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Criteria for Routine Hepatitis A Immunization

Question

What are the criteria for routine hepatitis A immunization in the United States?

Response

from William Cassidy, MD, 05/22/01
There are 3 criteria for routine hepatitis A immunization.^[1] These criteria include vaccination of those groups:

• of children living in areas where the incidence of hepatitis A is at least twice the national average
• at increased risk for hepatitis A virus (HAV) infection
• at increased risk of morbidity if infected with HAV

The CDC Web site http://www.cdc.gov/ncidod/diseases/hepatitis/a/vax/index.htm has a state- and county-specific map of the incidence of HAV. The 1987-1997 national average incidence of HAV is 10 cases per 100,000 population. HAV vaccine is recommended for children who live in states, counties, or communities with an average annual HAV incidence of >/= 20 cases per 100,000 population. The vaccine should also be considered for children living in areas with an average HAV rate of >/= 10 and < 20 cases per 100,000 population.

If resources are limited, then vaccination efforts should be focused to emphasize decreased transmission. As an example, if resources do not allow universal child vaccination in a high-incidence community, the CDC recommends vaccinating preschool- and school-age children. Vaccinating these cohorts systematically reduces HAV transmission at times of high risk of exposure.

People at increased risk for HAV infection include travelers to endemic countries, gay men, injection-drug users, persons with occupational risk for infection, and those with clotting-factor disorders.

Those individuals with underlying chronic liver disease have increased morbidity and mortality if infected with HAV. As per the last criteria, these patients should be vaccinated.

References

1. National Center for Infectious Diseases. Viral hepatitis A. Centers for Disease Control. Accessed May 16, 2001. Available at:
   http://www.cdc.gov/ncidod/diseases/hepatitis/a/index.htm

Comments

5/25/01
What are the risks of routinely immunizing children with hepatitis A vaccine? Are recommendations for routine immunizations being made by on a county by county basis, or are all children now recommended to receive the vaccine?

S. Schlegel, MD