Do You Know Your (Hepatitis) A, B, Cs?

August 10, 2015

Not much about the family of hepatitis viruses is as simple as ABC. Test yourself on a few of the fine points, here.

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In the 1980s-1990s, hepatitis A had an incidence of 40,000-60,000 cases a year in the US, with a sharp decline beginning in the late 1990s. In 2013, the CDC estimated that 3,500 new cases of hepatitis A occurred. New cases of hepatitis B peaked in the mid-1980s with about 160,000 new cases per year. Since then there has been a gradual drop off and the 2013 estimate of new cases of hepatitis B was 19,800.Hepatitis C was thought to have caused the most new cases in 2013 of these 3 viruses, with an estimated 29,700 cases.

2. The hepatitis A vaccine is a 2-dose series. The CDC/ACIP considers the following groups to be at higher risk and recommends routine vaccination for:A. Men who have sex with men

B. Persons with blood clotting disorders

C. Users of illegal drugs, injectable or non-injectable

D. All of the above

E. None of the above

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Person-to-person spread of hepatitis A is primarily through the fecal-oral route, but blood transmission is possible since hepatitis A does have a brief viremic phase (ie, when HAV is in the donor's blood). Routine use of the vaccine is recommend for children under age 2 years so eventually all these groups will have been immunized in childhood.

3. Two manufacturers produce hepatitis A vaccine for use in the US. Which one of the following scenarios violates ACIP recommendations for the vaccine?A. Giving a second dose from a different manufacturer than the first dose.

B. Giving a dose to an immunocompromised person.

C. Giving second dose from same manufacturer as the first dose exactly 24 weeks after the first dose.

D. None of the above; they all fall within the recommendations of the ACIP.

Please click here foranswer and discussion.

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The ACIP considers the two different vaccines to be interchangeable, so it is fine to “mix and match.” All the hepatitis A and B vaccines are inactivated meaning that administration to an immunocompromised person is safe, but immunogenicity cannot be guaranteed. The correct answer is Option C. The recommendation is to separate the two doses by 6 calendar months, not 24 weeks.