Hepatitis A virus vaccination and postexposure prophylaxis
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology
- Section Editor — Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
- Michelle Lai, MD, MPH
Michelle Lai, MD, MPH
- Assistant Professor, Harvard Medical School
- Beth Israel Deaconess Medical Center
- Section Editors
- Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
- Section Editor — Travel Medicine
- Head of Infectious Diseases Unit
- Monash University, Australia
- Elizabeth B Rand, MD
Elizabeth B Rand, MD
- Section Editor — Pediatric Hepatology
- Professor of Pediatrics
- University of Pennsylvania School of Medicine
Hepatitis A virus (HAV) infection is prevalent in many developing countries (figure 1) and is among the most common preventable infections acquired by travelers. Among visitors to developing countries, the incidence of HAV in unprotected travelers is about 3 per 1000 travelers (0.3 percent) per month of stay; this rate rises to 20 per 1000 travelers (2 percent) per month for those eating or drinking under poor hygienic conditions .
Humans are the only known reservoir for hepatitis A virus; therefore, in theory, the virus could be eradicated if widespread immunization strategies were employed successfully. Since the availability of the hepatitis A vaccine in 1995, the rates of HAV infection in the United States have declined by 95 percent [2-4].
Issues related to prevention of HAV are reviewed here. The epidemiology, major clinical manifestations, diagnosis, and treatment of HAV infection are discussed separately. (See "Hepatitis A virus infection in adults: An overview".)
INDICATIONS FOR VACCINATION
Indications for hepatitis A vaccination have changed over time; we are in agreement with the recommendations issue by the Advisory Committee on Immunization Practices (ACIP) of the United States Centers for Disease Control and Prevention (CDC). In 2006, ACIP revised its recommendations to include routine immunization of all children at one year of age. Previously, ACIP issued recommendations in 1996 for routine immunization of selected groups at high risk of hepatitis A virus (HAV) infection as summarized below; subsequently, in 1999, the ACIP expanded its recommendations to include immunization for children >2 years of age living in areas with high disease incidence.
Globally, the World Health Organization (WHO) recommends immunization for children aged ≥1 year in places with intermediate endemicity on the basis of incidence of acute hepatitis A . In places of high endemicity, almost all persons are asymptomatically infected with HAV in childhood, which provides immunity against clinical infection; therefore, universal vaccination in these countries is not recommended.
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- INDICATIONS FOR VACCINATION
- FORMS OF HEPATITIS A VACCINE
- Inactivated vaccine
- - Immunogenicity
- - Administration
- What to do about a missed dose
- - Vaccine coadministration
- Live attenuated vaccine
- ROLE OF SEROLOGIC TESTING
- POSTEXPOSURE PROPHYLAXIS
- Clinical approach
- Relevant exposures
- INFORMATION FOR PATIENTS