CDC Guidelines for Hepatitis A Post‑Exposure and Travel Prophylaxis

Post‑Exposure Prophylaxis (PEP)

• Single‑dose hepatitis A vaccine is recommended for healthy individuals aged 12 months to 40 years when given as soon as possible after a known exposure. 1
• Infants younger than 12 months should receive immune globulin (IG) only (0.1 mL/kg). 1
• Healthy persons 12 months–40 years receive hepatitis A vaccine alone (1 dose). 2
• Healthy persons > 40 years receive hepatitis A vaccine (1 dose) and may receive IG (0.1 mL/kg) based on provider risk assessment. 3
• Individuals ≥ 12 months with immunocompromise or chronic liver disease receive both hepatitis A vaccine and IG (0.1 mL/kg) administered at separate anatomic sites. 3
• If hepatitis A vaccine is contraindicated (e.g., severe anaphylaxis), IG alone (0.1 mL/kg) is given. 2
• PEP must be administered within 14 days of exposure; effectiveness beyond two weeks has not been demonstrated. 4
• The full two‑dose vaccine series (second dose ≥ 6 months) should be completed for long‑term immunity, although the second dose is not required for immediate PEP. 1
• Confirm the index case with IgM anti‑HAV serology before treating contacts. 5
• Do not screen contacts for pre‑existing immunity before giving PEP, as this causes harmful delays. 5

Pre‑Travel Prophylaxis

• For healthy travelers aged 12 months–40 years, a single dose of hepatitis A vaccine should be given as soon as travel is contemplated; IG is not needed. 1
• Children < 6 months receive IG only (0.1 mL/kg for ≤ 1 month travel; 0.2 mL/kg for ≤ 2 months travel). 2
• Children 6–11 months receive one dose of hepatitis A vaccine, which does not count toward the routine two‑dose series that begins at 12 months. 2
• Healthy travelers 12 months–40 years receive hepatitis A vaccine alone (1 dose). 1
• Healthy travelers > 40 years receive hepatitis A vaccine (1 dose) and may add IG (0.1–0.2 mL/kg) per provider risk assessment. 2
• All immunocompromised travelers, regardless of age, receive both hepatitis A vaccine (1 dose) and IG (0.1–0.2 mL/kg). 2

Prophylaxis Pitfalls and Special Considerations

• After IG administration, defer MMR vaccination for at least 3 months. 1
• Do not use the combined hepatitis A/B vaccine for post‑exposure prophylaxis; it contains only half the HAV antigen of the single‑antigen vaccine. 4
• Efficacy of PEP declines sharply after 14 days; prompt administration is essential. 6

High‑Risk Groups Requiring Both Vaccine and IG

• Immunocompromised individuals (any age ≥ 12 months). 3
• Patients with chronic liver disease (any age ≥ 12 months). 3
• Adults > 40 years with high‑risk exposures (e.g., household or sexual contact with a case). 3

Hepatitis A Vaccination Guidelines

Standard Vaccination Schedule

• The American Academy of Pediatrics recommends a 2-dose series of Hepatitis A vaccination, with the first dose administered at 12-23 months of age and the second dose given 6-12 months later for Havrix or 6-18 months later for Vaqta 7, 8
• The Centers for Disease Control and Prevention recommends a two-dose series of Hepatitis A vaccine for adults, with the second dose given 6-12 months later for Havrix or 6-18 months later for Vaqta 9

Special Populations and Considerations

• The Centers for Disease Control and Prevention recommends that immunocompromised persons and those with chronic liver disease receive both Hepatitis A vaccine and immune globulin (IG) simultaneously at different anatomic sites when exposed to HAV within the past 14 days 10, 11
• The Centers for Disease Control and Prevention recommends that international travelers receive a single dose of HepA vaccine as soon as travel is considered, with additional doses or IG given based on age, health status, and travel duration 12, 13

Postexposure Prophylaxis

• The Centers for Disease Control and Prevention recommends that postexposure prophylaxis be administered within 14 days of exposure, with a single dose of HepA vaccine given to children 12 months-40 years and adults >40 years receiving a single dose of HepA vaccine and possibly IG based on provider's risk assessment 10, 11

Administration Guidelines

• The American Academy of Pediatrics recommends administering Hepatitis A vaccine intramuscularly with appropriate needle length based on age and size, shaking the vaccine well before administration, and properly mixing the vaccine to appear as a slightly opaque, white-colored suspension 7, 8
• The American Academy of Pediatrics recommends that if the vaccination schedule is interrupted, only the required doses need to be administered, with no need to restart the series, and that different brands of hepatitis A vaccines are interchangeable for completing the series 7, 8

Storage Requirements

• The American Academy of Pediatrics recommends storing Hepatitis A vaccine between 2°C and 8°C (36°F and 46°F) and not freezing, as freezing destroys vaccine potency 7, 8

Important Clinical Considerations

• The Centers for Disease Control and Prevention recommends that no serologic testing is recommended before or after vaccination in the general population 14