A Modern Take on Hepatitis Immunization: Overcoming Today's Hurdles With Recent Guidelines and Practical Strategies

Co-Chairs, Robert G Gish, MD, and Stacey B. Trooskin, MD, PhD, prepared useful Practice Aids pertaining to hepatitis for this CME/NCPD/CPE/AAPA/IPCE activity titled “A Modern Take on Hepatitis Immunization: Overcoming Today's Hurdles With Recent Guidelines and Practical Strategies.” For the full presentation, downloadable Practice Aids, and complete CME/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bEIRUJ. CME/NCPD/CPE/AAPA/IPCE credit will be available until August 14, 2025.

1. HAV Vaccines
1

Full abbreviations, accreditation, and disclosure information available at PeerView.com/SHN40
RouteDose
b
TimeIndication
IM0.1 mL/kg
IM0.2 mL/kg
IM
IM0.1 mL/kg
BoosterScheduleRouteDosageAge Group, yVaccine
NoneIM0.5 mL (720 ELISA units inactivated HAV)
NoneIM1 mL (1,440 ELISA units inactivated HAV) ≥19
1-18
≥19
≥18 
(primary)
≥18 
(accelerated)
1-18 NoneIM0.5 mL (25 units HAV antigen)
NoneIM1 mL (50 units HAV antigen)
NoneIM
IM
HepA, inactivated
(2 doses)
HepA, inactivated
(2 doses)
Combined HepA and 
HepB
a 
(3 doses)
Twinrix
Havrix
Vaqta
Trade Name
1 mL (720 ELISA units inactivated HAV + 20 
mcg HBsAg)
1 mL (720 ELISA units inactivated HAV + 20 
mcg HBsAg)
12 mo
0, 6-12 mo
0, 6-12 mo
0, 6-18 mo
0, 6-18 mo
0, 1, 6 mo
0, 7, 21-30 d
0.2 mL/kg (repeat  every 2 mo)≥2 mo duration of travel
Within 2 wk of exposure
Up to 1 mo duration of travel
Up to 2 mo duration of travel
Pre-exposure prophylaxis
Pre-exposure prophylaxis
Pre-exposure prophylaxis
Post-exposure prophylaxis 
Vaccines Used to Prevent Hepatitis A Virus Infection
Dosage Recommendations for GamaSTAN Human Immune Globulin for
Pre-Exposure and Post-Exposure Prophylaxis Against Hepatitis A Infection

2. HAV Vaccines
1

Full abbreviations, accreditation, and disclosure information available at PeerView.com/SHN40
a
Combined HepA and HepB vaccine (Twinrix) should not be used for postexposure prophylaxis.
b
The dosage of immune globulin is based on weight for all ages and does not have a maximum dose for protection against hepatitis A.
c
See the Recommendations for Hepatitis A
Vaccine and Immune Globulin for Pre-exposure Prophylaxis section in this report for additional information. 1. https://www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.
Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the
Advisory Committee on Immunization Practices, 2020
c
CHILDREN
• All children aged 12-23 months
• Unvaccinated children and adolescents aged 2-18 years
PERSONS AT INCREASED RISK FOR SEVERE DISEASE
FROM HAV INFECTION
• Persons with chronic liver disease
• Persons with human immunodeficiency virus infection
OTHER PERSONS RECOMMENDED FOR VACCINATION
• Pregnant women at risk for HAV infection or severe
outcome from HAV infection
• Any person who requests vaccination
VACCINATION DURING OUTBREAKS
• Unvaccinated persons in outbreak settings who are at risk
for HAV infection or at risk for severe disease from HAV
HEPATITIS A VACCINATION IS NO LONGER
RECOMMENED BY ACIP
• Persons who receive blood products for clotting
disorders (eg, hemophilia)
IMPLEMENTATION STRATEGIES FOR SETTINGS
PROVIDING SERVICES TO ADULTS
• Persons in settings that provide services to adults in
which a high proportion of those persons have risk
factors for HAV infection
PERSONS AT INCREASED RISK FOR HAV INFECTION
• International travelers
• Men who have sex with men
• Persons who use injection or noninjection drugs
(eg, all those who use illegal drugs)
• Persons with occupational risk for exposure
• Persons who anticipate close personal contact with an
international adoptee
• Persons experiencing homelessness

3. HBV Vaccines
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SHN40
Three-Dose Recombinant
(Engerix-B, Recombivax-HB)
•May be given to all ages 
•Safe for  pregnancy
•Three doses given over 6 
months (at 0, 1, and 6 months)
Two-Dose Recombivant
Adjuvanted (Heplisav-B)
•For those aged 18 years and older; 
non-pregnant adults
•Two doses given 1 month apart
Three-Dose Combo HAV/HBV
Vaccine (Twinrix)
•May be given to all ages
•Three doses given over 6 months 
(at 0, 1, and 6 months)
Combo Pentavalent and
Hexavalent (Pediarix, Vaxelis)
•Given in pediatrics; protects against fve or 
six diseases, including DTaP-IPV-HepB+/- HiB
•Three doses given following birth dose 
HBV vaccine
ACIP Policy Statement for PreHevbrio, Added February 2022
1
PreHevbrio may be used as a HepB vaccine in persons aged ≥18 years and recommended
for vaccination against HBV infection

4. HBV Vaccines
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SHN40
New
Screening is recommended
Unchanged
For all adults aged >18 years at least
once in a lifetime
Screening is recommended for all
pregnant persons during each pregnancy,
preferably in the first trimester, regardless
of vaccination status or history of testing
For anyone who requests it
Testing is recommended for anyone
with a history of risk (all ages)
Susceptible during the period of risk
Using a three-test panel
(HBsAg, anti-HBs, total anti-HBc)
Periodic testing for susceptible persons
with ongoing risk (all ages)
2023 Updated Hepatitis B Screening and Testing Recommendations
2

5. HBV Vaccines
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SHN40
1. Weng MK et al. MMWR Morb Mortal Wkly Rep. 2022;71:477-483. 2. Conners et al. MMWR Recomm Rep. 2023;72:1-25.
3. Schillie S et al. MMWR Recomm Rep. 2018;67:1-31.
ACIP Vaccination Recommendations
1,3
Should receive HBV vaccine May receive HBV vaccine
• All infants
• Persons <19 years of age
• Adults 19 to 59 years of age
• Adults ≥60 years of age with risk
factors for HBV infection
• Adults ≥60 years of age without risk
factors for HBV infection
All patients with chronic liver disease should be vaccinated for hepatitis A and B

6. Strategies for Addressing Vaccine Hesitancy
1

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1. https://pharmaceutical-journal.com/article/ld/how-to-address-vaccine-hesitancy.
• Listen to the patient and acknowledge their concerns
without judgement
• Engage the patient in a dialogue and frame the
conversation beyond a binary yes/no vaccination decision
• Tailor your response to the patient’s concerns and keep
messages clear and easy to understand; avoid jargon and
using statements such as “no risk” as people mistrust
strong statements and may conversely believe the
opposite
• Help patients to weigh up the risks versus benefits; remind
patients of the benefits of vaccinations, the mildness of
vaccine adverse effects, and the very low risk of serious
adverse effects; highlight the risks of not immunizing
• Correct misinformation, accept questions, and explain
• Provide personal examples (eg, pharmacist’s own
vaccination, fact sheets, and other resources)
• Communicate the high level of endorsement of vaccines by
various communities
• Refer patients to other providers or schedule another
appointment to discuss remaining vaccination concerns
• Guide patients along the vaccine hesitancy continuum
towards acceptance and recognize the value of the
conversation, even if the patient does not get vaccinated at
that appointment
• Question an individual’s sacred values or group
identity
• Criticize a particular group, such as vaccine-
hesitant parents
• Get into an argument/debate back and forth,
or repeat vaccine myths (as the person will not
remember a detailed explanation of why the
vaccine myth is incorrect, but will remember the
simple narrative of the myth)
• Use fear, as this can backfire
• Overload the patient with information, as this
can backfire
DON’T DO