Recent advances in combination vaccines have resulted in the availability of two different multivalent vaccines, one containing hepatitis A and hepatitis B antigen (see below, Hepatitis B) and the other being hepatitis A and typhoid antigen (see below and Typhoid). These vaccines may be suitable for those travellers at dual risk of exposure to these diseases. The combined hepatitis A and B vaccine is licensed for both paediatric (0.1 ml; 1-15 years) and adult
(1.0ml; over 16 years) use by the intramuscular route, with the primary course being administered at day 0, 1 month and 6 months. The corresponding levels of antibody protection achieved at each of these time points are 94%, 99% and 100% for hepatitis A, and 34%, 97% and 99% for hepatitis B. Booster doses of the monovalent hepatitis A vaccine should be administered at 10-yearly intervals, with that of the monovalent hepatitis B recommended at 5-yearly intervals at present for those travellers at continued high risk. No serious side-effects have been reported using this combination vaccine. Recent clinical trial data have demonstrated that the hepatitis A and B vaccine may be administered at an accelerated schedule on days 0, 7 and 21, with a booster at month 12, with effective levels of protection at 1 month of 99%, 96% at 12 months and 100% at 13 months for hepatitis A, and 82%, 94% and 100%, respectively, for hepatitis B. Travellers, especially those travelling at short notice, will certainly benefit from the availability of this schedule once licensure has been obtained.
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