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Canada Communicable Disease Report

 

 

Canada Communicable Disease Report
Vol. 25 (ACS-3)
1 June 1999

An Advisory Committee Statement (ACS)
National Advisory Committee on Immunization (NACI)*

STATEMENT ON COMBINATION VACCINES AGAINST HEPATITIS A AND HEPATITIS B

Adobe Downloadable Document PDF (308 KB)

PREAMBLE

The National Advisory Committee on Immunization (NACI) provides Health Canada with ongoing and timely medical, scientific, and public-health advice relating to immunization. Health Canada acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge, and is disseminating this document for information purposes. Persons administering or using the vaccine(s) should also be aware of the contents of the relevant product monograph(s). Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) of the Canadian licensed manufacturer(s) of the vaccine(s). Manufacturer(s) have only sought approval of the vaccine(s) and provided evidence as to its safety and efficacy when used in accordance with the product monographs.

Safe and effective monovalent vaccines are available in Canada to protect against hepatitis A and against hepatitis B(1). In addition, one bivalent vaccine for adults has been licensed against both hepatitis A and hepatitis B (TWINRIX®, SmithKline Beecham Pharma Inc.). A reduced dose format for children aged 1 to 18 has also been licensed (TWINRIX® JUNIOR). These vaccines are made from the same bulk vaccines used for the monovalent formulations. Safety and efficacy for the bivalent vaccines have been established and have been discussed in previous NACI publications(2,3).

Bivalent hepatitis vaccine is the preferred vaccine for people with indications for both hepatitis A and hepatitis B vaccines. People who should be considered for bivalent hepatitis vaccine are

  • travellers to certain areas of Africa, Asia and the Americas in which both hepatitis A and hepatitis B are endemic
  • users of illicit drugs, both oral and injection
  • homosexual and bisexual males
  • hemophiliacs receiving plasma-derived replacement clotting factors
  • populations and communities in which both hepatitis A and hepatitis B are endemic
  • persons who have previously received hepatitis A vaccine and hepatitis B vaccine, and who require additional doses of both
  • persons with clinically significant chronic liver disease including chronic hepatitis due to hepatitis C virus

There are also situations in which different indications may apply for the two vaccine components. In these situations, bivalent vaccine is an efficient way to protect against both diseases. Examples include children who are scheduled to receive hepatitis B vaccine routinely in a universal program and who also have an indication for hepatitis A vaccine, or inmates who have not already received hepatitis B vaccine in a prison in which there is uncontrolled transmission of hepatitis A. Monovalent vaccine should be used when protection against only one of these diseases is required. Health professionals are advised to consult the Canadian Immunization Guide(1) for a complete discussion of indications and uses for hepatitis vaccines and recommendations for pre-immunization screening for hepatitis B markers.

Information on adverse events have been published previously(2,3). The contraindication to bivalent hepatitis vaccines is demonstrated previous anaphylaxis to any component of the bivalent vaccine.

Details on bivalent hepatitis vaccines, including dosage and administration, immunization schedule, storage and handling requirements and format of the vaccines have been published previously(2,3), and are contained in the product monographs.

References

  1. National Advisory Committee on Immunization. Canadian Immunization Guide. 5th Edition 1998. Ottawa, Ont.: Health Canada, 1998. (Minister of Public Works and Government Services Canada, Cat no.H49-8/998E.)

  2. National Advisory Committee on Immunization. Statement on the prevention of hepatitis A infections. CCDR 1994;20:133-43.

  3. National Advisory Committee on Immunization. Supplementary statement on hepatitis prevention. CCDR 1997;23:(ACS-4):1-6.

Members: Dr. V. Marchessault (Chairperson), Dr. J. Spika (Executive Secretary), N. Armstrong (Advisory Committee Secretariat Officer), Dr. G. De Serres, Dr. P. DeWals, Dr. I. Gemmill, Dr. B. Law, Dr. M. Naus, Dr. P. Orr, Dr. W. Schlech III, Dr. B. Ward.

Liaison Members: Dr. J. Carsley (CPHA), Dr. G. Delage (CPS), Dr. M. Douville-Fradet (ACE), Dr. T. Freeman (CFPC), Dr. J. Livengood (CDC), Dr. N. MacDonald (CIDS), Dr. A. McCarthy (ND), Dr. J. Salzman (CATMAT), Dr. J. Waters (ACE).

Ex-Officio Members: Dr. L. Palkonyay (LCDC), Dr. R. Pless (LCDC).

Our mission is to help the people of Canada maintain and improve their health.

Health Canada

 

[Canada Communicable Disease Report]
Last Updated: 2002-11-08 Top
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