Drug Detail:Vaqta (Hepatitis a adult vaccine [ hep-a-tye-tis ])
Drug Class: Viral vaccines
Highlights of Prescribing Information
VAQTA® (Hepatitis A Vaccine, Inactivated)
Suspension for Intramuscular Injection
Initial U.S. Approval: 1996
Indications and Usage for Vaqta
VAQTA is a vaccine indicated for the prevention of disease caused by hepatitis A virus (HAV) in persons 12 months of age and older. The primary dose should be given at least 2 weeks prior to expected exposure to HAV. (1.1)
Vaqta Dosage and Administration
- For intramuscular administration only. (2)
- Children/Adolescents: vaccination consists of a 0.5-mL primary dose administered intramuscularly, and a 0.5-mL booster dose administered intramuscularly 6 to 18 months later. (2.1)
- Adults: vaccination consists of a 1-mL primary dose administered intramuscularly, and a 1-mL booster dose administered intramuscularly 6 to 18 months later. (2.1)
Dosage Forms and Strengths
Suspension supplied in four presentations:
- 0.5-mL pediatric dose in single-dose vials and prefilled syringes. (3, 11, 16)
- 1-mL adult dose in single-dose vials and prefilled syringes. (3, 11, 16)
Contraindications
Do not administer VAQTA to individuals with a history of immediate and/or severe allergic or hypersensitivity reactions (e.g., anaphylaxis) after a previous dose of any hepatitis A vaccine or with an anaphylactic reaction to neomycin. (4, 11)
Warnings and Precautions
- The vial stopper and the syringe plunger stopper and tip cap contain dry natural latex rubber that may cause allergic reactions in latex-sensitive individuals. (5.2)
Adverse Reactions/Side Effects
The most common local adverse reactions and systemic adverse events (≥15%) reported in different clinical trials across different age groups when VAQTA was administered alone or concomitantly were:
- Children — 12 through 23 months of age: injection-site pain/tenderness (37.0%), injection-site erythema (21.2%), fever (16.4% when administered alone, and 27.0% when administered concomitantly) (6.1)
- Children/Adolescents — 2 through 18 years of age: injection-site pain (18.7%) (6.1)
- Adults — 19 years of age and older: injection-site pain, tenderness, or soreness (67.0%), injection-site warmth (18.2%) and headache (16.1%) (6.1)
To report SUSPECTED ADVERSE REACTIONS, contact Merck Sharp & Dohme LLC at 1-877-888-4231 or VAERS at 1-800-822-7967 or www.vaers.hhs.gov .
Drug Interactions
- Do not mix VAQTA with any other vaccine in the same syringe or vial. (7.1)
See 17 for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling.
Revised: 4/2023
Related/similar drugs
Twinrix, hepatitis a adult vaccine, HavrixFull Prescribing Information
2. Vaqta Dosage and Administration
FOR INTRAMUSCULAR ADMINISTRATION ONLY.
2.2 Preparation and Administration
Shake the single-dose vial or single-dose prefilled syringe well to obtain a slightly opaque, white suspension before withdrawal and use. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Discard if the suspension does not appear homogenous or if extraneous particulate matter remains or discoloration is observed.
For single-dose vials, withdraw and administer entire dose of VAQTA intramuscularly using a sterile needle and syringe. Discard vial after use.
For single-dose prefilled syringes, securely attach a needle by twisting in a clockwise direction and administer dose of VAQTA intramuscularly. Discard syringe after use.
For adults, adolescents, and children older than 2 years of age, the deltoid muscle is the preferred site for intramuscular injection. For children 12 through 23 months of age, the anterolateral area of the thigh is the preferred site for intramuscular injection.
3. Dosage Forms and Strengths
Suspension for injection available in four presentations:
- 0.5-mL pediatric dose in single-dose vials and prefilled syringes
- 1-mL adult dose in single-dose vials and prefilled syringes
[See Description (11) for listing of vaccine components and How Supplied/Storage and Handling (16).]
4. Contraindications
Do not administer VAQTA to individuals with a history of immediate and/or severe allergic or hypersensitivity reactions (e.g., anaphylaxis) after a previous dose of any hepatitis A vaccine, or to individuals who have had an anaphylactic reaction to any component of VAQTA, including neomycin [see Description (11)].
5. Warnings and Precautions
5.1 Prevention and Management of Allergic Vaccine Reactions
Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of the vaccine [see Contraindications (4)].
5.2 Hypersensitivity to Latex
The vial stopper and the syringe plunger stopper and tip cap contain dry natural latex rubber that may cause allergic reactions in latex-sensitive individuals [see How Supplied/Storage and Handling (16)].
5.3 Altered Immunocompetence
Immunocompromised persons, including individuals receiving immunosuppressive therapy, may have a diminished immune response to VAQTA and may not be protected against HAV infection after vaccination [see Use in Specific Populations (8.6)].
5.4 Limitations of Vaccine Effectiveness
Hepatitis A virus has a relatively long incubation period (approximately 20 to 50 days). VAQTA may not prevent hepatitis A infection in individuals who have an unrecognized hepatitis A infection at the time of vaccination. Vaccination with VAQTA may not result in a protective response in all susceptible vaccinees.
6. Adverse Reactions/Side Effects
6.1 Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared to rates in the clinical trials of another vaccine and may not reflect the rates observed in practice.
The safety of VAQTA has been evaluated in over 10,000 subjects 1 year to 85 years of age. Subjects were given one or two doses of the vaccine. The second (booster dose) was given 6 months or more after the first dose.
The most common local adverse reactions and systemic adverse events (≥15%) reported in different clinical trials across different age groups when VAQTA was administered alone or concomitantly were:
- Children — 12 through 23 months of age: injection-site pain/tenderness (37.0%), injection-site erythema (21.2%), fever (16.4% when administered alone, and 27.0% when administered concomitantly).
- Children/Adolescents — 2 through 18 years of age: injection-site pain (18.7%)
- Adults — 19 years of age and older: injection-site pain, tenderness, or soreness (67.0%), injection-site warmth (18.2%) and headache (16.1%)
Children — 12 through 23 Months of Age
Across five clinical trials, 4374 children 12 to 23 months of age received one or two 25U doses of VAQTA, including 3885 children who received 2 doses of VAQTA and 1250 children who received VAQTA concomitantly with one or more other vaccines, including Measles, Mumps, and Rubella Virus Vaccine, Live (M-M-R II®), Varicella Vaccine, Live (VARIVAX®), Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine, Adsorbed (Tripedia or INFANRIX), Measles, Mumps, Rubella, and Varicella Vaccine, Live (ProQuad®), Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197, Prevnar), or Haemophilus B Conjugate Vaccine (Meningococcal Protein Conjugate, PedvaxHIB®). Overall, the race distribution of study subjects was as follows: 64.7% Caucasian; 15.7% Hispanic-American; 12.3% Black; 4.8% other; 1.4% Asian; and 1.1% Native American. The distribution of subjects by gender was 51.8% male and 48.2% female.
In an open-label clinical trial, 653 children 12 to 23 months of age were randomized to receive a first dose of VAQTA with ProQuad and Prevnar concomitantly (N=330) or a first dose of ProQuad and pneumococcal 7-valent conjugate vaccine concomitantly, followed by a first dose of VAQTA 6 weeks later (N=323). Approximately 6 months later, subjects received either the second doses of ProQuad and VAQTA concomitantly or the second doses of ProQuad and VAQTA separately. The race distribution of the study subjects was as follows: 60.3% Caucasian; 21.6% African-American; 9.5% Hispanic-American; 7.2% other; 1.1% Asian; and 0.3% Native American. The distribution of subjects by gender was 50.7% male and 49.3% female.
Table 1 presents rates of solicited local reactions at the VAQTA injection site and rates of elevated temperatures (≥100.4°F and ≥102.2°F) that occurred within 5 days following each dose of VAQTA and elevated temperatures >98.6°F for a total of 14 days after vaccination; occurrences of these events were recorded daily on diary cards. Table 2 presents rates of unsolicited systemic adverse events that occurred within 14 days at ≥5% in any group following each dose of VAQTA.
Dose 1 | Dose 2 | |||
---|---|---|---|---|
Adverse reaction: Days 1-5 unless noted | VAQTA alone | VAQTA + ProQuad + Prevnar concomitantly | VAQTA alone | VAQTA + ProQuad concomitantly |
N=number of subjects for whom data are available. | ||||
|
||||
Injection site adverse reactions | N=274 | N=311 | N=251 | N=263 |
Injection site erythema | 11.7% | 9.6% | 12.7% | 9.5% |
Injection site pain/tenderness | 15.3% | 20.9% | 20.3% | 17.5% |
Injection site swelling | 9.5% | 6.8% | 7.6% | 6.1% |
Temperature > 98.6°F or feverish (Days 1-14) | 12.4% | 35.7% | 10.8% | 10.3% |
N=243 | N=285 | N=221 | N=237 | |
Temperature ≥ 100.4°F | 10.3% | 16.8% | 10% | 4.2% |
Temperature ≥ 102.2 °F | 2.1% | 3.5% | 2.3% | 2.5% |
Dose 1 | Dose 2 | |||
---|---|---|---|---|
Adverse Event: Days 1-14 | VAQTA alone | VAQTA + ProQuad + PREVNAR concomitantly | VAQTA alone | VAQTA + ProQuad concomitantly |
|
||||
N=274 | N=311 | N=251 | N=263 | |
General Disorders and Administration Site Conditions | ||||
Irritability | 3.6% | 6.1% | 2.8% | 2.7% |
Infections and Infestations | ||||
Upper respiratory tract infection | 3.3% | 6.1% | 4.8% | 5.7% |
Skin and Subcutaneous Tissue Disorders | ||||
Dermatitis diaper | 1.1% | 6.1% | 2.4% | 3.4% |
In Stage I of an open, multicenter, randomized study, children 15 months of age were randomized to receive the first dose of VAQTA alone (N=151) or concomitantly with PedvaxHIB and INFANRIX (N=155); another group of children 15 months of age were randomized to receive the first dose of VAQTA alone (N=152) or concomitantly with PedvaxHIB (N=159). All groups received the second dose of VAQTA alone at least 6 months following the first dose. The race distribution of Stage I study subjects was: 63.9% Caucasian; 17.5% Hispanic-American; 14.7% Black; 2.6% other; and 1.3% Asian. The distribution of subjects by gender was 54.0% male and 46.0% female. In Stage II of this study, an additional 654 children 12-17 months of age received the first dose of VAQTA alone followed by the second dose of VAQTA 6 months later. The race distribution of Stage II of the study subjects was: 66.1% Caucasian; 10.6% Hispanic-American; 16.8% Black; 4.7% other; and 1.5% Asian. The distribution of subjects by gender was 51.2% male and 48.8% female.
Table 3 presents rates of solicited local reactions at the VAQTA injection-site and rates of elevated temperatures (≥100.4°F and ≥102.2°F) that occurred within 5 days following each dose of VAQTA and elevated temperatures >98.6°F for a total of 14 days following each dose of VAQTA. Occurrences of these events were recorded daily on diary cards. Table 4 presents rates of unsolicited systemic adverse events that occurred within 14 days at ≥5% following each dose of VAQTA.
Stage I | Stage II | ||||
---|---|---|---|---|---|
Dose 1 | Dose 2 | Dose 1 | Dose 2 | ||
Adverse Reaction: Days 1-5 unless noted | VAQTA alone | VAQTA + PedvaxHIB and Infanrix or VAQTA + PedvaxHIB concomitantly | VAQTA alone | VAQTA alone | VAQTA alone |
N= number of subjects for whom data is available | |||||
Injection site adverse reactions | N=256 | N=302 | N=503 | N=647 | N=599 |
Injection site erythema | 18.0% | 19.9% | 21.5% | 11.7% | 16.2% |
Injection site pain/tenderness | 21.9% | 36.4% | 27.4% | 20.1% | 22.9% |
Injection site swelling | 10.2% | 14.2% | 10.1% | 7.1% | 7.0% |
Temperature > 98.6°F or feverish (Days 1-14) | 10.2% | 17.2% | 10.7% | 10.0% | 8.2% |
N=234 | N=290 | N=473 | N=631 | N=591 | |
Temperature ≥ 100.4°F | 9.0% | 16.9% | 9.1% | 9.4% | 8.6% |
Temperature ≥ 102.2 °F | 3.8% | 3.1% | 3.2% | 2.9% | 2.4% |
Stage I | Stage II | ||||
---|---|---|---|---|---|
Dose 1 | Dose 2 | Dose 1 | Dose 2 | ||
Adverse Event: Days 1-14 | VAQTA alone | VAQTA + PedvaxHIB and Infanrix or VAQTA + PedvaxHIB concomitantly | VAQTA alone | VAQTA alone | VAQTA alone |
N=256 | N=302 | N=503 | N=647 | N=599 | |
Gastrointestinal Disorders | |||||
Diarrhea | 3.9% | 8.3% | 3.8% | 4.6% | 3.8% |
Teething | 3.1% | 2.3% | 1.4% | 5.7% | 4.3% |
General Disorders and Administration Site Conditions | |||||
Irritability | 6.3% | 9.6% | 4.0% | 8.8% | 6.5% |
Infections and Infestations | |||||
Upper respiratory tract infection | 2.3% | 3.3% | 3.0% | 4.9% | 5.2% |
Respiratory, Thoracic and Mediastinal Disorders | |||||
Rhinorrhea | 2.0% | 4.0% | 3.8% | 6.2% | 3.8% |
Data presented in Tables 1 through 4 on solicited local reactions, and solicited and unsolicited systemic adverse events with incidence ≥5% following each dose of VAQTA are representative of other clinical trials of VAQTA in children 12 through 23 months of age. Across the five studies conducted in children 12-23 months of age, ≥39.9% of subjects experienced local adverse reactions and ≥55.7% of subjects experienced systemic adverse events. The majority of local and systemic adverse events were mild to moderate in intensity.
The following additional unsolicited local adverse reactions and systemic adverse events were observed at a common frequency of ≥1% to <10% in any individual clinical study. This listing includes only the adverse reactions not reported elsewhere in the label. These local adverse reactions and systemic adverse events occurred among recipients of VAQTA alone or VAQTA given concomitantly within 14 days following any dose of VAQTA across four clinical studies.
- Eye disorders: Conjunctivitis
- Gastrointestinal disorders: Constipation; vomiting
- General disorders and administration site conditions: Injection-site bruising; injection-site ecchymosis
- Infections and infestations: Otitis media; nasopharyngitis; rhinitis; viral infection; croup; pharyngitis streptococcal; laryngotracheobronchitis; viral exanthema; gastroenteritis viral; roseola
- Metabolism and nutrition disorders: Anorexia
- Psychiatric disorders: Insomnia; crying
- Respiratory, thoracic and mediastinal disorders: Cough; nasal congestion; respiratory congestion
- Skin and subcutaneous tissue disorders: Rash vesicular; measles-like/rubella-like rash; varicella-like rash; rash morbilliform
Children/Adolescents — 2 Years through 18 Years of Age
In 11 clinical trials, 2615 healthy children 2 years through 18 years of age received at least one dose of VAQTA. These studies included administration of VAQTA in varying doses and regimens (1377 children received one or more 25U doses). The race distribution of the study subjects who received at least one dose of VAQTA in these studies was as follows: 84.7% Caucasian; 10.6% American Indian; 2.3% African-American; 1.5% Hispanic-American; 0.6% other; 0.2% Oriental. The distribution of subjects by gender was 51.2% male and 48.8% female.
In a double-blind, placebo-controlled efficacy trial (i.e. The Monroe Efficacy Study), 1037 healthy children and adolescents 2 through 16 years of age were randomized to receive a primary dose of 25U of VAQTA and a booster dose of VAQTA 6, 12, or 18 months later, or placebo (alum diluent). All study subjects were Caucasian: 51.5% were male and 48.5% were female. Subjects were followed days 1 to 5 postvaccination for fever and local adverse reactions and days 1 to 14 for systemic adverse events. The most common adverse events/reactions were injection-site reactions, reported by 6.4% of subjects. Table 5 summarizes local adverse reactions and systemic adverse events reported in ≥1% of subjects. There were no significant differences in the rates of any adverse events or adverse reactions between vaccine and placebo recipients after Dose 1.
Adverse Event | VAQTA (N=519) | Placebo (Alum Diluent)*,†,‡
(N=518) Rate (Percent) |
|
---|---|---|---|
Dose 1*
Rate (Percent) | Booster Rate (Percent) |
||
N=Number of subjects enrolled/randomized. | |||
Percent=percentage of subjects for whom data are available with adverse event | |||
n=number of subjects for whom adverse events available | |||
|
|||
Injection Site§ | n=515 | n=475 | n=510 |
Pain | 6.4% | 3.4% | 6.3% |
Tenderness | 4.9% | 1.7% | 6.1% |
Erythema | 1.9% | 0.8% | 1.8% |
Swelling | 1.7% | 1.5% | 1.6% |
Warmth | 1.7% | 0.6% | 1.6% |
Systemic¶ | n=519 | n=475 | n=518 |
Abdominal pain | 1.2% | 1.1% | 1.0% |
Pharyngitis | 1.2% | 0% | 0.8% |
Headache | 0.4% | 0.8% | 1.0% |
Adults — 19 Years of Age and Older
In an open-label clinical trial, 240 healthy adults 18 to 54 years of age were randomized to receive either VAQTA (50U/1-mL) with Typhim Vi (Typhoid Vi polysaccharide vaccine) and YF-Vax (yellow fever vaccine) concomitantly (N=80), typhoid Vi polysaccharide and yellow fever vaccines concomitantly (N=80), or VAQTA alone (N=80). Approximately 6 months later, subjects who received VAQTA were administered a second dose of VAQTA. The race distribution of the study subjects who received VAQTA with or without typhoid Vi polysaccharide and yellow fever vaccine was as follows: 78.3% Caucasian; 14.2% Oriental; 3.3% other; 2.1% African-American; 1.7% Indian; 0.4% Hispanic-American. The distribution of subjects by gender was 40.8% male and 59.2% female. Subjects were monitored for local adverse reactions and fever for 5 days and systemic adverse events for 14 days after each vaccination. In the 14 days after the first dose of VAQTA, the proportion of subjects with adverse events was similar between recipients of VAQTA given concomitantly with typhoid Vi polysaccharide and yellow fever vaccines compared to recipients of typhoid Vi polysaccharide and yellow fever vaccines without VAQTA. Table 6 summarizes solicited local adverse reactions and Table 7 summarizes unsolicited systemic adverse events reported in ≥5% in adults who received one or two doses of VAQTA alone and for subjects who received VAQTA concomitantly with typhoid Vi polysaccharide and yellow fever vaccines. There were no solicited systemic complaints reported at a rate ≥5%. Fever ≥101°F occurred in 1.3% of subjects in each group.
Adverse Event | VAQTA administered alone (N=80) | VAQTA + ViCPS* and Yellow Fever vaccines administered concomitantly†
(N=80) |
---|---|---|
Rate (Percent) | ||
N=Number of subjects enrolled/randomized. | ||
Percent=percentage of subjects with adverse event. | ||
|
||
Injection-site‡ | ||
Pain/tenderness/soreness | 78.8% | 70.3% |
Warmth | 23.7% | 23.7% |
Swelling | 16.2% | 8.8% |
Erythema | 17.5% | 6.3% |
Body System | VAQTA administered alone (N=80) | VAQTA + ViCPS* and Yellow Fever vaccines administered concomitantly†
(N=80) |
---|---|---|
Adverse Event | ||
Rate (Percent) | ||
N=Number of subjects enrolled/randomized with data available. | ||
Percent=percentage of subjects with adverse event for whom data are available. | ||
|
||
General disorders and administration site reactions‡ | ||
Asthenia/fatigue | 7.5% | 11.3% |
Chills | 1.3% | 7.5% |
Gastrointestinal disorders‡ | ||
Nausea | 7.5% | 12.5% |
Musculoskeletal and connective tissue disorders‡ | ||
Myalgia | 5.0% | 10.0% |
Arm pain | 0.0% | 6.3% |
Nervous system disorders‡ | ||
Headache | 23.8% | 26.3% |
Infections and infestations‡ | ||
Upper respiratory infection | 7.5% | 3.8% |
Pharyngitis | 2.5% | 6.3% |
In four clinical trials involving 1645 healthy adults 19 years of age and older who received one or more 50U doses of hepatitis A vaccine, subjects were followed for fever and local adverse reactions 1 to 5 days postvaccination and for systemic adverse events 1 to 14 days postvaccination. One single-blind study evaluated doses of VAQTA with varying amounts of viral antigen and/or alum content in healthy adults ≥170 pounds and ≥30 years of age (N=210 adults administered 50U/1-mL dose). One open-label study evaluated VAQTA given with immune globulin (IG) or alone (N=164 adults who received VAQTA alone). A third study was single-blind and evaluated 3 different lots of VAQTA (N=1112). The fourth study that was also single-blind evaluated doses of VAQTA with varying amounts of viral antigen in healthy adults ≥170 pounds and ≥30 years of age (N=159 adults administered the 50U/1-mL dose). Overall, the race distribution of the study subjects who received at least one dose of VAQTA was as follows: 94.2% Caucasian; 2.2% Black; 1.5% Hispanic; 1.5% Oriental; 0.4% other; 0.2% American Indian. 47.6% of subjects were male and 52.4% were female. The most common adverse event/reaction was injection-site pain/soreness/tenderness reported by 67.0% of subjects. Of all reported injection-site reactions 99.8% were mild (i.e., easily tolerated with no medical intervention) or moderate (i.e., minimally interfered with usual activity possibly requiring little medical intervention). Listed below in Table 8 are the local adverse reactions and systemic adverse events reported by ≥5% of subjects, in decreasing order of frequency within each body system.
Body System | VAQTA (Any Dose) (N=1645) |
---|---|
Adverse Events | Rate (n/total n) |
N=Number of subjects enrolled/randomized. | |
n=Number of subjects in each category with data available. | |
Percent=percentage of subjects for whom data are available with adverse event. | |
|
|
Nervous system disorders* | n=1641 |
Headache | 16.1% |
General disorders and administration site reactions† | n=1640 |
Injection-site pain/tenderness/soreness | 67.0% |
Injection-site warmth | 18.2% |
Injection-site swelling | 14.7% |
Injection-site erythema | 13.7% |
The following additional unsolicited systemic adverse events were observed among recipients of VAQTA that occurred within 14 days at a common frequency of ≥1% to <10% following any dose not reported elsewhere in the label. These adverse reactions have been reported across 4 clinical studies.
- Musculoskeletal and connective tissue disorders: Back pain; stiffness
- Reproductive system and breast disorders: Menstruation disorders
6.2 Post-Marketing Experience
The following additional adverse events have been reported with use of the marketed vaccine. Because these reactions are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or establish a causal relationship to a vaccine exposure.
Blood and lymphatic disorders: Thrombocytopenia.
Nervous system disorders: Guillain-Barré syndrome; cerebellar ataxia; encephalitis.
7. Drug Interactions
7.1 Use with Other Vaccines
Do not mix VAQTA with any other vaccine in the same syringe or vial. Use separate injection sites and syringes for each vaccine. Please refer to package inserts of coadministered vaccines.
In clinical trials in children, VAQTA was concomitantly administered with one or more of the following US licensed vaccines: Measles, Mumps, and Rubella Virus Vaccine, Live; Varicella Vaccine, Live; Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine, Adsorbed; Measles, Mumps, Rubella, and Varicella Vaccine, Live; Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197); and Haemophilus B Conjugate Vaccine (Meningococcal Protein Conjugate). Safety and immunogenicity were similar for concomitantly administered vaccines compared to separately administered vaccines.
In clinical trials in adults, VAQTA was concomitantly administered with typhoid Vi polysaccharide and yellow fever vaccines [see Adverse Reactions (6.1) and Clinical Studies (14.2, 14.7)]. Safety and immunogenicity were similar for concomitantly administered vaccines compared to separately administered vaccines.
7.2 Use with Immune Globulin
VAQTA may be administered concomitantly with Immune Globulin, human, using separate sites and syringes. The recommended vaccination regimen for VAQTA should be followed. Consult the manufacturer's product circular for the appropriate dosage of Immune Globulin. A booster dose of VAQTA should be administered at the appropriate time as outlined in the recommended regimen for VAQTA [see Clinical Studies (14.5)].
8. Use In Specific Populations
8.4 Pediatric Use
The safety of VAQTA has been evaluated in 4374 children 12 through 23 months of age, and 2615 children/adolescents 2 through 18 years of age who received at least one 25U dose of VAQTA [see Adverse Reactions (6) and Dosage and Administration (2)].
Safety and effectiveness in infants below 12 months of age have not been established.
8.5 Geriatric Use
In the post-marketing observational safety study which included 42,110 persons who received VAQTA [see Adverse Reactions (6.2)], 4769 persons were 65 years of age or older and 1073 persons were 75 years of age or older. There were no adverse events judged by the investigator to be vaccine-related in the geriatric study population. In other clinical studies, 68 subjects 65 years of age or older were vaccinated with VAQTA, 10 of whom were 75 years of age or older. No overall differences in safety and immunogenicity were observed between these subjects and younger subjects; however, greater sensitivity of some older individuals cannot be ruled out. Other reported clinical experience has not identified differences in responses between the elderly and younger subjects.
11. Vaqta Description
VAQTA is an inactivated whole virus vaccine derived from hepatitis A virus grown in cell culture in human MRC-5 diploid fibroblasts. It contains inactivated virus of a strain which was originally derived by further serial passage of a proven attenuated strain. The virus is grown, harvested, purified by a combination of physical and high performance liquid chromatographic techniques developed at the Research Laboratories of Merck Sharp & Dohme LLC, Rahway, NJ, USA, formalin inactivated, and then adsorbed onto amorphous aluminum hydroxyphosphate sulfate.
VAQTA is a sterile suspension for intramuscular injection. One milliliter of the vaccine contains approximately 50U of hepatitis A virus antigen, which is purified and formulated without a preservative. Within the limits of current assay variability, the 50U dose of VAQTA contains less than 0.1 mcg of non-viral protein, less than 4 × 10–6 mcg of DNA, less than 10–4 mcg of bovine albumin, and less than 0.8 mcg of formaldehyde. Other process chemical residuals are less than 10 parts per billion (ppb), including neomycin.
Each 0.5-mL pediatric dose contains 25U of hepatitis A virus antigen and adsorbed onto approximately 0.225 mg of aluminum provided as amorphous aluminum hydroxyphosphate sulfate, and 35 mcg of sodium borate as a pH stabilizer, in 0.9% sodium chloride.
Each 1-mL adult dose contains 50U of hepatitis A virus antigen and adsorbed onto approximately 0.45 mg of aluminum provided as amorphous aluminum hydroxyphosphate sulfate, and 70 mcg of sodium borate as a pH stabilizer, in 0.9% sodium chloride.
14. Clinical Studies
14.1 Efficacy of VAQTA: The Monroe Clinical Study
The immunogenicity and protective efficacy of VAQTA were evaluated in a randomized, double-blind, placebo-controlled study involving 1037 susceptible healthy children and adolescents 2 through 16 years of age in a U.S. community with recurrent outbreaks of hepatitis A (The Monroe Efficacy Study). All of these children were Caucasian, and there were 51.5% male and 48.5% female. Each child received an intramuscular dose of VAQTA (25U) (N=519) or placebo (alum diluent) (N=518). Among those individuals who were initially seronegative (measured by a modification of the HAVAB radioimmunoassay [RIA]), seroconversion was achieved in >99% of vaccine recipients within 4 weeks after vaccination. The onset of seroconversion following a single dose of VAQTA was shown to parallel the onset of protection against clinical hepatitis A disease.
Because of the long incubation period of the disease (approximately 20 to 50 days, or longer in children), clinical efficacy was based on confirmed cases1 of hepatitis A occurring ≥50 days after vaccination in order to exclude any children incubating the infection before vaccination. In subjects who were initially seronegative, the protective efficacy of a single dose of VAQTA was observed to be 100% with 21 cases of clinically confirmed hepatitis A occurring in the placebo group and none in the vaccine group (p<0.001). The number of clinically confirmed cases of hepatitis A ≥30 days after vaccination were also compared. In this analysis, 28 cases of clinically confirmed hepatitis A occurred in the placebo group while none occurred in the vaccine group ≥30 days after vaccination. In addition, it was observed in this trial that no cases of clinically confirmed hepatitis A occurred in the vaccine group after day 16.2 Following demonstration of protection with a single dose and termination of the study, a booster dose was administered to a subset of vaccinees 6, 12, or 18 months after the primary dose.
No cases of clinically confirmed hepatitis A disease ≥50 days after vaccination have occurred in those vaccinees from The Monroe Efficacy Study monitored for up to 9 years.
- 1
- The clinical case definition included all of the following occurring at the same time: 1) one or more typical clinical signs or symptoms of hepatitis A (e.g., jaundice, malaise, fever ≥38.3°C); 2) elevation of hepatitis A IgM antibody (HAVAB-M); 3) elevation of alanine transferase (ALT) ≥2 times the upper limit of normal.
- 2
- One vaccinee did not meet the pre-defined criteria for clinically confirmed hepatitis A but did have positive hepatitis A IgM and borderline liver enzyme (ALT) elevations on days 34, 50, and 58 after vaccination with mild clinical symptoms observed on days 49 and 50.
14.2 Other Clinical Studies
The efficacy of VAQTA in other age groups was based upon immunogenicity measured 4 to 6 weeks following vaccination. VAQTA was found to be immunogenic in all age groups.
14.3 Timing of Booster Dose Administration
Children/Adolescents — 2 through 18 Years of Age
In the Monroe Efficacy Study, children were administered a second dose of VAQTA (25U/0.5 mL) 6, 12, or 18 months following the initial dose. For subjects who received both doses of VAQTA, the GMTs and proportions of subjects who seroconverted 4 weeks after the booster dose administered 6, 12, and 18 months after the first dose are presented in Table 9.
Months Following Initial 25U Dose | Cohort* (n=960) 0 and 6 Months | Cohort* (n=35) 0 and 12 Months | Cohort* (n=39) 0 and 18 Months |
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Seroconversion Rate GMT (mIU/mL) (95% CI) |
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6 | 97% 107 (98, 117) | — | — |
7 | 100% 10433 (9681, 11243) | — | — |
12 | — | 91% 48 (33, 71) | — |
13 | — | 100% 12308 (9337, 16226) | — |
18 | — | — | 90% 50 (28, 89) |
19 | — | — | 100% 9591 (7613, 12082) |
14.4 Duration of Immune Response
In follow-up of subjects in The Monroe Efficacy Study, in children (≥2 years of age) and adolescents who received two doses (25U) of VAQTA, detectable levels of anti-HAV antibodies (≥10 mIU/mL) were present in 100% of subjects for at least 10 years postvaccination. In subjects who received VAQTA at 0 and 6 months, the GMT was 819 mIU/mL (n=175) at 2.5 to 3.5 years and 505 mIU/mL (n=174) at 5 to 6 years, and 574 mIU/mL (n=114) at 10 years postvaccination. In subjects who received VAQTA at 0 and 12 months, the GMT was 2224 mIU/mL (n=49) at 2.5 to 3.5 years, 1191 mIU/mL (n=47) at 5 to 6 years, and 1005 mIU/mL (n=36) at 10 years postvaccination. In subjects who received VAQTA at 0 and 18 months, the GMT was 2501 mIU/mL (n=53) at 2.5 to 3.5 years, 1614 mIU/mL (n=56) at 5 to 6 years, and 1507 mIU/mL (n=41) at 10 years postvaccination.
In adults that were administered VAQTA at 0 and 6 months, the hepatitis A antibody response to date has been shown to persist at least 6 years. Detectable levels of anti-HAV antibodies (≥10 mIU/mL) were present in 100% (378/378) of subjects with a GMT of 1734 mIU/mL at 1 year, 99.2% (252/254) of subjects with a GMT of 687 mIU/mL at 2 to 3 years, 99.1% (219/221) of subjects with a GMT of 605 mIU/mL at 4 years, and 99.4% (170/171) of subjects with a GMT of 684 mIU/mL at 6 years postvaccination.
The total duration of the protective effect of VAQTA in healthy vaccinees is unknown at present.
14.5 Concomitant Administration of VAQTA and Immune Globulin
The concurrent use of VAQTA (50U) and immune globulin (IG, 0.06 mL/kg) was evaluated in an open-label, randomized clinical study involving 294 healthy adults 18 to 39 years of age. Adults were randomized to receive 2 doses of VAQTA 24 weeks apart (N=129), the first dose of VAQTA concomitant with a dose of IG followed by the second dose of VAQTA alone 24 weeks later (N=135), or IG alone (N=30). The race distribution of the study subjects who received at least one dose of VAQTA or IG in this study was as follows: 92.3% Caucasian; 4.0% Hispanic-American; 3.0% African-American; 0.3% Native American; 0.3% Asian/Pacific. The distribution of subjects by gender was 28.7% male and 71.3% female. Table 10 provides seroconversion rates and GMTs at 4 and 24 weeks after the first dose in each treatment group and at one month after a booster dose of VAQTA (administered at 24 weeks) [see Drug Interactions (7.2)].
VAQTA plus IG | VAQTA | IG | |
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Weeks | Seroconversion Rate GMT (mIU/mL) (95% CI) |
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N/A = Not Applicable. | |||
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4 | 100% 42 (39, 45) (n=129) | 96% 38 (33, 42) (n=135) | 87% 19 (15, 23) (n=30) |
24 | 92% 83 (65, 105) (n=125) | 97%*
137* (112, 169) (n=132) | 0% Undetectable† (n=28) |
28 | 100% 4872 (3716, 6388) (n=114) | 100% 6498 (5111, 8261) (n=128) | N/A |
14.6 Interchangeability of the Booster Dose
A randomized, double-blind clinical study in 537 healthy adults, 18 to 83 years of age, evaluated the immune response to a booster dose of VAQTA and HAVRIX given at 6 or 12 months following an initial dose of HAVRIX. Subjects were randomized to receive VAQTA (50U) as a booster dose 6 months (N=232) or 12 months (N=124) following an initial dose of HAVRIX or HAVRIX (1440 EL. U) as a booster dose 6 months (N=118) or 12 months (N=63) following an initial dose of HAVRIX. The race distribution of the study subjects who received the booster dose of VAQTA or HAVRIX in this study was as follows: 87.2% Caucasian; 8.0% African-American; 1.9% Hispanic-American; 1.3% Oriental; 0.9% Asian; 0.4% Indian; 0.4% other. The distribution of subjects by gender was 44.9% male and 55.1% female. When VAQTA was given as a booster dose following HAVRIX, the vaccine produced an adequate immune response (see Table 11) [see Dosage and Administration (2.1)].
First Dose | Booster Dose | Seropositivity Rate | Booster Response Rate* | Geometric Mean Titer |
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HAVRIX 1440 EL.U. | VAQTA 50 U | 99.7% (n=313) | 86.1% (n=310) | 3272 (n=313) |
HAVRIX 1440 EL.U. | HAVRIX 1440 EL.U. | 99.3% (n=151) | 80.1% (n=151) | 2423 (n=151) |
17. Patient Counseling Information
Advise the patient to read the FDA-approved patient labeling (Patient Information).
Information for Vaccine Recipients and Parents or Guardians
- Inform the patient, parent or guardian of the potential benefits and risks of the vaccine.
- Question the vaccine recipient, parent, or guardian about the occurrence of any symptoms and/or signs of an adverse reaction after a previous dose of hepatitis A vaccine.
- Inform the patient, parent, or guardian about the potential for adverse events that have been temporally associated with administration of VAQTA.
- Tell the patient, parent, or guardian accompanying the recipient, to report adverse events to the physician or clinic where the vaccine was administered.
- Prior to vaccination, give the patient, parent, or guardian the Vaccine Information Statements which are required by the National Childhood Vaccine Injury Act of 1986. These materials are available free of charge at the Centers for Disease Control and Prevention (CDC) website (www.cdc.gov/vaccines).
- Tell the patient, parent, or guardian that the United States Department of Health and Human Services has established a Vaccine Adverse Event Reporting System (VAERS) to accept all reports of suspected adverse events after the administration of any vaccine, including but not limited to the reporting of events required by the National Childhood Vaccine Injury Act of 1986. The VAERS toll-free number is 1-800-822-7967. Reporting forms may also be obtained at the VAERS website at (www.//vaers.hhs.gov/).
Patient Information VAQTA® (pronounced “vac-ta”) (Hepatitis A Vaccine, Purified Inactivated) |
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This is a summary of information about VAQTA®. Read this information carefully before you or your child receives each dose of VAQTA. If you have any questions about VAQTA after reading this leaflet, you should ask your doctor. This information does not take the place of talking about VAQTA with your doctor or healthcare provider. |
What is VAQTA? |
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What do you need to know about VAQTA? |
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Who should not get VAQTA? |
Do not get VAQTA if you or your child:
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What should you tell the doctor or healthcare provider before getting VAQTA? |
Tell your doctor or healthcare provider if you or your child:
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If you have already gotten a Hepatitis A shot, talk to your doctor or healthcare provider to see if VAQTA is right for you. |
The doctor will help decide if you or your child should get the shot. |
What are the possible side effects of VAQTA? |
The most common side effects seen with VAQTA are:
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If you or your child have any of the following problems, tell your doctor right away because these may be signs of an allergic reaction:
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If you or your child has any side effects that worry you or seem to get worse, tell your doctor or healthcare provider right away. |
There may be other side effects that are not listed. For more information, ask your doctor or healthcare provider. |
You may report any side effects to your or your child’s doctor or directly to the Vaccine Adverse Event Reporting System (VAERS) at 1-800-822-7967 or www.vaers.hhs.gov, or to Merck Sharp & Dohme LLC at 1-877-888-4231. |
How is VAQTA given? |
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Active ingredient: Hepatitis A virus, Inactivated. Other ingredients: Aluminum hydroxyphosphate sulphate, sodium borate,
sodium chloride, water. |
This vaccine contains a trace amount of neomycin. |
The vial stopper, syringe plunger stopper and tip cap contain natural latex rubber. |
VAQTA does not have any preservatives in it. |
For more information, ask your doctor or healthcare provider. Keep this information in case you have questions later. |
PRINCIPAL DISPLAY PANEL - 0.5 mL Vials Carton
NDC 0006-4831-41
10 Single-dose ~25U/0.5-mL Vials
(HEPATITIS A VACCINE, INACTIVATED)
VAQTA®
PEDIATRIC/ADOLESCENT
0.5 mL vial contains approximately 25U of hepatitis A virus antigen on an Amorphous aluminum
hydroxyphosphate sulfate adjuvant. Hepatitis A virus is grown in cell culture in human MRC-5
diploid fibroblasts.
Rx only
PRINCIPAL DISPLAY PANEL - 0.5 mL Syringes Carton
NDC 0006-4095-02
10 Single-Dose 0.5-mL Syringes
[HEPATITIS A VACCINE,
INACTIVATED]
VAQTA®
PEDIATRIC/ADOLESCENT
FORMULATION
This package contains 10 single-dose syringes.
Each 0.5-mL syringe contains approximately 25U of hepatitis A virus antigen
on an amorphous aluminum hydroxyphosphate sulfate adjuvant.
Hepatitis A virus is grown in cell culture in human MRC-5 diploid fibroblasts.
Rx only
PRINCIPAL DISPLAY PANEL - 1 mL Syringes Carton
NDC 0006-4096-02
10 Single-Dose 1-mL Syringes
[HEPATITIS A VACCINE,
INACTIVATED]
VAQTA®
ADULT FORMULATION
This package contains 10 single-dose syringes.
Each 1-mL syringe contains approximately 50U of hepatitis A virus antigen
on an amorphous aluminum hydroxyphosphate sulfate adjuvant.
Hepatitis A virus is grown in cell culture in human MRC-5 diploid fibroblasts.
Rx only
VAQTA
hepatitis a vaccine, inactivated injection, suspension |
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Labeler - Merck Sharp & Dohme LLC (118446553) |