Hepatitis A and B immunization for individuals with inherited bleeding disorders

Abstract

Hepatitis A and B vaccines are highly effective tools that can greatly reduce infection risk in the bleeding disorder population. Although hepatitis A and B immunization for individuals with bleeding disorders is universally recommended, various advisory bodies often differ with respect to many practical aspects of vaccination. To review the published literature and guidelines and form a practical, comprehensive and consistent approach to hepatitis A and B immunization for individuals with bleeding disorders. We reviewed published immunization guidelines from North American immunization advisory bodies and published statements from North American and international haemophilia advisory bodies. A search of the MEDLINE database was performed to find original published literature pertaining to hepatitis A or B immunization of patients with haemophilia or bleeding disorder patients that provided supporting or refuting evidence for advisory body guidelines. Various advisory bodies' immunization guidelines regarding individuals with bleeding disorders have contradictory statements and often did not clarify issues (e.g. post vaccination surveillance). Published literature addressing immunization in bleeding disorder patients is sparse and mostly examines route of vaccine administration, complications and corresponding antibody response. Although the risk of hepatitis A and B infection is low, the use of simple measures such as vaccination is reasonable and advocated by haemophilia advisory bodies. Following our review of the available literature and North American guidelines, we have developed comprehensive and practical recommendations addressing hepatitis A and B immunization for the bleeding disorder population that may be applicable in Bleeding Disorder clinics.

Guidelines for the management of hemophilia

“… All people with hemophilia treated with plasma-derived products that are not adequately virus-inactivated should be screened for hepatitis B antigen and anti-hepatitis B at least every 6–12 months and whenever clinically indicated. (Level 4) [ ] Active HBV infection should be managed as per local infectious disease guidelines and protocols. Those without HBV immunity should be given the anti-HBV vaccine. Protective seroconversion should be rechecked following vaccination.…”

Principles of care for the diagnosis and treatment of von Willebrand disease

“…Vaccination against hepatitis A is similarly advisable 38 although recommendations vary amongst different groups. 39 VWF and FVIII levels in VWD can be normalized by the infusion of virally-inactivated plasma-derived concentrates containing both these proteins and these concentrates are the mainstay of treatment for patients not candidates for the use of DDAVP. A recombinant VWF concentrate is under investigation but at present no indications on its use can be given.…”

Subcutaneous diphtheria and tetanus vaccines in children with haemophilia: A pilot study and review of the literature

“…There is insufficient evidence to support the practice of obtaining post‐vaccination titres in children who have received SQ diphtheria and tetanus vaccines. Post‐vaccination titres are recommended for Hepatitis B depending on patient risk factors and may be of utility in children with concurrent immunologic disorders, liver disease or HIV …”