USE OF HEPATITIS A VACCINE IN PREGNANCY

Hepatitis A vaccine is an inactivated vaccine and is available in the United Kingdom as a monovalent vaccine, or in combination with hepatitis B or typhoid vaccines.

Hepatitis A is generally a short-lived, self-limiting infection and serious complications are uncommon, although 10-15% of symptomatic individuals can have prolonged or relapsing disease lasting up to six months.

Hepatitis A vaccination is indicated for people at increased risk of contracting the infection (such as travellers to certain areas, or those with occupational risk), or of fulminant hepatitis, should infection occur.

Hepatitis A infection during pregnancy is not believed to pose a risk to embryofetal development, although there is some evidence that acute infection during the second and third trimesters of pregnancy is associated with gestational complications and preterm labour.

Data relating to hepatitis A vaccination in pregnancy is provided by cohort studies and clinical trials that collectively detail the outcomes of approximately 1,800 exposed pregnancies. Up to ~700 additional exposed pregnancies are detailed as case reports, largely from post-marketing surveillance/adverse event reporting systems.

Overall, the available data do not raise concern of increased risks of adverse pregnancy outcomes following gestational exposure to hepatitis A vaccines. Data relating to non-live vaccines as a class are similarly reassuring.

The Department of Health in the UK recommends that hepatitis A vaccine can be given to pregnant women if clinically indicated. Inadvertent exposure to hepatitis A vaccine at any stage in pregnancy is not regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.