POST 00682E : HepB VACCINE DOSES INTERVAL
Follow-up on Post 00674E
3 June 2004
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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.
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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
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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
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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
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