Updated ACIP recommendations for prevention of hepatitis A infection

The United States Advisory Committee on Immunization Practices (ACIP) has issued updated recommendations for prevention of hepatitis A virus (HAV) infection in November 2018. Published in the Morbidity and Mortality Weekly Report, the ACIP says that postexposure prophylaxis (PEP) with hepatitis A (HepA) vaccine or immune globulin (IG) prevents infection with hepatitis A virus when administered within 2 weeks of exposure. 

As per the guidelines, hepatitis A vaccine for postexposure prophylaxis provides advantages over IG, including induction of active immunity, longer duration of protection, ease of administration and greater acceptability and availability.

·         Hepatitis A vaccine is now recommended for persons aged ≥12 months who have been exposed to hepatitis A virus within the past 14 days and have not previously completed the 2-dose Hepatitis A vaccine series. These persons should receive a single dose of Hepatitis A vaccine.

·         Persons who are immunocompromised or have chronic liver disease and who have been exposed to hepatitis A virus within the past 14 days and have not previously completed the 2-dose Hepatitis A vaccination series should receive both IG (0.1 mL/kg) and Hepatitis A vaccine simultaneously in a different anatomic site at the earliest post-exposure.

·         Infants aged <12 months and persons for whom vaccine is contraindicated should be administered IG (0.1 mL/kg) instead of the vaccine, as soon as possible and within 2 weeks of exposure.

·         Preexposure prophylaxis with hepatitis A vaccine is recommended for infant travelers aged 6 to 11 months.

Homelessness is now a new indication for HAV vaccination, given the recent increase in infection rates in this group.

In infants scheduled to receive their measles, mumps, and rubella (MMR) vaccine, the vaccine should be administered preferentially to the hepatitis A vaccine; the MMR vaccine should not be administered earlier than 3 months after the immune globulin for hepatitis A. 

Suggested Reading

1.    Nelson NP, et al. Update: Recommendations of the Advisory Committee on Immunization Practices for use of hepatitis A vaccine for postexposure prophylaxis and for preexposure prophylaxis for international travel. MMWR Morb Mortal Wkly Rep 2018; 67:1216.

2.    Foster M, et al. Hepatitis A Virus outbreaks associated with drug use and homelessness - California, Kentucky, Michigan, and Utah, 2017. MMWR Morb Mortal Wkly Rep 2018;67:1208.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA