On May 11, 2001 the Food and Drug Administration (FDA) approved a new combination vaccine, Twinrix, by SmithKline Beecham Pharmaceuticals (GlaxoSmithKline). It combines two already approved vaccines, Havrix (Hepatitis A Vaccine, Inactivated) and Engerix-B (Hepatitis B Vaccine [Recombinant]). The vaccine protects individuals 18 years of age or older against diseases caused by the hepatitis A virus (HAV) and the hepatitis B virus (HBV). Now, people at high risk for exposure to these viruses can be immunized against both at the same time. Twinrix is given in a three dose series at 0-, 1- and 6-months.
Twinrix is recommended for travelers who, because of certain behaviors or occupations, are at high risk for HBV, and who are visiting countries where there is a high or intermediate rate of both HAV and HBV disease. Areas with a high rate of both HAV and HBV include Africa, parts of South America, most of the Middle East, and South and Southeast Asia.
HAV infection can be contracted by ingestion of contaminated water or food, such as raw shellfish. Travel to certain areas of the world with poor hygienic conditions or being in places where usual sanitary conditions have declined, such as a flood region, can increase the risk of HAV infection. HAV infection typically causes fever, malaise, and jaundice, or it may be asymptomatic. Rarely, patients with HAV infection progress to liver failure and death.
HBV infection is spread through contact with infected blood or other body fluids, through using contaminated needles, or having unprotected sex with an infected person. Health care workers are also among those considered at risk. HBV infection may also be asymptomatic or result in similar symptoms to HAV infection. Some HBV infections in adults result in chronic hepatitis leading to cirrhosis and liver cancer.
Nurses should be aware of this new vaccine and encourage teens who were not immunized against HAV and HBV to receive Twinrix.
March 15, 2002