Viral vaccine - ATC Code: J07BC02

hepatitis a vaccine (inactivated, adsorbed)

One 0.5 millilitre dose contains: Hepatitis A virus, GBM strain (inactivated)1, 2……160 U3 1 produced in human diploid (MRC-5) cells 2 adsorbed on aluminium hydroxide, hydrated (0.3 milligrams Al) 3 In the absence of an international standardised reference, the antigen content is expressed using an in- house reference

Suspension for injection in a pre-filled syringe. Hepatitis A vaccine (inactivated, adsorbed) is a cloudy and white suspension.

AVAXIM is indicated for active immunisation against infection caused by hepatitis A virus in susceptible adults and adolescents of 16 years of age and above.

The use of AVAXIM should be based on official recommendations.

Posology

The recommended dosage for subjects of at least 16 years of age is 0.5 millilitre for each injection.

Initial protection is achieved with one single dose of vaccine. Protective levels of antibody may not be reached until 14 days after administration of the vaccine.

In order to provide long-term protection, a second dose (booster) of an inactivated hepatitis A vaccine should be given. The second dose is preferably given between 6 and 12 months but may be administered up to 36 months after the first dose. It is predicted that HAV antibodies persist for many years (beyond 10 years) after the second dose.

The vaccine may be used to provide the second dose (booster) in subjects from 16 years of age who received another inactivated hepatitis A vaccine (monovalent or with purified Vi polysaccharide typhoid) 6 months to up to 36 months previously.

AVAXIM is not recommended for use in children of less than or equal to 15 years of age due to insufficient data on safety and efficacy.

Method of administration

AVAXIM should be administered by intramuscular injection in the deltoid region.

AVAXIM must not be administered intradermally or intravascularly.

The vaccine should not be administered into the buttocks, due to the varying amount of fatty tissue in this region, contributing to variability in effectiveness of the vaccine.

In exceptional circumstances (e.g. in patients with thrombocytopenia or in patients at risk of haemorrhage), the vaccine may be injected by the subcutaneous route.

Under 16 years, not recommended.

• Hypersensitivity to the active substance(s) or to any of the excipients.

• Hypersensitivity following a previous injection of this vaccine.

• Systemic hypersensitivity to neomycin, which may be present in the vaccine in trace amounts.

• Vaccination should be delayed in subjects with an acute severe febrile illness.

As with all vaccines, appropriate medical treatment and supervision should be readily available for immediate use in case of rare anaphylactic reaction following vaccination. AVAXIM should only be given by a physician or health care worker trained in the administration of vaccines.

AVAXIM has not been studied in patients with impaired immunity. The immune response to AVAXIM could be impaired by immunosuppressive treatment or in immunodeficiency states. In such cases, it is recommended to measure the antibody response to be sure of protection and, if possible, to wait for the end of any suppressive treatment before vaccination. Nevertheless, vaccination of subjects with chronic immunodeficiency such as HIV infection is recommended although the antibody response may be limited.

Because of the incubation period of hepatitis A, infection may be present but not clinically apparent at the time of vaccination. The effect of AVAXIM on individuals late in the incubation period of hepatitis A has not been documented.

Individuals having grown up in areas of high endemicity and/or with a history of jaundice may be immune to hepatitis A, in which case the vaccine is unnecessary. Testing for antibodies to hepatitis A prior to a decision on immunisation should be considered in such situations. If not, seropositivity against hepatitis A is not a contraindication. AVAXIM is as well tolerated in seropositive as in seronegative subjects.

AVAXIM does not provide protection against infection caused by hepatitis B virus, hepatitis C virus, hepatitis E virus or by other liver pathogens.

As no studies have been performed with AVAXIM in subjects with liver disease, the use of this vaccine in such subjects should be considered with care.

As with any vaccine, vaccination may not result in a protective response in all susceptible vaccinees.

No clinical data on concomitant administration of AVAXIM with other inactivated vaccine(s) or recombinant hepatitis B virus vaccine have been generated. When concurrent administration is considered necessary, AVAXIM must not be mixed with other vaccines in the same syringe, and other vaccines should be administered at different sites with different syringes and needles.

Seroconversion rates were not modified when AVAXIM was given at the same time as but at a different injection site to a Vi polysaccharide typhoid vaccine or a yellow fever vaccine reconstituted with a Vi polysaccharide typhoid vaccine.

Concomitant administration of immunoglobulin and AVAXIM at two separate sites may be performed. Seroconversion rates are not modified, but antibody titres could be lower than after vaccination with AVAXIM alone. Therefore, consideration should be given to whether or not the subject is likely to be at long-term risk of exposure.

No interaction with other medicinal products is currently known.

Adverse event data are derived from clinical trials and worldwide post-marketing experience.

Within each system organ class, the adverse events are ranked under headings of frequency, most frequent reactions first, using the following convention:

Very common (1/10), Common (1/100, <1/10), Uncommon (1/1000, <1/100), Rare (1/10000, <1/1000), Very rare (<1/10000) including isolated reports.

Clinical Studies

In clinical trials, adverse reactions were usually mild and confined to the first few days after vaccination with spontaneous recovery. The adverse reactions observed with AVAXIM were:

Nervous system disorders

Common: headache

Gastrointestinal disorders

Common: nausea, vomiting, decreased appetite, diarrhoea, abdominal pain

Musculoskeletal and connective tissue disorders

Common: myalgia/arthralgia

General disorders and administration site conditions

Very common: asthenia, mild injection site pain

Common: mild fever

Uncommon: injection site erythema

Rare: injection site nodule

Investigations

Rare: transaminases increased (mild and reversible)

Reactions were less frequently reported after the booster dose than after the first dose. In subjects seropositive against hepatitis A virus, AVAXIM was as well tolerated as in seronegative subjects.

Post marketing experience

Based on spontaneous reporting, the following additional adverse events have been reported during the commercial use of AVAXIM. These events have been very rarely reported, however exact incidence rates are not known (cannot be estimated from the available data).

Skin and subcutaneous tissue disorders

urticaria, rashes associated or not with pruritus

Sanofi Pasteur MSD Limited

(POM)

26 March 2012