ACIP updates hepatitis A vaccination recommendations

The Advisory Committee on Immunization Practices (ACIP) recently updated its recommendations on hepatitis A vaccination (HAV).

The recommendations, which were published by Morbidity and Mortality Weekly Report on July 3, supplant and summarize previous recommendations from the ACIP regarding the prevention of HAV infection in the U.S.

Among the changes, the ACIP now recommends vaccination of:

• anyone ages 1 year or older infected with HIV;
• anyone with chronic liver disease, including but not limited to persons with hepatitis B virus infection, hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, or an alanine aminotransferase or aspartate aminotransferase level persistently greater than twice the upper limit of normal;
• pregnant women who are identified to be at risk for HAV infection during pregnancy; (e.g., those who travel internationally, are homeless, use injection or noninjection drugs, have occupational risk for infection, or anticipate close personal contact with an international adoptee) or at risk for a severe outcome from HAV infection (e.g., with chronic liver disease or HIV); and
• people in settings where a high proportion have risk factors for HAV infection (e.g., treatment centers for those who use injection or noninjection drugs, group homes, and nonresidential day care facilities for developmentally disabled persons).

During an HAV outbreak, the ACIP recommends vaccination of anyone with risk for HAV infection (e.g., those who use illicit drugs or are homeless, men having sex with men) or with risk for severe disease from HAV (e.g., with chronic liver disease or HIV).

The vaccination of people who receive blood products for clotting disorders (e.g., hemophilia) is no longer recommended.

The ACIP also changed its recommendations on catch-up vaccination of children and adolescents ages 2 to 18 years, as well as included new clinical guidance on vaccination of infants and those with immunocompromising conditions. In addition, the article reviewed HAV vaccine formulations and safety and efficacy data and addressed post-exposure prophylaxis, implementation strategies, and other vaccination management issues and considerations.