RECOMMENDED IMMUNIZATIONS: HEPATITIS В, HEPATITIS A AND В
RECOMMENDED IMMUNIZATIONS: HEPATITIS В, HEPATITIS A AND ВHepatitis ВHepatitis В is highly prevalent in parts of South America, Africa, Southeast Asia, and the South Pacific, and it is transmitted through unprotected sexual exposure and activities that involve contact with blood or blood-derived products. The risk of hepatitis В infection for international travelers is generally low but increases the longer a person remains in an endemic area. The risk of infection may be associated with medical or dental care received abroad, exposure to blood products due to an accident or illness, and sexual or intravenous needle contact.Hepatitis В vaccination should be considered for the following people:- Travelers who expect to have close contact with local populations that have high rates of hepatitis В transmission.- Individuals who plan an extended stay (6 months or longer) in an area of hepatitis В endemicity.- Persons who might have need for medical treatment while abroad.- Travelers who anticipate sexual contact with local residents.- Persons born overseas who travel back to their country of origin to visit family and friends.Two hepatitis В vaccines are currently available in the United States, Recombivax-HB (Merck) and Engerix-B (GlaxoSmithKline). The standard schedule with either formulation for adults 20 years of age and older calls for three doses of vaccine (each 1.0 mL) at 0, 1, and 6 months. For patients leaving immediately, an accelerated schedule with Engerix-B is available and consists of vaccination at 0, 1, and 2 months with a booster given 12 months after the first dose. Serologic testing to assess immune response is not necessary in healthy hosts. Pain at the injection site and occasional low-grade fever are the most common side effects among vaccines. The vaccine is not contraindicated in pregnancy.
Hepatitis A and ВA new combination hepatitis A and В vaccine (Twinrix, GlaxoSmithKline) containing the same antigenic components as Engerix-B and pediatric Havrix was approved by the Food and Drug Administration in 2001 for use in adults older than 18 years, and this vaccine is as efficacious as each of the monovalent vaccines. The indications for this vaccine are similar to those for hepatitis A and В vaccines in travelers. Primary immunization occurs at 0, 1, and 6 months. An accelerated schedule of 0, 1, and 3 weeks, with a fourth dose 12 months after the first dose, is as efficacious as with the standard schedule. The main adverse effects are headache and nausea. Its safety in pregnancy has not been determined.*184/348/5*
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