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nathnac advice during hep A shortage
karen.rudd

11589 Posts

Posted:  15-Jun-2017 21:36 Log in to like this post
Nathnac and PHE have issued this short term off licence advice during shortage

https://travelhealthpro.org.uk/news/222/hepatitis-a-vaccine-shortage-implications-and-advice-for-clinical-practice

Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.

karen
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buffy

227 Posts

Posted:  18-Jun-2017 19:48
Thanks Karen x
pymouth1

841 Posts



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Posted:  19-Jun-2017 14:17
I read the Nathnac advice to mean that a single Hep A vaccination lasts up to 5 years. Am I right in thinking that? 

Judy
CarolC

49 Posts

Posted:  19-Jun-2017 18:21
Phoned PHE last week to check just that. The answer was yes but not a confident yes. Hoping Karen can clarify?
AlonaZen1975

3 Posts

Posted:  19-Jun-2017 22:23
Thanks very useful link x
Jururawat63

3 Posts

Posted:  20-Jun-2017 21:58
Just to clarify when an adult is administered the Paediatric dose of the Hepatitis A monovalent vaccine as a boosting dose a) Is this done under a PSD as opposed to a PGD & b) How long will the boosting effect last.

Does Hepatitis A & B combined vaccine given as a booster for Adult Hepatitis A (off label)also mean PGD and do they need to have a second Hep B vaccine which is a chargeable vaccine normally when given singularly?

What a nightmare !!

Jururawat
karen.rudd

11589 Posts

Posted:  21-Jun-2017 15:06 Log in to like this post
Jururawat
No PGD is likely to cover the off licence short term advice and vaccine options during the current shortages
thus a PSD would be in order in most cases where monovalent adult hep A vaccine is not in your stock.

Regarding how long a booster with one dose of twinrix or hep paed dose to an adult will last or how long a priming first dose with twinrix or paediatric hep A will last.... I agree there is a lack of clarity on the advice we have received and I await verification which I will share regarding timing of further boosters if needed. 
Pymouth
I also interpret that there must be enough data to support one full dose of hep A providing up to five years cover for the JCVI to okay the interim advice, but will also attempt to clarify this.

I will be attending the Nathnac/ PHE/ RCN meeting this Saturday and will feed back to the forum

  Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction. karen
pymouth1

841 Posts



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Posted:  21-Jun-2017 16:35
Thank you very much Karen! You are very helpful! 

Judy
karen.rudd

11589 Posts

Posted:  21-Jun-2017 17:04
The travax team have replied to similar queries on the travax discussion forum to which you may not all have access. 

'The evidence which was looked at to underpin the current dose sparing recommendations suggest that by delaying boosting to 5 years, in most cases, the individual will remain sufficiently protected against Hep A. 
 
Factors which you would need to consider, since they can affect seroconversion and duration of response in an individual ,would include
  • person-specific (age, immune competence, etc), amount of antigen in the primary dose  (1440units  v’s 720units) .
 
However in someone who has a fully functioning immune system and has received a primary dose of hep A 1440 units then this is a feasible approach to preserve vaccine during periods of constraint. I would also suggest postponing routine boosting at 6-12 months (for those travellers not at continuing risk) at the moment .
 
The team here are currently compiling a list of FAQs around this  (which are growing longer by the day !) which we hope to be able to share soon - but we will do this in conjunction with colleagues at NaTHNaC and PHE to ensure everyone is getting the same information.' Posted on travax discussion forum yesterday Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction. karen
karen.rudd

11589 Posts

Posted:  23-Jun-2017 23:23
Further verification from nathnac today but more to follow
https://travelhealthpro.org.uk/news/225/hepatitis-a-vaccine-shortage-implications-and-advice-for-clinical-practice

Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.karen
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Della

1459 Posts

Posted:  24-Jun-2017 20:52
So I'm a little confused - they're saying that first dose can give up to 5 yrs protection - but previously even if there was a delay between doses Green Book says it restart a course.

So when Hep A is back in stock, should we give 2 further doses if first dose was more than 5 yrs ago?
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karen.rudd

11589 Posts

Posted:  24-Jun-2017 21:19
The green book does not suggest restarting a hep A course. ? Work of van damme has proven that is not needed. When stock is back you will revert to normal scheduling

PHE and Nathnac have confirmed at the rcn conference today that if no adult vaccine available ....a paed dose can be used to prime the immune system and suggested those adults receiving a paed dose as a primer or as a booster return to see if they need any further doses 12 months later? They are awaiting JCVI confirmation before posting further than they did last night.
This applies to fit immunocompetent travellers but HIV positive or immunosuppressed travellers shot receive full dose. All comes down to risk assessment? Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.karen
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Della

1459 Posts

Posted:  25-Jun-2017 07:35 Log in to like this post
Thanks Karen, that was my thinking but then I doubted it based on the statement issued - my first post should've said GB says NOT to restart a course despite the length of time from first dose to booster!
karen.rudd

11589 Posts

Posted:  26-Jun-2017 14:44
Travax have posted a useful FAQ document for those with access
http://www.travax.nhs.uk/diseases/vaccine-preventable/hepatitis-a/hepatitis-a-vaccine-dose-sparing-faqs.aspx



Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.

karen
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