For professionals:

• Mode/route of transmission:
  • 1) Fecal-oral (enteral), and
  • 2) Blood-borne (parenteral).

• A and E: fecal-oral. ---
  • related to environmental sanitation and personal hygiene.

• B, C, D and G: blood-borne ---
  • related to contact with infected blood including body fluid and sexual contact.

• Vaccination:
  • against HAV and HBV available.

• HAV infection in Taiwan:
  • Most of the residents in western plain region, who were born before 1966, have already been infected with HAV and having antibody to HAV, therefore, they will not be reinfected by HAV.
  • However, those born after 1980, having grown under the well controlled environmental sanitation and never infected by HAV, are susceptible to infection by HAV because they have no antibody to HAV.
  • Those born between 1967 to 1979 are having antibody to HAV in different proportion, the lower in those born later.

• Those born after 1980 should receive vaccination against HAV before traveling to endemic area of HAV, such as south-east Asia and mainland China, even to mountain area of Taiwan.

• In Taiwan, screening test for HCV of all transfusion blood has been implemented since July 1992, afterwards very few cases of post-transfusion hepatitis C was found.

• In Taiwan, nation-wide vaccination against HBV has been enforced since July 1984, and showed an effective results
  • Seroepidemiology of hepatitis B virus infection in children: Ten years of mass vaccination in Taiwan. by Chen, H-L, Chang, M-H et al: ( JAMA 276; 906-908, 1996)
  • Efficacy of a mass hepatitis B immunization program after switching to recombinant hepatitis B vaccine: a population-based study in Taiwan. by Hsu HM, Lee SC, Wang MC, Lin SF, Chen DS, et al. (Vaccine 2001 Apr 6;19(20-22):2825-9; )

• For those having not infected with HBV may receive vaccination before marriage or undertaking high risk works.

• No vaccine as yet available for D and C.

Vaccination against HAV

• Transmission may occur:
  • direct person to person contact,
  • from contaminated water, fruits, vegetable and other foods which are eaten uncooked,
  • from shellfish harvested from sewage-contaminated water.
• HAV is inactivated by boiling or cooked to 85 C for one minute.

• cooked food may become contaminated after cooking during handling.

• Superinfection of HAV on chronic HCV infection may lead to fulminant hepatitis and fatal outcome.
  Vento et al. --- Although most patients with chronic hepatitis B who acquired HAV infection had an uncomplicated course, patients with chronic hepatitis C had a substantial risk of fulminant hepatitis and death associated with HAV superinfection. Our data suggest that patients with chronic hepatitis C should be vaccinated against hepatitis A. (N Engl J Med 1998;338:286-90.)
  Safety and immunogenesity of HAV vaccine in patient with chronic liver disease have also been reported. (Hepatology, 1998; 27:881)

• Vaccination schedule for travellers to endemic area:
  • Two products of HAV vaccines are available now (intramuscular injection)
    • For HAVRIX (SKB):
      • adults (>18 yrs ): two 1440 Elisa Units (EL.U) doses with second dose given 6 ~ 12 months after the first dose (i.m.)
      • for children and adolescent (2 ~ 18 yrs):
        • two 720 (EL.U) doses, given as adults.
        • three 360 (EL.U) doses with second dose given one month after the first dose and third dose given 6 ~ 12 months after the first dose.
    • For VAQTA (Merck):
      • for adults (> 17 yrs): two dose of 50 Units with second dose given 6 months after the first dose.
      • for children and adolescents (2 ~ 17 yrs): the second dose given 6 ~ 18 months after the first dose.
  • For travellers who are going to travel to developing countries less than 4 weeks after the initial dose of vaccination should receive additional immunoglobin injection (0.02 ml/kgm body weight) for protection. (Traveller can be considered to be protected 4 weeks after the first dose vaccine.)
  • The vaccine is estimated to protect whom received vaccination from HAV infection for 20 yrs, it is still under observation.
  • Persons, who are allergic to vaccine component, should receive a single dose of Immunoglobulin (0.02 ml/kgm body weight), if the travel is less than three months. For prolonged travel or residence, IG (0.06 ml/kgm body weight) should be given and repeated every 5 months.

  • Vaccination information for HAV

Vaccination against HBV

• Fact sheet: HBV vaccine (CDC, USA):
  • Hepatitis B is a serious disease, responsible for an estimated 4000 to 5000 deaths each year in the United States due to cirrhosis and liver cancer.
  • Hepatitis B vaccine prevents hepatitis B disease and its serious consequences. Therefore, this is the first anti-cancer vaccine.
• Universal (nationwide) vaccination program:
  • First dose within one week after birth.
  • Second dose one month after first dose.
  • Third dose six months after first dose.
  • When born to HBeAg-positive mother additional HBIG one dose should be given within 24 hrs after birth.
• For those other than newborn babies:
  Three doses devided in 0, 1, 6 months.
• Alternate Two-Dose Hepatitis B Vaccination Schedule for Adolescents Aged 11--15 Years
  • In September 1999, Merck Vaccine Division (Merck & Co., Inc., West Point, Pennsylvania*) received approval from the Food and Drug Administration for an optional two-dose schedule of Recombivax HBR for vaccination of adolescents aged 11--15 years. The Advisory Committee on Immunization Practices approved the optional two-dose schedule in October 1999 and recommended to include this schedule in the Vaccines for Children Program in February 2000. Using the two-dose schedule, the adult dose of Recombivax HBR (1.0 mL dose containing 10 £gg of hepatitis B surface antigen [HBsAg]) is administered to adolescents aged 11--15 years, with the second dose given 4--6 months after the first dose.

• On May 11, 2001, the Food and Drug Administration (FDA) licensed a combined hepatitis A and B vaccine (TwinrixR) for use in persons aged >18 years.