Hepatitis A and B vaccine

Hepatitis A and B combination vaccine gives protection against hepatitis (inflammation of the liver) caused by both hepatitis A and B viruses. 

Hepatitis A spreads through food, drink and poor hygiene. Hepatitis B is transmitted in blood-to-blood and sexual contact.

Vaccine-preventable diseases

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To whom is the hepatitis A and B combination vaccine administered?

A free vaccine is offered as part of the national programme to persons who are at an increased risk of both infections:

  • haemophiliacs receiving regular treatment
  • intravenous drug users 
  • persons close to intravenous drug users, including family members, housemates and sexual partners
  • men who have sex with men

The vaccination is also recommended for those working in certain tasks. Vaccination needs associated with work or business travel are assessed by the occupational healthcare services. These vaccinations are paid for by the employer.

The vaccination may also be administered for free time travel to a country in which both hepatitis A and B occur. These vaccinations are paid for by the recipient. 
Hepatitis A and B (Traveller's guide to vaccinations)

The combination vaccine is an alternative to separate vaccines.

Which vaccine is used and what does it contain?

The product used in the national programme is called Twinrix. There are different vaccine products for children and adults.

  • The vaccine does not contain live pathogens.
  • The active substance is surface structures of the hepatitis B virus and inactivated whole hepatitis A viruses.
  • The adjuvant is an aluminium compound.
  • The excipients are salts and purified water.
  • The vaccine contains no preservatives.

Dosage and schedule

Twinrix Pediatric vaccine is for children aged from 1 to 15 years. A single dose is 0.5 ml.

Twinrix Adult vaccine is used for those aged 16 years or over. A single dose is 1 ml.

The primary vaccination series consists of three vaccinations administered in months 0, 1 and 6.

When protection is needed urgently, in exceptional situations the vaccines can be administered on days 0, 7 and 21 to recipients aged 16 years and over. In this case, a fourth dose is needed one year after the first dose to ensure long-term protection.

Boosters are not needed, as the vaccine is currently believed to give lifelong protection.

What are the benefits of the hepatitis A and B combination vaccine?

The vaccine prevents hepatitis A and B virus infections.

The combination vaccine affords good protection against both types of hepatitis. It helps to reduce the number of administrations and lower the costs of the vaccine.

What are the potential adverse effects of the hepatitis A and B combination vaccine?

The most common adverse effects are local symptoms at the injection site, including pain, redness and swelling.

Transient generalised symptoms are also common, including 

  • headaches
  • nausea
  • gastrointestinal symptoms
  • tiredness.

Fever, skin symptoms and actual hypersensitivity reactions are rare.

Local and generalised symptoms usually begin within a few days of administration and go on for some days. They may be treated with fever and pain medications.

Local and generalised symptoms are not a contraindication for further vaccinations.

What are the contraindications and precautions associated with the vaccine?

The vaccine may not be administered to a person who has had a confirmed anaphylactic reaction following a previous dose of a hepatitis A and B combination vaccine or a vaccine containing similar components.

The vaccination should be postponed if the person has a fever or febrile infection.

History of the combination vaccine in the national vaccination programme

The combination vaccine was introduced in the programme as hepatitis A vaccinations were started in 2005 for the same at-risk groups to which the hepatitis B vaccine was already offered. 

These groups include haemophiliacs receiving regular treatment as well as intravenous drug users and persons close to them. 

In 2017, men who have sex with men were added to the target groups.