CDC Panel Backs Routine Hepatitis A Shots for Homeless

Kerry Dooley Young


October 25, 2018

Advisers to the Centers for Disease Control and Prevention (CDC) on Wednesday endorsed hepatitis A vaccines for people experiencing homelessness and also made tweaks to the current roster of recommendations on routine vaccinations.

The CDC's Advisory Committee on Immunization Practices (ACIP) held its annual meeting to update its recommendations to physicians. The panel cast a single vote, with a tally of 11-0, to endorse both proposed schedules for next year for adults and for children and adolescents. These recommendations incorporate work done by ACIP in recent months. The official announcement of the 2019 schedule will be made in February.

Recent outbreaks of hepatitis A among the homeless spurred the new recommendation, ACIP said. People without their own homes may not be able to follow the handwashing recommendations that help counter the spread of this infection, CDC staff said in a briefing for the ACIP meeting.

Ten states reported more than 6500 hepatitis A infections, over 3800 hospitalizations, and about 70 deaths associated with person-to-person transmission between January 2017 to October 2018, the CDC said. People experiencing homelessness made up a large percentage of the cases (more than 40% in San Diego and Utah, and more than 10% in Michigan, Kentucky, West Virginia, and Tennessee) in the states that report risk factor information, the CDC said.

Many people who are homelessness have a recommended risk factor for hepatitis A vaccination, including drug use or chronic liver disease, the CDC said. Still, about 25% would not have a medical history that includes an indication triggering a recommendation for hepatitis A vaccination.

The CDC already recommends that hepatitis A vaccinations begin for infants around age 12 months. Among adults, the vaccine is recommended for international travelers to high prevalence countries, people who inject drugs, and men who have sex with men.

ACIP also made other adjustments to the 2019 immunization schedules for adults and for children and adolescents. As previously reported by Medscape Medical News, ACIP and the CDC have backed a live attenuated influenza vaccine (LAIV) for the 2018-2019 season. According to the American Academy of Family Physicians,  ACIP had recommended against the use of LAIV for the 2016-2017  and 2017-2018 flu seasons because the vaccine's influenza A (H1N1) component didn't protect against that influenza strain.

On Wednesday ACIP also supported including information in both of its immunization schedules on use of the CpG-adjuvanted hepatitis B vaccine.

In addition, ACIP will include updated information in the schedule about revaccination of children who received Tdap at 7 to 10 years of age.

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