Hepatitis A vaccine (HepA) should be administered intramuscularly (IM), using the appropriate injection site and needle size as determined by the patient’s age and body mass. See Immunize.org’s clinical resource, “How to Administer Intramuscular and Subcutaneous Vaccine Injections” for details, www.immunize.org/catg.d/p2020.pdf.
Yes. Other inactivated and/or live virus vaccines can be administered at the same time as HepA vaccine, but should be given at a different anatomical site, if possible. If given in the same muscle, separate the injections by a minimum distance of 1 inch.
Yes, VFC-supported HepA vaccine is available for children 12 months through 18 years who are VFC-eligible. In addition, combination HepA and HepB vaccine (Twinrix; GSK) is also available for people who are age 18 years who are VFC-eligible.
You do not need to start the series over again. The immunogenicity of 1 dose of HepA vaccine is 94% to 100%; studies have shown persistent protection from a single dose lasting more than 10 years. To ensure optimal long-term protection it is important to administer the second dose.
A person should receive the dosage of HepA vaccine appropriate for their age at the time of administration. You should give the patient one adult dose of HepA to complete the 2-dose series. It is not necessary to restart the vaccine series.
In general, if the error is discovered on the same clinic day, you can administer the other “half” of the dose on that same day. If the error is discovered later, the dose should not be counted, and then the person should be recalled to the office and given a full age-appropriate repeat dose.
If you give more than an age-appropriate dose (for example, an adult dose of HepA vaccine given to a child), count the dose as valid and notify the patient/parent about the error. There may be an increased risk of a local adverse reaction when more than the recommended dose is given. If the error occurred with the first dose of the series the child should still receive the second dose on schedule. Giving a “double” dose for the first dose does not negate the need for a second dose.
Avoid such errors by checking the vaccine vial label 3 times.
The efficacy data from the clinical trials were based on age at time of vaccination, and not on the weight of the individual. Hence, the dosage recommendations reflect this age-based efficacy data. The same holds true for HepB vaccine. In addition, higher response rates are expected in younger people, even if their weights are above the norm.