Those who are acutely ill, especially with fever, should return for their immunization at a later date.

The safety of Hepatitis A and B vaccine during pregnancy is being studied, and since the vaccine is prepared from inactivated virus, it is anticipated there is no risk to the developing fetus. If there is an exposure during pregnancy, it is advisable to consult with the attending physician.

What are the risks if the vaccine is not received?

The chance of acquiring Hepatitis A is related to a person’s risk of exposure. These risks include:

• Travellers to areas where Hepatitis A is common or regions that have poor food and water sanitation. This includes military personnel and humanitarian workers posted to these areas.
• Household or close contacts of a person with an acute case of Hepatitis A or with children adopted from a country where Hepatitis A disease is common.
• Persons with lifestyle risks for infection including those who use illicit drugs (both injectable and non-injectable), and men who have sex with men.
• Persons with hemophilia A or B receiving plasma-derived replacement clotting factors. Persons with chronic liver disease including those with or at risk of developing Hepatitis B or C disease are encouraged to receive Hepatitis A vaccine to prevent more serious disease if infection were to occur.

Hepatitis A is one of the most common vaccine preventable diseases in travellers. Hepatitis A vaccine is a very safe vaccine. When given as recommended Hepatitis A vaccine is at least 85-90 per cent effective in persons with a normal immune system when given before exposure.

The chance of acquiring Hepatitis B is related to a person’s risk of exposure. These risks include:

• careers that have higher rates of exposure to blood and body fluids such as health care and emergency service personnel;
• persons working or living in, or visiting, an area where Hepatitis B is common;
• those involved in high-risk lifestyle activities (eg. intravenous drug use);
• household contacts of an infected person;
• infants born to Hepatitis B positive mothers; and
• occupations such as those who may be exposed to sharps, aggressive behavior and/or injury (eg. correctional and police officers, sewage and waste workers).

Hepatitis B is a preventable disease. Hepatitis B vaccine is very safe and when given as recommended Hepatitis B vaccine is over 95 per cent effective in persons with a normal immune system when given before exposure.