Should Hepatitis A Vaccine (Hepislav) Be Given to a Sick Patient?
Hepatitis A vaccine can be safely administered to patients with minor acute illness, but should be deferred in those with moderate-to-severe acute illness until clinical improvement. 1
Contraindications to Vaccination
The only absolute contraindications to hepatitis A vaccination are 2, 1:
- Severe allergic reaction (anaphylaxis) to a previous dose of hepatitis A vaccine 1
- Known severe allergy to any vaccine component, including neomycin 1
When to Defer Vaccination
Moderate-to-severe acute illness warrants deferral of vaccination until the patient improves. 1 This precaution exists to avoid confusing symptoms of the underlying illness with potential vaccine adverse reactions, not because the illness increases vaccine risks. 2
Minor acute illness (such as mild upper respiratory infection or low-grade fever) is NOT a contraindication and vaccination can proceed. 2
Special Populations Who Can Receive the Vaccine
Immunocompromised Patients
Immunocompromised persons may receive hepatitis A vaccine, though immune response may be reduced. 3, 2 The vaccine is inactivated, not live, making it safe in immunosuppressed individuals. 3, 1
- Consider simultaneous administration of immune globulin (IG) with vaccine in severely immunocompromised patients for immediate protection 2
- IG dose: 0.02 mL/kg administered concurrently at a different injection site 3
Chronic Liver Disease
Patients with chronic liver disease should receive hepatitis A vaccine as they are at higher risk for severe manifestations of hepatitis A infection. 3 However, for postexposure prophylaxis in this population, IG is preferred over vaccine alone due to more predictable protection. 3
Pregnant Women
While no data exist on hepatitis A vaccine administration during pregnancy, the theoretical risk is extremely low to nonexistent because it is an inactivated vaccine. 3 The vaccine can be administered when indicated. 3
Common Pitfalls to Avoid
- Do not confuse minor illness with true contraindications – only severe allergic reactions and component allergies contraindicate vaccination 2
- Do not delay indicated vaccination if the patient has risk factors for hepatitis A exposure 2
- Do not use combination hepatitis A/B vaccine for postexposure prophylaxis – it contains half the hepatitis A antigen of single-antigen vaccine and lacks efficacy data for this indication 3
Timing Considerations
If vaccination is indicated (routine immunization or postexposure prophylaxis), proceed unless the patient has moderate-to-severe acute illness. 2, 1
For postexposure prophylaxis specifically: