Pre.docx

Pre- and post-exposure prevention of HAV can be either through active or passive immunization. The HAV vaccine was initially recommended only for children and adolescents living in HAV endemic areas. In 2006, the CDC recommended that all children aged 12–23 months be immunized against HAV, making it part of their routine immunization schedule.1 Active immunization requires the patient receive 2 doses of the inactivated HAV vaccine, either HAVRIX (GlaxoSmithKline) or VAQTA (Merck & Co.), at 0 and 6 months, starting at 1 year of age.7 If the patient had not been immunized as a child, then a catch-up vaccine schedule can be implemented.1 Patients 18 years and older who have never received the hepatitis A or B vaccines can get a combination inactivated vaccine.7 Twinrix(GlaxoSmithKline) provides immunization for both hepatitis A and B and is given as 3 doses at 0, 1, and 6 months or as an accelerated schedule of 0, 7, 21–30 days, with a booster 12 months after the first dose.1 The administration of Twinrix provides rapid immunity but cannot be used as post-exposure prophylaxis.7 Pre-exposure intervention also involves recommending the HAV vaccine to those who have never been immunized, who are at a high risk of being exposed to HAV, or who could suffer from potential complications related to contracting HAV. The HAV vaccine is highly recommended for adults who are MSM, illegal drug users, have blood-clotting disorders, have chronic liver disease, or who are immunocompromised. Those who work with HAVinfected primates, as well as those who will be traveling to HAV endemic areas, should also receive the vaccine as a pre-exposure intervention. If a person is traveling to an HAV endemic area within the next 2 weeks, the combination of the HAV vaccine and passive immunization with IG is recommended.7 The IG will provide immediate protection, whereas the HAV vaccine will provide lifelong immunity. The HAV vaccine is also recommended as postexposure treatment in persons aged 1–40 years (Table). The vaccine is not routinely recommended for health care personnel, food handlers, childcare workers, and sanitation workers unless they have been exposed to HAV.1 Most individuals will be protected after 1 dose of the HAV vaccine; with the second vaccine, there is usually lifetimeimmunity.12