Hepatit1

Article Contents ::

Details About Generic Salt ::  Hepatit1

Main Medicine Class:: Vaccine, inactivated virus   

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

 

Drugs Class ::

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

Indications for Drugs ::

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

Drug Dose ::

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

Contraindication ::

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

Drug Precautions ::

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

Drug Side Effects ::

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

Drug Mode of Action ::  

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

Drug Interactions ::

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

Drug Assesment ::

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

Drug Storage/Management ::

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

Drug Notes ::

(hep-uh-TIGHT-iss)
Engerix-B
Injection (adult formulation)
20 mcg/mL hepatitis B surface antigen
Injection (pediatric formulation)
10 mcg/0.5 mL hepatitis B surface antigen
Recombivax HB
Injection (adult formulation)
10 mcg/mL hepatitis B surface antigen
Injection (pediatric/adolescent formulation)
5 mcg/0.5 mL hepatitis B surface antigen
Injection (dialysis formulation)
40 mcg/mL hepatitis B surface antigen
Class: Vaccine, inactivated virus

 

 Action Induces specific antibodies against hepatitis B virus.

 

 Indications Induction of active immunity against hepatitis B virus among people of all ages who are currently or who will be at increased risk of infection with this virus. Routine vaccination is recommended for infants and adolescents. All individuals not receiving the hepatitis B vaccine are recommended to be vaccinated at 11 to 12 yr. In addition, vaccination is recommended in older unvaccinated adolescents at high risk.

Vaccination is also indicated for those at high risk of exposure to or development of hepatitis B virus, such as health care personnel (eg, dentists; dental hygienists; nurses; oral surgeons; health care providers; surgeons; podiatrists; paramedical and ambulence personnel; patients and staff in hemodialysis units and hematology/oncology units; hemodialysis patients and patients with early renal failure before they require hemodialysis; blood bank and plasma fractionation workers; laboratory personnel handling blood, its products, and patients’ specimens; dental, medical, and nursing students); hospital cleaning staff who handle potentially infectious waste; patients requiring frequent or large-volume blood transfusions or clotting factor concentrates; residents and staff of institutions for mentally handicapped; household and other intimate contacts of people with persistent hepatitis B antigenemia; infants born to HBsAg-positive mothers; populations with high incidence of hepatitis B virus (eg, Alaskan Eskimos, Indochinese refugees, Haitian refugees); people at increased risk because of their sexual practices (eg, prostitutes; people who repeatedly contract STDs; homosexually active men; people with multiple sexual partners; international travelers; morticians; embalmers; prisoners; users of illicit injectable drugs; police and fire department personnel who render first aid or medical assistance.

Risk factors for hepatitis C are similar to those for hepatitis B. Consquently, immunization with hepatitis B vaccine is recommended for individuals with chronic hepatitis C.

Revaccination (booster doses): Adults and children with normal immune status: Antibody response lasts 10 yr or more. Hemodialysis patients: Vaccine protection is less complete and may persist only as long as antibody levels remain more than 10 mIU/mL. Vaccinated People who Experience Percutaneous or Needle Exposure to HBsAg-Positive Blood: Serological tests to assess immune status is recommended. If inadequate levels exist, treat with a booster dose of vaccine. Nonresponders: Most people who do not initially respond to the primary series may develop adequate antibody concentrations after revaccination with a fourth or fifth dose or a new complete vaccine series.

 

 Contraindications Hypersensitivity to yeast or any other component of vaccine.

 

 Route/Dosage

Adults 20 Yr or Older: Engerix-B: IM 20 mcg at 0, 1, and 6 mo; Recombivax HB: IM 10 mcg at 0, 1, and 6 mo. Children and Adolescents 1 to 19 Yr: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo, alternatively. Adolescents 11 to 15 Yr: Recombivax HB: IM 10 mcg at 0 and 4 to 6 mo. Infants of HBsAg-Positive or -Negative Mothers: Engerix-B: IM 10 mcg at 0, 1, and 6 mo; Recombivax HB: IM 5 mcg at 0, 1, and 6 mo. Adult Predialysis and Dialysis Patients: Engerix-B: IM 40 mcg at 0, 1, 2, and 6 mo: Recombivax HB: IM 40 mcg at 0, 1, and 6 mo.

Alternate Schedule

Engerix B: Designed for certain populations (eg, neonates born of hepatitis B-infected mothers, others who may have been recently exposed to the virus, certain travelers to high-risk areas). Adults (Older than 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo. Adolescents (11 to 19 Yr): IM 20 mcg at 0, 1, 2, 12 mo, or 20 mcg at 0, 1, 6 mo. Adolescents 11 to 16 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Children (Birth to 10 Yr): IM 10 mcg at 0, 1, 2, 12 mo. Children 5 to 10 Yr (For Whom an Extended Schedule is Acceptable Based on Risk of Exposure): IM 10 mcg at 0, 12, and 24 mo. Infants Born of HBsAG-Positive Mothers: IM 10 mcg at 0, 1, 2, and 12 mo. Revaccination: Hemodialysis Patients: A booster dose may be considered for patients undergoing dialysis if anti-HBs level less than 10 mIU/mL 1 to 2 mo after third dose. Other patients (when a booster dose is appropriate) (Engerix-B): Adults and adolescents 11 to 19 yr: IM 20 mcg. Children 10 yr or younger: IM 10 mcg.

 

 Interactions

Immunosuppressants (including high-dose corticosteroids or radiation therapy): May result in an inadequate response to immunization. Yellow Fever Vaccine: May reduce antibody titer otherwise expected from yellow fever vaccine. Separate these vaccines by 1 mo. Anticoagulants: Use caution when administering to patients receiving anticoagulant therapy because coadministration may increase the immunization drug.

 

 Lab Test Interferences None well documented.

 

 Adverse Reactions

CNS: Fatigue; weakness; headache; malaise; dizziness. DERMATOLOGIC: Flushing; angioedema. EENT: Earache; pharyngitis. GI: Nausea; diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Fever; pain; tenderness; pruritus; induration; erythema; ecchymosis; swelling; warmth or nodule formation at injection site; thrombocytopenia.

 

 Precautions

Pregnancy: Category C. Problems have not been reported and are unlikely. Use if woman is likely to be exposed to hepatitis B virus during or after pregnancy. Lactation: Undetermined. Elderly: Hepatitis B immunogenicity may be reduced in patients older than 40 yr. Hypersensitivity: Anaphylaxis and symptoms of immediate hypersensitivity have occurred within hours of administering vaccine. Immunosuppressed Patients: May require larger doses and may not respond to vaccine. Infection: Delay use of hepatitis B vaccine in presence of serious active infection except when withholding vaccine entails greater risk. Multiple Sclerosis (MS): Although no casual relationship has been established, rare instances of MS exacerbation have been reported following administration of hepatitis vaccines and other vaccines. Severely compromised cardiopulmonary status: Administer vaccine with caution. Unrecognized hepatitis B infection: May be present at time of vaccination and vaccine may not prevent hepatitis B because of long incubation period.

PATIENT CARE CONSIDERATIONS


 

 Administration/Storage

  • Shake well before use to maintain suspension of the vaccine.
  • Administer IM in deltoid muscle in adults. In infants and young children administer IM in anterolateral thigh. Avoid gluteal injection into buttock, which may result in less than optimal immune response.
  • May administer vaccine SC in patients who are at risk of hemorrhage following IM injection (eg, people with hemophilia or thalassemia). However, SC route may produce less than optimal response and may lead to increased incidence of local reactions.
  • Always record manufacturer’s name and vaccine lot number in patient’s permanent record file along with date of administration, name, and title of person administering vaccine.
  • Have epinephrine 1:1000 available in case of laryngospasms.
  • Use vaccine as supplied. No dilution or reconstitution is necessary. Note that vaccine is slightly opaque, white suspension.
  • Refrigerate vials. Do not freeze. Freezing destroys potency.

 

 Assessment/Interventions

  • Obtain complete history, including drug history and any known allergies.
  • Review patient’s medical history for history of serious adverse reactions to previous dose of hepatitis B vaccine.
  • Check patient’s immunization history to verify that administration regimen is being followed.
  • Consider delaying immunization during course of serious active infection.
  • Monitor for hypersensitivity or anaphylaxis. Always have epinephrine available to counteract any possible reactions.

 

 Patient/Family Education

  • Instruct patient or parent to complete the series of injections for vaccine to be effective.
  • Provide patient or parent with immunization history record and record of this immunization in patient’s medical records.
  • Instruct patient or parent to use antipyretics for fever or analgesics (eg, acetaminophen) for local pain.
  • Inform patient or parent of immunization schedule.

Disclaimer ::

The Information available on this site is for only Informational Purpose , before any use of this information please consult your Doctor .Price of the drugs indicated above may not match to real price due to many possible reasons may , including local taxes etc.. These are only approximate indicative prices of the drug.

Leave a comment

Your email address will not be published. Required fields are marked *

royalmpo Royalmpo Royalmpo royalmpo royalmpo royalmpo royalmpo https://malangtoday.id/ https://guyonanbola.com/ renunganhariankatolik.web.id royalmpo royalmpo royalmpo dewaslot168 ri188 https://hayzlett.com/c-suite-network/ kingslot jkt88 mpodewa https://going-natural.com/the-story-behind-the-mutilated-scalp-video/ royalmpo/ pisang88/ langkahcurang/ mpohoki/ mpocuan/ royalmpo/ mporoyal/ asiaslot/ rajaslot138/ royalmpo https://hayzlett.com/news/ rajaslot88/ Analisis Scatter Hitam MahjongWays RTP Terukur Kemenangan Puluhan Grid Fase Awal Mahjong Pola Perilaku Pemain Harian Prediksi Strategi Game Terbaik RTP Strategi Target Kemenangan Tekanan Meja Live Kasino Slot Digital Hiburan Ringan Slot Online Tanpa Target Mengelola Mood Pemain Slot https://going-natural.com/my-braid-locs/ https://going-natural.com/kellen-marcus/ narutoslot bangslot royalmpo royalmpo macanasia bosslot slotking
pengalaman memahami dinamika rtp harian optimalisasi analisis algoritma pola perubahan studi kondisi ideal mahjongways trafik strategi adaptif pengelolaan sistem big analisis probabilistik reel mahjong ways metode sistematis membaca pola data kajian empiris pola perilaku pengguna peluang menang mahjong ways pgsoft evaluasi indikator rtp analisis probabilitas insight rtp real time strategi algoritma slot membaca pola pemain perjalanan pemula pola slot berbasis eksplorasi naskah kuno nilai ekonomi optimalisasi pengelolaan referensi ilmiah sistematis menghindari kesalahan fatal slot pola hasil pendekatan komprehensif stabilitas slot pgsoft evaluasi kinerja slot digital rtp variabilitas Mengurai Pola RTP Modern Strategi Formula Terbaru 2026 Teknik Cerdas Eksplorasi RTP Statistik Lanjutan Algoritma Membongkar Cara Kerja RNG Slot Optimalisasi Data RTP Live Strategi Studi Probabilitas Spin Mahjong Wins Strategi Profit Jangka Menengah Analisis Transformasi Ekonomi Digital Evolusi Game Pengembangan Model Stokastik Analisis Distribusi Teknik Kontrol Spin Stabilitas RTP analisis rtp terbaru strategi profit stabil update teknik 2026 cara efektif cuan pendekatan ilmiah rtp statistik inferensial algoritma mekanisme rng game reel simulasi terbuka membaca data rtp real time strategi analisa probabilitas spin mahjong wins pola strategi target profit jangka menengah tren dampak ekonomi digital industri game mahjong inovasi analisis distribusi rtp model stokastik panduan stabilitas rtp mahjong ways spin mengurai probabilitas spin mahjong ways pola cara objektif membaca rtp uji konsistensi eksplorasi pola angka distribusi simbol strategi membedah struktur layer mahjong ways mekanisme penerapan analisis statistik rtp efektivitas permainan strategi stabilitas spin mahjong ways metode dinamika rtp model probabilitas inferensial algoritma membaca pola simbol dan ritme permainan interaksi scatter mahjong ways analisis frekuensi mengupas pergerakan rtp model probabilitas sistem rahasia pola spin mahjong analisis frekuensi scatter hitam dampak peluang menang mahjong algoritma baru membaca scatter dan wild data rtp aktif kunci performa permainan pergerakan rtp tidak stabil pola bermain strategi spin rtp mahjong online terbaik derivasi kumulatif sistem analisis data permainan cara menjaga momentum agar peluang tidak pendekatan longitudinal dinamika permainan slot akurat pola spin mahjong ways 2026 analisis pendekatan data terbaru optimalkan akurasi rtp analisis mikro mahjong ways segmentasi fase evolusi sistem game online automasi interaksi strategi stabil menang mahjong ways tanpa studi terkini pola dinamis rtp live pola konsumsi digital hubungan rtp ketertarikan membaca scatter wild pendekatan algoritmik terstruktur perbandingan mahjong ways vs mahjong wins pendekatan variansi modern pola kemenangan gates metode terukur analisis konsistensi rtp mahjong evaluasi pola rtp dinamis mahjong model probabilitas nonlinier mahjong wins optimalisasi performa mahjong ways manajemen panduan adaptif pemula pola ritme pendekatan statistik rtp distribusi probabilitas pengaruh cache smartphone stabilitas mahjong peran ai analisis pola permainan strategi efektif tren rtp target strategi taruhan optimal berdasarkan fluktuasi studi tren pola mahjong ways
gacorway
Perubahan Pola Mahjong Wins1 Timing Scatter Mahjong Wins3 Arah Scatter Mahjong Wins2 PGSoft Strategi Simbol Tengah Misteri Grid Naga Merah Ritme Spin Pendek Mahjong Wins Bonus Mahjong Wins 3 Sinkron Analisa Mahjong Wins 2 & Olympus Pergerakan Grid Cepat Rahasia Sinkronisasi Reel Pola Berulang Putaran Awal Kombinasi Mahjong Wins 2 & Olympus Mode Manual Mahjong Wins 2 Indikator Lompatan Simbol Aktivitas Mahjong Wins 2 Meningkat Sinkronisasi Simbol Mahjong Wins3 Petunjuk Warna Simbol Taktik Shift-Gear Mahjong Wins 3 Teknik Delay Spin Pola Berlapis Mahjong Wins & Starlight Auto Off Mahjong Wins 2 Lebih Terbaca Perubahan Scatter Cepat Strategi Pause Spin Perubahan Arah RTP Mahjong Wins 2 Irama Putaran Manual Mahjong Wins 3 RTP Dinamis Mahjong Wins 2 Ritme Stabil Mahjong Wins 2 Integrasi Olympus Mahjong Wins 1 Mode Manual Mahjong Wins 1 Kombinasi Mahjong Wins 1 & Starlight Sinyal Reel Kanan Scatter Beruntun Mahjong Wins3 Grid Tracking Mahjong Wins 3 Pola Simetris Mahjong Wins 1 Pengaruh Sweet Bonanza Sinkronisasi Mahjong Wins 3 Memuncak Variasi Simbol Mahjong Wins1 Teknik Adaptif Spin Penentu Arah Fase Awal Interaksi Mahjong Wins 3 & Starlight Trik Cerdik Mahjong Ways 2 Kombinasi Mahjong Ways 3 dan Starlight Princess Cara Untung di Mahjong Ways 1 Trik Lama Mahjong Ways 2 Teknik Rahasia Mahjong Wins 2 Spin Cepat di Mahjong Ways 2 Kombinasi Mahjong Wins 2 dan Gates of Olympus Mahjong Wins 1 Versi Manual Pola Baru Mahjong Wins 1 RTP Mahjong Wins 3 Cara Membaca Mahjong Ways Trik Scatter Mahjong Wins 2 Mahjong Ways 3 Teknik Delay Spin Teknik Adaptif Mahjong Wins 3 Strategi Mahjong Ways 2 RTP Stabil Cara Main Mahjong Ways 1 Cara Membaca Mahjong Ways 3 RTP Mahjong Wins 3 Hari Ini Teknik Lama Mahjong Wins 3 Mahjong Ways 2 PGSoft Sinyal RTP Pola Mahjong Wins 1 Putaran Awal Kombinasi Mahjong Wins dan Princess Kombinasi Mahjong Ways dan Sweet Bonanza Grid Mahjong Ways 1 RTP Mahjong Wins 2 Jam Tertentu Mahjong Ways 1 Pola Acak Kombinasi Mahjong Ways 3 dan Olympus Mahjong Ways 2 Versi Manual Mahjong Wins 3 RTP Bergerak RTP Mahjong Wins 3 Pola Lama Cara Untung Cepat Mahjong Ways 2 Mahjong Wins 1 Pola Sederhana Mahjong Ways 3 Ritme Cepat Mahjong Ways 2 Mode Manual Cara Membaca Mahjong Ways 1 Mahjong Ways 2 Pola Tidak Stabil Mahjong Wins 2 Teknik Spin Pendek Mahjong Wins 3 Scatter Mulai Terbentuk Teknik Adaptif Mahjong Ways 3 Trik Rahasia Mahjong Ways 2 PGSoft Cara Untung Mahjong Ways 2 Grid Acak Trik Lama Mahjong Ways 1 Kombinasi Mahjong Wins 2 dan Sweet Bonanza Pondasi Permainan Mahjong Wins 1 Mahjong Ways 1 Putaran Awal Kombinasi Mahjong Wins 2 dan Olympus Mahjong Wins 1 Mode Manual Mahjong Wins 3 Perubahan RTP Kombinasi Mahjong Wins 2 dan Starlight Princess Metode Withdraw Bertahap Mahjong Ways 3 Ujung Tombak Mahjong Wins 3 Starlight Princess Saling Sikut Mahjong Ways 1 Modal Receh Rp 8.000.200 Mahjong Wins 1 Multiplier 500x Mahjong Wins 2 Siapa Cepat Dia Dapat Mahjong Ways 3 Ujung Tombak Mahjong Wins 3 Starlight Princess Saling Sikut Mahjong Ways 1 Modal Receh Rp 8.000.200 Mahjong Wins 1 Multiplier 500x Mahjong Wins 2 Siapa Cepat Dia Dapat Mahjong Ways 3 dan Sweet Bonanza Mahjong Wins 3 Kombinasi Tidak Sinkron Teknik Sinkronisasi IP Address Mahjong Wins 1 Game Online Mahjong Ways 2 Tanpa Pola Mahjong Ways 2 RTP Live Melesat Mahjong Wins 3 Kondisi Paling Subur Mahjong Ways 2 Penyelamat Mahjong Ways 2 Jam Rawan Scatter Mahjong Wins 1 Pagi Buta Free Spin Mahjong Ways 3 Gates of Olympus Bocor Mahjong Wins 2 Scatter Tanpa Dikomando Mahjong Ways 1 WD Rp 7.210.000 Mahjong Ways 2 Pagi Buta Mahjong Ways 1 Fitur Capes Mahjong Wins 3 Siklus Tersembunyi Mahjong Wins 3 Sweet Bonanza Banjir Mahjong Ways 2 Numpuk Bonus Mahjong Ways 2 Sesi Paling Berkesan Mahjong Wins 1 Kemenangan Tanpa Drama Mahjong Ways 1 Pagi Hari Mahjong Wins 2 Tanpa Perubahan Setting Mahjong Wins 2 Sistem Bermasalah Mahjong Wins 3 RTP Live Mahjong Ways 1 Tanpa Ritme Mahjong Wins 1 Putaran Awal Mahjong Wins 2 Grid Tidak Menentu Mahjong Ways 3 dan Princess Mahjong Ways 2 Mode Manual Mahjong Ways 1 Tips Game Mahjong Ways 3 Jackpot Dadakan Mahjong Ways 1 FreeSpin Beruntun Mahjong Ways 2 Rp 14.555.000 Mahjong Wins 1 Konsisten Kasih Nafas Mahjong Ways 1 Jam 1 Siang Mahjong Wins 3 BuySpin Pecah Mahjong Ways 2 Gaspol Rp 12.888.500 Mahjong Ways 2 5 Scatter Auto Kaya Mahjong Ways 2 BuySpin Rp 22.150.000 Mahjong Wins 3 Gates of Olympus Rp 20.111.800 Menelusuri Performa RTP Live Hari Ini, Permainan Mahjong Ways 3 PGSoft Tunjukkan Konsistensi Menarik Game Mahjong Wins 2 Pragmatic Play Memiliki Siklus Bonus Yang Bisa Diamati Bukan Sekedar Hoki RTP Live Stabil Sejak Pagi, Banyak Pemain Beralih Ke Mahjong Ways 1 PGSoft Untuk Mengawali Sesi Observasi Menarik Dari Permainan Mahjong Wins 3 PGSoft, Frekuensi Scatter Meningkat Tanpa Pola Tertentu Mahjong Ways 2 Pragmatic Play Menjadi Perbincangan, Game Ini Dinilai Paling Ramah Untuk Pemula Fakta Di Balik RTP Live Malam Ini, Permainan Mahjong Wins 1 PGSoft Sedang Dalam Fase Subur Tinjauan Kritis Terhadap Mahjong Wins 2 Pragmatic Play, Apakah Game Ini Masih Relevan di Tahun Ini? Mahjong Ways 1 PGSoft Mulai Dilirik, Permainan Dengan Tingkat Volatilitas Yang Cukup Terukur Kombinasi Game Mahjong Ways 3 PGSoft dan Gates of Olympus, Tawarkan Pengalaman Bermain Berbeda RTP Live Hari Ini Jadi Sorotan, Mahjong Ways 2 Pragmatic Play Termasuk Game Dengan Performa Terbaik Mahjong Ways 1 PGSoft Mahjong Wins 1 Tanpa Auto Spin Kombinasi Mahjong Wins 1 dan Sweet Bonanza Mahjong Wins 2 Tips dan Pola Aman Mahjong Ways 3 PGSoft Mahjong Wins 1 Grid Tidak Sesuai Mahjong Ways 2 PGSoft Mahjong Ways 1 Siang Hari Mahjong Ways 1 HP Jadul Mahjong Wins 1 Ganti Pola Mahjong Ways 1 RTP Live Hijau Mahjong Ways 2 Jam 2 Malam Mahjong Wins 3 Banjir Scatter Mahjong Ways 1 Freespin 100x Mahjong Ways 3 Gaspol Rp 17.432.100 Pendekatan Sederhana Pada Permainan Mahjong Wins 1 PGSoft, Fokus Pada Konsistensi Bukan Kejar Target Penelusuran Data Menunjukkan, Game Mahjong Wins 3 PGSoft Sering Memberikan Kejutan Saat RTP Live Naik Game Mahjong Ways 1 PGSoft Menawarkan Pengalaman Berbeda Saat Dimainkan Tanpa Fitur Auto Spin Mahjong Wins 3 PGSoft Jadi Pilihan, Permainan Ini Dinilai Memberikan Ruang Gerak Yang Cukup Luas Kombinasi Game Mahjong Ways 3 PGSoft dan Sweet Bonanza, Dua Game Yang Sering Dikombinasikan Dalam Sesi Panjang Game Mahjong Ways 1 PGSoft Menawarkan Pengalaman Berbeda Saat Dimainkan Tanpa Fitur Auto Spin Permainan Mahjong Ways 3 PGSoft Mulai Ramai Dibahas, Banyak Pemain Raih Keuntungan Rp 7.888.000 Analisa Singkat Permainan Mahjong Wins 3 PGSoft, Menemukan Hubungan Antara Kecepatan Spin dan Bonus Ada Temuan Menarik Dari Game Mahjong Ways 2 Pragmatic Play, Siklus Bonus Muncul Setiap 30 Menit Dari Sekian Banyak Game, Mahjong Wins 1 PGSoft Paling Sering Disebut Dalam Diskusi RTP Live Dari Sekian Banyak Game, Mahjong Wins 1 PGSoft Paling Sering Disebut Dalam Diskusi RTP Live RTP Live Malam Ini Terpantau Tinggi, Mahjong Wins 1 PGSoft Jadi Salah Satu Game Incaran RTP Live Konsisten Sejak Sore, Mahjong Ways 1 PGSoft Jadi Game Pembuka Sesi Yang Tepat Observasi Lapangan Menunjukkan, Permainan Mahjong Wins 3 PGSoft Lebih Responsif Saat Pagi Hari Kombinasi Game Mahjong Wins 2 Pragmatic Play dan Starlight Princess, Apakah Efektif? RTP Live Hari Ini Menarik Perhatian, Mahjong Wins 2 Pragmatic Play Masuk Dalam Daftar Game Prioritas Strategi Bermain Mahjong Wins 1 PGSoft, Memanfaatkan Data RTP Live Untuk Menentukan Waktu Berhenti Mahjong Ways 2 Pragmatic Play Tak Pernah Sepi, Game Ini Punya Basis Pemain Yang Cukup Loyal Mahjong Ways 2 Pragmatic Play, Game Dengan Tingkat Return to Player Yang Cukup Kompetitif Mahjong Wins 2 Pragmatic Play Layak Dicoba, Permainan Ini Punya Mekanisme Bonus Yang Cukup Unik Permainan Mahjong Ways 3 PGSoft dan Gates of Olympus, Perpaduan Yang Mulai Diuji Coba Banyak Pemain Riset Kecil-Kecilan Pada Game Mahjong Wins 3 PGSoft, Ternyata Jam 1 Siang Punya Potensi Tersendiri Mahjong Wins 2 Pragmatic Play, Game Yang Sering Direkomendasikan Untuk Pemain Dengan Modal Terbatas Mengapa Game Mahjong Ways 1 PGSoft Sering Jadi Andalan? Ternyata Ini Faktor Utamanya Dari Sesi Eksperimen, Permainan Mahjong Ways 3 PGSoft Terbukti Bisa Dikombinasikan Dengan Starlight Princess Permainan Mahjong Wins 1 PGSoft Mulai Dilirik Lagi, Banyak Pemain Laporkan Hasil Memuaskan RTP Live Malam Ini Stabil, Mahjong Ways 3 PGSoft Jadi Game Yang Paling Banyak Dimainkan RTP Live Menjadi Acuan, Mahjong Wins 3 Pragmatic Play Termasuk Game Dengan Predikat Favorit Dari Observasi Langsung, Game Mahjong Wins 3 PGSoft Paling Sering Memberikan Bonus Beruntun Mahjong Ways 1 PGSoft dan Sweet Bonanza, Dua Game Yang Sering Berdampingan Dalam Sesi Pemain RTP Live Hari Ini Cenderung Stabil, Mahjong Ways 3 PGSoft Jadi Game Andalan Banyak Pemain