The Centers for Disease Control and Prevention estimate that 60,000 people annually in the United States contract hepatitis a or b, 22,000 and 38,000 respectively.
This is particularly important when you consider that Hepatitis B is one of the nation's leading causes of liver cancer. Should we live in fear of this? Absolutely not! With a little prevention we can be sure to protect ourselves and our loved ones.
Children now receive vaccines for Hepatitis A and B during childhood, so where does this leave adults? If they work in the healthcare industry, odds are they have been vaccinated against Hepatitis B. For the rest of the adult population, which make up the majority of new Hepatitis B infections, they may still be unvaccinated. Are you at risk? Read on and find out!
Hepatitis A risk is most typically associated with travel, as it is one of the most common infections of travelers. The Hepatitis A virus is spread through a fecal-oral route, meaning that someone must ingest infected feces, or something contaminated with infected feces. Not a pretty thought. Is this something that is isolated only to third world countries? Unfortunately not, some of you may remember a high profile Hepatitis A outbreak in 2003, which was traced back to a Chi-Chi’s restaurant. Other risk factors include having a family member with Hepatitis A, and being a man who has sex with men.
Hepatitis B, unlike Hepatitis A, is transmitted through exposure to infected blood and body fluids. This exposure typically occurs through sexual activity, or percutaneous exposure, such as a needle stick or sharing IV drug needles. What sexual activities constitute high risk? Having multiple sexual partners, more than one partner in the last six months, or being a man who has sex with men both increase your risk. Traveling to an area with high levels of Hepatitis B? That also places you at risk, and as such you would be recommended for vaccination.
Multiple vaccine options are available to those at risk. Both Hepatitis A and B are available as single antigen vaccines, each given as a separate series. Hepatitis B vaccines must be given as a three vaccine series, spaced out over 6 months. The Hepatitis A vaccine is also given as a series over six months, except only two doses of vaccine are needed. This can prove problematic for someone who needs the vaccines prior to travel as he may not have time to complete the vaccine series prior to his travel.
This is where the true advantage of Twinrix, manufactured by GlaxoSmithKline, lies. This is a combination vaccine that contains both Hepatitis A and B vaccines. Yes it is more convenient to receive one shot instead of two, but being able to complete the vaccine series with full protection level in only three weeks is the big strength. Twinrix may be given on the same six month schedule as a single antigen Hepatitis B vaccine series, or as an accelerated schedule. For the accelerated Twinrix schedule it will require an extra dose. The accelerated schedule for Twinrix will be given as follows:
Even with the regular schedule, Twinrix does supply an "extra" dose of hepatitis a vaccine. Technically it is a third dose of the Hepatitis A vaccine, which as I stated earlier is given as a two dose series. The difference here is that while Twinrix contains an adult dose of Hepatitis B vaccine, it contains a pediatric dose of Hepatitis A vaccine. Given as a three dose series the pediatric dose of Hepatitis A has been shown to be as effective as two adult doses.
If you have any of the previously discussed risk factors, which also include any history of infection with a viral hepatitis, or liver disease, you should discuss vaccination with your healthcare provider. Persons over 18 years of age, who require both Hepatitis A and B vaccinations, are candidates for Twinrix. Visit the Centers for Disease Control and Prevention For more Twinrix Information.
Written by Mark Riegel, MD
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