Hepatitis A Prevention and Treatment

Vaccination Strategies

The Centers for Disease Control and Prevention recommends that all children should receive hepatitis A vaccine at age 12-23 months, with catch-up vaccination for unvaccinated children aged 2-18 years, as this is the cornerstone of HAV elimination strategy 1, 2
Universal vaccination of children aged 12-23 months is recommended, integrated into the routine childhood vaccination schedule 1, 2
Vaccination should be completed according to licensed schedules for long-term protection 2
Children not vaccinated by age 2 years can receive catch-up vaccination at subsequent visits 1
The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that travelers to countries with high or intermediate HAV endemicity should receive hepatitis A vaccination, which should begin as soon as travel is considered 1, 2
Men who have sex with men should receive hepatitis A vaccination 2
Users of injection and non-injection illicit drugs should receive hepatitis A vaccination 2
Persons with chronic liver disease, including hepatitis B, hepatitis C, cirrhosis, or those awaiting/received liver transplants, should receive hepatitis A vaccination 2
Persons with clotting-factor disorders should receive hepatitis A vaccination 2

For travelers to endemic areas, optimal protection requires starting vaccination as soon as travel is considered, with protection assumed within 4 weeks after the first dose 1, 2
For travelers departing in <4 weeks, consider adding immune globulin (IG) 0.02 mL/kg at a different anatomic injection site for optimal protection 1, 2
Travelers departing in <4 weeks who cannot receive IG should still receive vaccine, though protection may not be complete 1
Persons recently exposed to HAV who have not previously received hepatitis A vaccine should receive IG (0.02 mL/kg) as soon as possible, ideally within 2 weeks of exposure 3, 4, 2
Household and close personal contacts of serologically confirmed hepatitis A cases should receive IG 3, 4
Persons who shared illicit drugs with an infected person should receive both IG and hepatitis A vaccine 3, 4

Up to 20% of patients may experience prolonged or relapsed course lasting up to 6 months 5, 6
Less than 1% experience acute liver failure, with case-fatality ratio of 0.3-0.6% overall, but reaching 1.8% in adults >50 years 5, 6

During community outbreaks, accelerated vaccination programs should be implemented as an additional control measure, with focused efforts on high-risk adult populations 4, 2
Routine childhood vaccination programs have dramatically reduced large community outbreaks 2
Limited outbreaks among high-risk adults require targeted vaccination efforts 2