OREGON HEALTH AUTHORITY IMMUNIZATION PROTOCOL …

1 OREGON HEALTH AUTHORITY . IMMUNIZATION PROTOCOL FOR PHARMACISTS. HEPATITIS A VACCINES: Havrix Vaqta Twinrix . Last Reviewed 06 August 2018. Last Revised 06 August 2018. This order expires 31 July 2019. OUTBREAK POST-EXPOSURE PROPHYLAXIS:4. At-risk persons greater than 7 years of age should receive a hepatitis A. vaccine as prophylaxis during an outbreak. In addition, persons greater than 40 years of age may also need post- exposure immune globulin based on their doctor's risk assessment. Persons with 2 valid doses of hepatitis A vaccine do not need a third dose In addition to hepatitis A vaccine, IG may be administered to persons age >40.

2 Years depending on the providers risk assessment. Provider Guidance: Factors to consider in the decision to use IG in addition to vaccine Age Immune status and underlying conditions Exposure type (risk of transmission). Availability of IG. I. OREGON IMMUNIZATION PHARMACY PROTOCOL : 1. Check the ALERT IMMUNIZATION Information System (IIS) to determine whether the patient needs this vaccine and any other vaccines. 2. Screen clients for contraindications. 3. Provide a current Vaccine Information Statement (VIS) and answer any questions. 4. Verify needle length for IM injection. 5. Both client and vaccinator must be seated for vaccine administration.

3 6. Administer hepatitis A vaccine Avoid injecting into the upper third of deltoid Preferred dosages and schedules of hepatitis A vaccines #. Doses Vaccine Age group Dose Volume Schedule in series Hepatitis A Vaccines P a g e | 2 of 14. 7 18 years 720 mL 2 0, 6 12 mos. Havrix1 *. (GlaxoSmithKline [GSK]) 1440. 19 years mL 2 0, 6 12 mos. *. Vaqta2 7 18 years 25 U** mL 2 0, 6 18 mos. (Merck & Co.). 19 years 50 U** mL 2 0, 6 18 mos. * = Elisa Units **U = Units Combination vaccine using hepatitis A and hepatitis B vaccines #. Age Doses Vaccine Antigens used Volume Schedule group in series 18 3 0, 1, 6 mos. Twinrix3 years Havrix (720 ) combined 0, 7, 21 30.

4 ML. (GlaxoSmithKline [GSK]) and with Engerix-B (20 mcg) 4 days, 12. older months Adapted from on 04-10-2018. 7. Record all required data elements in the client's permanent HEALTH record. 8. This vaccine may be given with all ACIP recommended child and adult vaccinations. 9. Ask client to remain seated on the premises for 15 minutes after vaccination to decrease the risk of injury should they faint. Immunizing Pharmacist Date Hepatitis A Vaccines P a g e | 3 of 14. III. LICENSED VACCINES*. Product Vaccine Minimum Latex Thimerosal name component(s). Acceptable age range LICENSED MONOVALENT HEPAITITS A. Havrix 1 Hepatitis A 7 years Tip caps may None contain natural rubber latex Vaqta 2 Hepatitis A 7 years Vial stopper, syringe None plunger stopper, and tip caps contain natural rubber latex LICENSED COMBINATION HEPATITIS A and B.

5 Twinrix 3 Hepatitis A Tip caps may (Havrix ) 18 years contain natural Trace Hepatitis B rubber latex (Engerix-B ). *. Limited data suggest that vaccines from different manufacturers are interchangeable. Completion of the hepatitis A vaccination series with vaccine from the same manufacturer is preferable, but if the initial vaccine product is unknown or unavailable, vaccination with either product is . Schedules using a combination of Twinrix and single-antigen hepatitis A vaccines have not been studied. Guidelines for use of Twinrix to complete a hepatitis A. vaccine series begun with monovalent vaccine and for use of monovalent vaccine to complete a series begun with Twinrix have been provided by the Advisory Committee on IMMUNIZATION Practices (ACIP).

6 See Section IV. E. Vaccine Interchangeability Hepatitis A Vaccines P a g e | 4 of 14. IV. A. RECOMMENDATIONS FOR USE. A. Pre-exposure Prophylaxis General 1. Hepatitis A vaccination is recommended by the ACIP for all children and adolescents aged 7 year of To provide protection to persons at increased risk for infection People experiencing homelessness People who use illicit drugs (whether by injection or noninjection). Twinrix is approved for hepatitis A prophylaxis for adults 18 years and older 2. Vaccine is recommended for adults greater than 18 years of age at increased risk of infection, including: Persons traveling to or working in countries that have a high or intermediate endemicity of infection,6 including persons with travel related to international Household members and other close personal contacts ( , regular babysitters) of adopted children newly arriving from countries with high or intermediate hepatitis A endemicity.

7 9. Persons with direct contact with persons who have hepatitis A. Men who have sex with Injection drug Persons with occupational risk for infection, working with non-human primates or with hepatitis A virus (HAV) in a research Persons who have chronic liver disease, Hepatitis B virus or Hepatitis C virus infections, or have received or are waiting for a liver Persons who have clotting factor disorders ( , hemophilia).6. All clients seen in STD IG is preferred for adult contacts 40 years of age. Vaccine can be used if IG. cannot be IG should be used for infants <12 months, those who are immunocompromised, or have chronic liver disease; and for contacts for whom vaccine is 3.

8 Any person wishing to obtain Hepatitis A Vaccines P a g e | 5 of 14. IV. B. Pre-exposure Prophylaxis Foreign Travel 1. All susceptible persons 7 years of age traveling to or working in countries that have high or intermediate hepatitis A endemicity should be vaccinated or receive IG before 2. For optimal protection, IG can be considered, in addition to vaccine, for older adults, immunocompromised persons, and persons with chronic liver disease or other chronic medical conditions who are traveling to an area within 2 , 7. 3. Travelers who elect not to receive vaccine, are 40 years of age or are allergic to a vaccine component should receive a single dose of IG ( mL/kg ( mL/lb) IM) which provides protection for 1 month.

9 See table below for specifics on duration of travel: 4, 7. Hepatitis A Immune Globulin (IG) Prophylaxis Product Name Vaccine Duration of Dose Components Travel11, 12. GamaSTAN S/D12 Up to 1 month mL/kg ( Human Plasma mL/lb) IM. Up to 2 months mL/kg ( mL/lb) IM. 2 months Repeat mL/kg every 2 months IM. Exposure of ( Contacts11, 12 mL/lb) IM. IV. C. Pre-exposure Prophylaxis Food Handlers 6, 10. In general, persons working as food handlers in OREGON are not at increased risk for hepatitis A infection when compared to the general public. Therefore, it is not currently recommended that food handlers get immunized because of their occupation.

10 Some food handlers however, do have other risks for hepatitis A ( listed under IV-A. General Pre-Exposure Prophylaxis-B), and should be immunized for their own protection. Hepatitis A Vaccines P a g e | 6 of 14. IV. D. Post-Exposure Hepatitis A vaccines should be administered for post-exposure prophylaxis for all persons age 7 years of age who have been exposed to hepatitis A within the past 14 days. In addition to hepatitis A vaccine, IG may be administered at mL/kg ( mL/lb) IM* depending on the providers' risk IG should be used for adults 40 years of age for whom vaccine is contraindicated, immunocompromised persons, and persons with chronic liver disease.