POST 00682E : HepB VACCINE DOSES INTERVAL

POST 00682E : HepB VACCINE DOSES INTERVAL Follow-up on Post 00674E 3 June 2004 _______________________________ Three colleagues contributed answers to Vladimir Petrovic's question on HepB doses interval. First Ann Kempe (mailto:[email protected]) from Australia, followed by Mary Catlin (mailto:[email protected]) from the USA, and finally Steven Wiersma (mailto:[email protected]) from WHO/Geneva. _______________________________ The recommendation from the Australian Technical Advisory Group on Immunisation (ATAGI) is that there should be a minimum interval of 1 month between the 1st and 2nd dose and 2 months between the 2nd and 3rd. The OPTIMAL interval is as per the recommended schedule (0, 1, and 5 months) and there is no MAXIMUM interval - you always build on previous doses for the catch up regardless of how long time has passed. Much of our catch up advice is based on the USA ACIP recommendations by the way. For further information see our Online Australian Immunisation Handbook (8th edition) 2003 http://www1.health.gov.au/immhandbook/ Follow links to page 42 "Catch-up Vaccination", page 45 "Table 1.9.1 Minimum interval table", page 50 "Catch-up for hepB"; and page 145 HepB chapter. regards Ann Kempe Member ATAGI Consultant, Health Projects University of South Australia _______________________________ Quoting from the Plotkin"s and Orenstein's excellent reference, "Vaccines". "Available immunogenicity datas from "off-schedule" vaccination suggest that, if the series is interrupted after the first dose, the second dose should be given as soon as possible and the second and thrid doses should be separated by an interval of at least 2 months; if only the third dose is delayed, it should be administered as soon as possible. In any age group, when the vaccination schedule is interrupted it is not necessary to restart the vaccine series. " Mast E., Mahoney F., Kane M., Marlgolis H.; Chapter 16 Hepatitis B Vaccine, in Plotkin SA and Orenstein WA, Eds. Fourth Edition.2004. Saunders, Philadelphia. p. 314 Mary Catlin Injury and Infection Prevention Tucson, AZ, USA ________________________________ I would like to respond to the excellent question posed by Dr. Petrovic. The issue of timing doses of the hepatitis B vaccine is an issue often faced by health professionals and immunization programme managers. According to guidance published in the WHO publication " Introduction of hepatitis B vaccine into childhood immunization services" (WHO/V&B/01.31), "the minimum interval between dose 1 and dose 2 is four weeks, and the minimum interval between dose 2 and dose 3 is four weeks." This leads to great flexibility in scheduling this very effective vaccine. This flexibility is seen in the tremendous variety of schedules used throughout the world to deliver the "first vaccine against cancer". A database of schedules can be viewed at the WHO website: http://www.who.int/vaccines/globalsummary/immunization/scheduleselect.cfm If a dose of hepatitis B vaccine is missed, it should be given as soon as possible. There is no need to start the schedule again by repeating previous doses of vaccine. WHO recommends vaccination of other populations at risk for hepatitis B including health workers using a standard 3-dose schedule . This policy is found in the Core Information for the Development of Immunization Policy (WHO/V&B/02.28) p. 42, as well as in an Aide Memoire entitled, Health Care Worker Safety (WHO/BCT/03.11). Most inquiries about a late 3rd dose are in reference to adults. Regards, Dr.Steven Wiersma, MD, MPH Medical Officer/Hepatitis Focal Point Expanded Programme on Immunization World Health Organization ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[email protected] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (http://www.ccisd.org) ______________________________________________________________________________