TWINRIX

Hepatitis A and B: Disease Overview

Hepatitis A

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• Hepatitis A is an infectious disease that can affect the liver and cause mild to severe illness* 1, 2

Possible signs and symptoms†

If symptoms are present, they usually appear abruptly and may include:† 1, 3

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Abdominal discomfort
• Dark urine
• Jaundice

Clinical features†

• Symptoms usually last less than 2 months 1, 3
• While most infected people recover, 10% to 15% may be ill for as long as 6 months‡ 1, 3
• Older persons are more likely to have symptoms than children 1
• Approximately 25% of adults infected with hepatitis A are hospitalized 4

Transmission§

• The hepatitis A virus is usually transmitted from person to person by the fecal-oral route, through direct contact with infected people or indirectly through ingestion of contaminated water or foods 1, 4
  
• Hepatitis A virus can survive up to 10 months in water and on dried surfaces for 7 days 1

Transmission during incubation§

• The uninfected person ingests food or water contaminated with the feces of an infected person 1, 4
• It takes an average of 28 days (range: 15-50 days) for hepatitis A symptoms to appear†‡ 1
• During this incubation period, the infected person may transmit the virus to others, despite showing no symptoms‡ 1

Hepatitis B

• Hepatitis B is a common and serious infectious disease that affects the liver*† 1, 5
• In Canada, it is estimated that less than 5% of the population have had hepatitis B during their lifetime 4

Possible signs and symptoms†

Acute symptoms of hepatitis B may include: 1, 6, 7

• Jaundice
• Fatigue
• Loss of appetite
• Nausea
• Abdominal discomfort
• Dark urine
• Clay-coloured bowel movements
• Joint pain

Clinical features†

• The hepatitis B virus may cause a severe form of hepatitis 5, 6, 7
• The incubation period is an average of 90 days (range 60 to 150 days) after exposure to the hepatitis B virus‡ 7
• Symptoms occur in about 70% of patients† 1
• Symptoms are more likely to occur in adults than in children 1
• Older persons are more likely to experience acute symptoms 1

Potential long term effects

• Approximately 10% of adults infected with hepatitis B virus develop persistent viremia or chronic carrier state¶ 8
• Hepatitis B carriers are at a high risk of developing chronic liver disease that may lead to cirrhosis or primary hepatocellular carcinoma (liver cancer)*†¶ 6, 7

Transmission§

• The hepatitis B virus is found in body fluids such as blood, semen, vaginal secretions, or saliva of infected individuals 4
• The virus is generally spread from person to person through any perforation in the skin 1
• Hepatitis B viral infection may be present with no symptoms in 30% of patients. People with asymptomatic hepatitis B can transmit the virus without knowing they are infected†‡ 1
• Almost one-third of hepatitis B patients do not know how their infection was acquired 4

TWINRIX combined hepatitis A (inactivated) and hepatitis B (recombinant) vaccine is indicated for active immunization against hepatitis A and hepatitis B virus infection in adults, adolescents, children and infants. 1

TWINRIX will not protect against infection caused by other agents such as hepatitis C, hepatitis E and other pathogens known to infect the liver. It can be expected that hepatitis D will also be prevented by immunization with TWINRIX as hepatitis D (caused by the delta agent) does not occur in the absence of hepatitis B infection. 1

* TWINRIX is not indicated to reduce the effects of hepatitis A or B on the liver or the severity of the disease.
† TWINRIX is not indicated to treat the features or symptoms of or reduce morbidity and mortality associated with hepatitis A or B.
‡ It is possible that latent infection may be present at the time of vaccination. TWINRIX may not prevent hepatitis A or B in such cases. 1
§ TWINRIX is not indicated to reduce transmission of hepatitis A or B.
¶ TWINRIX is not indicated to prevent carrier status.