RECOMBIVAX HB® |
MSD |
Hepatitis B Vaccine (Recombinant) |
Vaccine |
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Pharmacology: Hepatitis B vaccine (recombinant) is a noninfectious subunit
viral vaccine derived from hepatitis B surface antigen (HBsAg) produced in yeast cells. A
portion of the hepatitis B virus gene, coding for HBsAg, was cloned into yeast and the
vaccine for hepatitis B was produced from cultures of this recombinant yeast strain
according to methods developed by MSD. |
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The antigen is harvested and purified from fermentation cultures of a recombinant
strain of the yeast Saccharomyces cerevisiae containing the gene for the adw subtype of
HBsAg. The HBsAg protein is released from the yeast cells by cell disruption and purified
by a series of physical and chemical methods including butyl agarose chromatography. The
vaccine produced has been shown to be equivalent to the plasma vaccine in terms of animal
potency (mouse, monkey, and chimpanzee) and protective efficacy (chimpanzee). |
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The vaccine against hepatitis B, prepared from recombinant yeast cultures, is free of
association with human blood or blood products and therefore the diseases potentially
transmitted by blood and blood products. |
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Indications: For immunization against infection caused by all known subtypes of
hepatitis B virus. |
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It will not prevent hepatitis caused by other agents, such as hepatitis A virus,
non-A, non-B hepatitis viruses, or other viruses known to infect the liver. |
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Vaccination is recommended in persons of all ages, especially those who are or will be
at increased risk of infection with hepatitis B virus. |
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The incidence of infection is known to vary greatly in different geographic areas and
in different populations throughout the world. Vaccination strategy should vary
accordingly. |
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Areas with high prevalence: In these areas, most of the population are at risk
of acquiring hepatitis B, often at a young age. Therefore, vaccination should be targeted
to: infants born to HBsAg-positive mothers; infants and children; susceptible adults. |
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Areas with low prevalence: In these areas vaccination may be limited to those
who are in groups identified as being at increased risk of infection. The following
categories might be identified in low-prevalence areas: |
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Infants born to HBsAg-positive mothers. |
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Health Care Personnel: Dentists and oral surgeons. Physicians and surgeons.
Nurses. Paramedical personnel and custodial staff who may be exposed to the virus via
blood or other patient specimens. Dental hygienists and dental nurses. Laboratory
personnel handling blood, blood products and other patient specimens. Dental, medical and
nursing students. |
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Selected Patients and Patient Contacts: Patients and staff in hemodialysis
units and hematology/oncology units. Patients requiring frequent and/or large volume blood
transfusions or clotting factor concentrates (e.g., persons with hemophilia, thalassemia).
Patients (residents) and staff of institutions for the mentally handicapped. Classroom
contacts of deinstitutionalized mentally handicapped persons who have persistent hepatitis
B antigenemia and who show aggressive behavior. Household and other intimate contacts of
persons with persistent hepatitis B antigenemia. |
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Military Personnel Identified as Being at increased Risk. |
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Morticians and Embalmers. |
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Blood Bank and Plasma Fractionation Workers. |
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Persons at Increased Risk of the Disease Due to Their Sexual Practices such as: Persons
who repeatedly contract sexually transmitted diseases. Homosexually active males. Female
prostitutes. |
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Prisoners. |
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Users of Illicit Injectable Drugs. |
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Contraindications: Hypersensitivity to any component of the vaccine. |
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Warnings: Because of the long incubation period for hepatitis B, it is possible
for unrecognized infection to be present at the time hepatitis B vaccine (recombinant) is
given. It may not prevent hepatitis B in such patients. |
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Patients who develop symptoms suggestive of hypersensitivity after an injection should
not receive further injections (see Contraindications). |
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Precautions: General: Persons with immunodeficiency or those receiving
immunosuppressive therapy require larger vaccine doses and respond less well than healthy
individuals. As with any parenteral vaccine, epinephrine should be available for immediate
use should an anaphylactoid reaction occur. |
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Any serious active infection is reason for delaying use of hepatitis B vaccine
(recombinant), except when, in the opinion of the physician, withholding the vaccine
entails a greater risk. |
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Pregnancy: Animal reproduction studies have not been conducted. It is also not
known whether hepatitis B vaccine (recombinant) can cause fetal harm when administered to
a pregnant woman or can affect reproductive capacity. It should be given to a pregnant
woman only if clearly needed. |
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Lactation: Data not available. |
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Adverse Effects: Hepatitis B vaccine (recombinant) is generally well tolerated.
No serious adverse reactions attributable to vaccination were reported during the course
of clinical trials involving its administration to over 1 000 individuals. The
frequency of complaints was somewhat lower following the second and third vaccine doses
compared with the first dose. As with any vaccine, there is the possibility that broad use
of the vaccine could reveal rare adverse reactions not observed in clinical trials. |
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In a group of studies 3 258 doses of vaccine were administered to
1 252 healthy adults. Vaccine recipients were monitored for 5 days after
each dose, and the following side effects were reported: |
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Local Reactions in Injection Site: injection site reactions, consisting
principally of local pain, soreness and tenderness and including pruritus, erythema,
ecchymoses, swelling, warmth and nodule formation (16.7%). |
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Body as a Whole: fatigue/asthenia 4.2%; malaise 1.2%; fever (³37.8°C) 3.2%;
sweating 0.5%; chills 0.2%; flushing 0.2%; aching 0.4%; sensation of warmth 0.4%. |
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Integumentary: pruritus 0.3%, rash 0.2%, urticaria 0.1%. |
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Digestive: nausea 1.8%, diarrhea 1.1%, vomiting 0.3%, abdominal pains/cramps
0.3%, dyspepsia 0.2%, diminished appetite 0.1%. |
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Musculoskeletal: myalgia 0.4%, arthralgia 0.5%, back pain 0.2%, neck pain 0.2%,
shoulder pain 0.2%, neck stiffness 0.2%. |
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Nervous: headache 4.1%, lightheadedness 0.3%, vertigo/dizziness 0.5%,
paresthesia 0.1%. |
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Respiratory: pharyngitis 1.2%, rhinitis 0.8%, cough 0.2%, upper respiratory
infection (NOS) 1.0%, influenza (NOS) 0.3%. |
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Special Senses: earache 0.2%. |
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Dosage: The deltoid muscle is the preferred site for i.m. injection in adults.
Data suggest that injections given in the buttocks frequently are given into fatty tissue
instead of into muscle. Such injections may result in lower seroconversion rate than is
expected. The anterolateral thigh is the recommended site for i.m. injection in infants
and children. |
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I.M.: Do not inject i.v. or intradermally. |
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Hepatitis B vaccine (recombinant) is for i.m. injection. It may, however, be
administered s.c. to persons at risk of hemorrhage following i.m. injections. However,
when other aluminum-adsorbed vaccines have been administered s.c., an increased incidence
of local reactions including s.c. nodules has been observed. Therefore, s.c.
administration should be used only in persons (e.g., hemophiliacs) at risk of hemorrhage
following i.m. injections. |
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Shake well before withdrawal and use. Thorough agitation at the time of administration
is necessary to maintain suspension of the vaccine. Parenteral drug products should be
inspected visually for particulate matter and discoloration prior to administration. After
thorough agitation, hepatitis B vaccine (recombinant) is a slightly opaque, white
suspension. |
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The immunization regimen consists of 3 doses of vaccine given according to the
following schedule: 1st dose: at elected date; 2nd dose: 1 month later; 3rd dose:
6 months after the first dose. |
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The volume of vaccine to be given on each occasion is shown in Table I. |
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Recombivax HB Dialysis Formulation: Recombivax HB dialysis formulation
(40 µg/mL) is intended only for adult predialysis/dialysis patients. |
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The recommended vaccination regimen for predialysis/dialysis patients is shown in
Table II. |
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Dosage for Infants Born to HBsAg-Positive Mothers: Infants born to
HBsAg-positive mothers are at high risk of becoming chronic carriers of hepatitis B virus
and of developing the chronic sequelae of hepatitis B virus infection. Well-controlled
studies have shown that administration of three 0.5 mL doses of hepatitis B immune
globulin starting at birth is 75% effective in preventing establishment of the chronic
carrier state in these infants during the first year of life. Protection is transient and
the effectiveness of the hepatitis B immune globulin declines thereafter. Results from
clinical studies indicate that administration of one 0.5 mL dose of hepatitis B
immune globulin at birth and three 5 µg (0.5 mL) doses of hepatitis B vaccine
(recombinant), the first dose given within 1 week after birth, was 96% effective in
preventing establishment of the chronic carrier state in infants born to HBsAg- and
HBeAg-positive mothers. Testing for HBsAg and anti-HBs is recommended at 12 to
15 months to monitor the final success or failure of therapy. If HBsAg is not
detectable, and anti-HBs is present, the child has been protected. |
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The recommended dosage for infants born to HBsAg-positive mothers is shown in Table
III. |
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Acute Exposure to Blood Containing HBsAg: There are no prospective studies
directly testing the efficacy of a combination of hepatitis B immune globulin and
hepatitis B vaccine (recombinant) in preventing clinical hepatitis B following
percutaneous, ocular or mucous membrane exposure to hepatitis B virus. However, recent
studies have established the relative efficacies of immune globulins and/or hepatitis B
vaccine in various exposure situations. Since most persons with such exposures (e.g.,
health care workers) are candidates for the hepatitis B vaccine and since combined
hepatitis B immune globulin plus vaccine is more efficacious than hepatitis B immune
globulin alone in perinatal exposures, the following guidelines are recommended for
persons who have been exposed to hepatitis B virus such as through (1) percutaneous
(needlestick), ocular, mucous membrane exposure to blood known or presumed to contain
HBsAg, (2) human bites by known or presumed HBsAg carriers, that penetrate the skin, or
(3) following intimate sexual contact with known or presumed HBsAg carriers: Hepatitis B
immune globulin (0.06 mL/kg) should be given as soon as possible after exposure and
within 24 hours if possible. Hepatitis B vaccine 1.0 mL
(10 µg/1.0 mL) should be given i.m. within 7 days of exposure and second
and third doses given 1 and 6 months, respectively, after the first dose. |
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It is important to use a separate sterile syringe and needle for each individual
patient to prevent transmission of hepatitis and other infectious agents from one person
to another. |
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For Syringe Use Only: Withdraw the recommended dose from the vial using a
sterile needle and syringe free of preservatives, antiseptics, and detergents. |
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Supplied: Adults: Each 1 mL dose of sterile, suspension contains:
hepatitis B surface antigen 10 µg/vial. Formulated in an alum adjuvant, and
thimerosal (mercury derivative) 1:20 000 added as a preservative. Single dose
vials of 1 mL; 3 dose vials of 3 mL. |
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Children: Each 0.5 mL dose of sterile suspension contains: hepatitis B
antigen 5 µg/vial. Formulated in an alum adjuvant, and thimerosal (mercury
derivative) 1:20 000 added as a preservative. Single dose vials of 0.5 mL. |
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Dialysis Formulation: Each single dose vial for adult predialysis and dialysis
patients contains: hepatitis B antigen 40 µg. Single dose vials of 1 mL. |
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Store unopened and opened vials at 2 to 8°C. Storage above or below the
recommended temperature may reduce potency. Do not freeze because freezing destroys
potency. |
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The vaccine is used directly as supplied. No dilution or reconstitution is necessary.
Thimerosal (mercury derivative) in 1:20 000 dilution is present in the vaccine
as a preservative. Do not use vaccine after the expiration date. |