The Trouble with Twinrix

Twinrix is the most requested vaccine from Travel medicine clinics but confusion arises because clients are asking only for this without understanding what it actually does.

Hepatitis is inflammation of the liver caused by many unrelated viruses that were labelled with letters as they were discovered.

Some viruses like Hepatitis A and E are transmitted by infectious food and water whereas others like Hepatitis B, C and D are from infectious bodily fluids.

Presently we have only vaccines protective against Hepatitis A and B.

Hepatitis A is universally recommended for travelers visiting developing nations as infected foodstuffs easily transmit it. One dose gives immediate protection for 12 months and a second dose after 6 months will protect for at least 10 years.

Hepatitis B is still an important vaccine and is given to Grade 4 Manitoban children. It is very necessary for health care students, long tern travelers and anyone who is concerned with contracting Hepatitis B either domestically or abroad.

Both Health Canada and the Centre for Disease Control (CDC) are clear that Hepatitis B is not recommended for every short-term vacationer who are at low risk for Hepatitis B.

Hepatitis B requires 3 doses (0,1 and 6 months). Two doses will protect travelers although a third dose is recommended for complete immunity.

Twinrix contains both Hepatitis A and B vaccines and is given in 3 doses like Hepatitis B.

Twinrix contains only half of one regular dose of hepatitis A and one full dose of hepatitis B vaccines so travellers need at least 2 doses of Twinrix 4 weeks apart to be protected for both Hepatitis A or B.

There is also the “accelerated dosing” of Twinrix (where it is given at 0,7 and 21 days and 12 months). This is more expensive since each traveler is now coming for more visits for the hepatitis B component compared with a single visit if they only needed hepatitis A protection.

When departing in less than 3 weeks there is never enough time to be protected with Twinrix.

Last-minute travellers are better protected with a full Hepatitis A vaccine especially if they are at very low risk for Hepatitis B.

I have actually seen people who had been immunized with Twinrix even though it was known that they had already been proven immune to both Hepatitis A and B. While not harmful this is both expensive and unnecessary.

Twinrix is still good for people who have enough time and who want to make the extra investment.

Attending a clinic, earlier before departure will enable prospective travelers to get 2 doses of Twinrix 4 weeks apart which protects effectively against Hepatitis A and B.

Twinrix is only a brand name. All hepatitis A and B vaccines brands in Canada are equal in effectiveness and have been recommended and given either singly or together even before the “invention” of Twinrix and can still be done today.