VAKSINASI HEPATITIS

DR RAHMINI SHABARIAH SPA

 Vaksinasi Hepatitis A
PASIF ; NHIG ( UMUR < 2 TAHUN)
PRA PAJANAN :
USIA < 2 TAHUN
• BERKUNJUNG KE DAERAH ENDEMIS
< 3 BULAN : IG 0,02 ML/KGBB/IV
>4 BULAN : IG 0,06 ML/KGBB/IV
JANGKA PANJANG : IG 0,06 ML/KGBB SAAT
BERANGKAT DAN TIAP 5 BULAN BILA
PAPARAN (+)
 Vaksinasi Hepatitis A
PRA PAJANAN :
USIA > 2 TAHUN
• BERKUNJUNG KE DAERAH ENDEMIS
< 3 BULAN : IG 0,02 ML/KGBB/IV
>4 BULAN : IG 0,06 ML/KGBB/IV
JANGKA PANJANG  VAKSINASI
 Vaksinasi Hepatitis A
PASCA PAJANAN :
1. KURANG 2 MINGGU
KEMUNGKINAN TIDAK TERPAPAR
SEGALA UMUR IG 0,02ML/KGBB/IV
TERPAPAR > 2 TAHUN IG 0,02 ML/KGBB DAN
VAKSINASI
2. LEBIH 2 MINGGU , KEMUNGKINAN TIDAK
TERPAPAR SEGALA UMUR TIDAK PERLU
BILA TERPAPAR .> 2 THN  VAKSINASI
 VAKSINASI HEPATITIS A
AKTIF : HAVRIX ( > 2 THN)
USIA 2-18 THN : 720 EUI 0,5 ML ( 0-6-12)

USIA 18 THN : 1440 EUI 1 ML (0,6,12)

AVAXIM : DOSIS SAMA
 PEMERIKSAAN STATUS
IMUNOLOGIS
ANAK RISIKO TINGGI
1. IMMUNOKOMPROMAISE
2. IBU HEP B/ HBsAG (+)
3. KELUARGA DG HBsAG (+)
 DIAGNOSIS
HBV KRONIS

HBs HBe IgM IgG Anti Anti DNA

Ag Ag HBc HBc HBs HBe
Replikasi + + + - +

Non Repl + + + -

Flare up + +/- + + - +

PreCore + - + - + +
mutant
 Superinfection Drugs, toxin
HVA, HVC, (acetaminophen
lain2 etc)

HBsAg (+)
Acute hepatitis

Acute HBV Reactivation Exacerbation

HBsAg, IgM chronic chronic HBV,
antiHBc HBV eAg conversion

Differential diagnosis HBV

 PREVENTION OF SPREAD

transmission
Horizontal Vertical

• General: screening, infection control

• Specific:
Pre-exposure: active immunization
Post-exposure: passive-active immunization
Long term follow up
 HBV VACCINATION
Cutting chain of transmission
Newborn, adolescent High risk adults
• In endemic area -  • Dialysis, transfused
maternal infection • IVDU, homosex, active
• Early infection  heterosexuals
chronic – reservoir
• Household contacts of
• HCC at any age HBV carriers
• Provide protection –
adolescent - risk • Health care worker

Eliminating HBV, decreasing HCC

The only vaccine against CANCER
 HBV VACCINATION
Cutting chain of transmission
Anti HBs- HBsAg
neutralizing immunogenik
Antibody HBIG
PASSIVE ACTIVE
• Quick-short immunity • Long term immunity
• IM, safe • Deep IM (deltoid,
thigh); safe
• Acute exposure:
• Seroconvert 95%
Newborn HBV mother
• Protects (10 mIU/ml)
Occupational min 12 ys – booster (-)
Sexual contact
Household contact
 SEROLOGIC TESTING
Not recommended for infants - children

PREVACCINATION POST-
Consider : VACCINATION
• High risk • Infants - HBsAg
population (+) mothers
• Adolescents – • High risk newborns
endemic area • Immunodeficient
• Family members – • Dialysis patients
HBV carriers • Health care
• Health care staff workers
 RECOMMENDED DOSE
Booster – not recommended for any group

GROUP VACCINE
(ys) HBvax-II Engerix-B Uniject
HepavacGene
Infant, children, 5 g/ 10 g/ 10 g/ 0.5 ml
adolescents 0.5 ml 0.5 ml
Adults > 20 ys 10 g/ 20 g/ ?
1 ml 1 ml
Dialysis 40 g/ 40 g ?
2 ml
 HBV IMMUNIZATION
in infants
HBsAg Immuni- Dose Schedule
Mother zation
Active Engerix-B,Uniject 10 g 12 hours,
(+) HBVax-II 5 g month 1,6
Passive HBIg 100 U -0.5 ml
(-) Active Engerix-B,Uniject 10 g ASAP
HBVax-II 2.5 g BW  2kg
Age  2 mo
? Active* Engerix-B,Uniject 10 g 12 hours,
HBVax-II 5 g month 1,6
 POST-EXPOSURE
Sexual contact – acute or HBV carrier
EXPOSED SOURCE: SOURCE:
CONTACT ACUTE HBV CARRIER

Unvaccinated/ HBIG 0.06 ml/kg or HBIG &

Anti HBs (-) HBIG & vaccine or vaccine
test if high risk Or test
Vaccinated None None
Unknown – Anti HBs (-): Similar
anti HBs test HBIG & vaccine application
 POST-EXPOSURE to BLOOD
HBsAg-HBeAg (+)
 clinical hepatitis 22 – 31%
sero-evidence HBV 37 – 61%

Exposed Treatment if source is

Vaccine, AB HBsAg + HBsAg ??
Unvaccinated/ HBIG-vaccine or Vaccine or
AB response ? test if high risk Test if high risk
Responder None None
Non HBIG x2 or High risk source:
responder HBIG-vaccine As in HBsAg (+)
 VACCINE NONRESPONDERS
< 5% vaccinees – persistent non-responders

• Complete the 2nd series of 3 doses

• Usual schedule
• Retest 1 – 2 months after completion
• Check HBsAg & HBeAg status
• If exposed, treat as nonresponder
with postexposure prophylaxis
 THIMEROSAL - HVB VACCINE

• Stabilizes, perservative,
ethil mercury/EM (inactive) – HVB
vaccine - 25 µg
• Active mercury– methil mercury (MM)
• MM: 3.3 µg/kg/wk
• WHO: theoritical – autism (-),
 DECISION MAKING

HBeAg + -

DNA + + -

LFT N   N

Th/ IFN (–) IFN IFN Observ-

other antivirus ?! ed
 CHRONIC HBV INFECTION
(HBsAg positive > 6 months)

HBeAg + -

DNA + + -

LFT N   N

Th/ IFN (–) IFN IFN Observ-

other antivirus ?! ed
HEPATITIS C VIRUS (HCV)
The silent killer

• Intrafamilial 4.3%; sexual 5%

• Vertical transmission 6% (2-11%)
Risk factors: maternal RNA titer RNA

viremia +/- (8 vs 3%),
Pervaginam/SC (6 vs 0%)
• Infant  anti HVC – after aged 
7/12
 Exposure
(acute phase)
HIV and
alcohol
Resolved Chronic

Stable Cirrhosis

Slowly HCC
progressive Transplant
Death
 SEROLOGY SEROLOGY
ACUTE HCV - RESOLVED CHRONIC HCV
Anti Anti
symptom HVC symptom HVC
HVC RNA HVC RNA

SGPT SGPT

Normal Normal

Months Years Months Years

PREVENTION
High rate of mutation – vaccine (-)

General  HBV • SPECIFIC

Screening: • Identify new cases
Donor, children : pregnant mother,
carrier mother, baby – HCV mom,
IVDU, close contact,
chronic hep, HCC,
sexual behavior,
cirrhosis, ALT – ?
multi-transfused,
medical staff , • SC ?!
LTx recipient • Immunization (-) ?
 HCV VACCINE
Still far from completion

Failure to develop a vaccine

• Which is the neutralizing antibody
• E2, CAP, NS3 peptide?
• E2 – highly mutational
No identified antigen peptide – that
produces adequate immune response

!! Prevention
 HCV – RNA
Liver biopsy

Cirrhosis Moderate-severe Mild

Offer th/ Th/ 3/12 Observed

Repeat biopsy
Refused Prefer Th/ Repeat PCR

Follow-up (+) (-)

Stop Th/ Th/ 1 yr
• SAY NO TO: Alkohol – rokok – narkotik –
sex
• Jangan berbagi jarum suntik dg orang lain
• Makan obat hanya bila sangat perlu.
Hindari pemakaian beberapa obat sekaligus
• Hindari zat kimia
• Diet sehat dan seimbang, hindarkan
kegemukan
FINAL MESSAGE

• Get yourself vaccinated

• Get your family vaccinated
• Get your patients vaccinated
• Get your community vaccinated
• Spread the knowledge