Prevention of Hep A and B

Question 1

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Review the dosages of All Hep A and B vaccines if needed.

Question 2

How effective is protection after the first injection of HAV and for how long?

Answer 2

When provided according to the recommended schedule, HBV vaccine is 95% to 100% effective in preventing chronic infection for at least 30 years following immunization

Question 3

When are people considered immune to Hep B?

Answer 3

Healthy people who develop anti-HBs titre of at least 10 IU/L following completion of vaccine series are considered protected for life. However, immunocompromised individuals and people with chronic renal or liver disease may require periodic boosters if anti-HBs titre falls below 10 IU/L.

Question 4

When are immunoglobulins used?

Answer 4

Immunoglobulins (Hep A: GamaSTAN®; Hep B: HepaGam B™, HyperHEP B™ S/D - available through Canadian Blood Services) provide passive immunity for varying periods of time (up to 5 months). They are used when immediate immunity is necessary.

Question 5

What is immune response like from Hep A vaccine in patients who are on hemodialysis and immunocompromised?

Answer 5

Immune response of hemodialysis patients to standard doses of Hep A vaccine demonstrated good antibody response and no serious adverse effects
Vaccine efficacy may be reduced in immunocompromised individuals, but still recommended since it will provide some protection. Immunoglobulin should be considered for pre-exposure and post-exposure management

Question 6

Describe the immune response against Hep B for patients with diabetes, renal failure and chronic liver disease?

Answer 6

There is diminished response in patients with diabetes (70-80% antibody response), renal failure (60-70%), and chronic liver disease (60-70%)

Question 7

Will people undergoing chronic dialysis acquire immune memory?

Answer 7

Most people undergoing chronic dialysis will not develop an immune memory

Question 8

What about immunocompromised persons?

Answer 8

In immunocompromised persons, the amount of antibody response depends on the level of immune deficiency
Immunocompromised individuals and dialysis patients should receive a higher dose of vaccine and may require booster doses periodically if anti-HBs titre falls below 10IU/L
If patients do not develop anti-HBs titre of at least 10 IU/L after initial Hep B vaccine series, a second series should be given