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

Noele P. Nelson, MD, PhD; Ruth Link-Gelles, PhD; Megan G. Hofmeister, MD; José R. Romero, MD; Kelly L. Moore, MD; John W. Ward, MD; Sarah F. Schillie, MD

Disclosures

Morbidity and Mortality Weekly Report. 2018;67(43):1216-1220. 

In This Article

Abstract and Introduction

Abstract

Postexposure prophylaxis (PEP) with hepatitis A (HepA) vaccine or immune globulin (IG) effectively prevents infection with hepatitis A virus (HAV) when administered within 2 weeks of exposure. Preexposure prophylaxis against HAV infection through the administration of HepA vaccine or IG provides protection for unvaccinated persons traveling to or working in countries that have high or intermediate HAV endemicity. The Advisory Committee on Immunization Practices (ACIP) Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine for PEP to persons aged >40 years and reviewed the HepA vaccine efficacy and safety in infants and the benefits of protection against HAV before international travel. The February 21, 2018, ACIP recommendations update and supersede previous ACIP recommendations for HepA vaccine for PEP and for international travel. Current recommendations include that HepA vaccine should be administered to all persons aged ≥12 months for PEP. In addition to HepA vaccine, IG may be administered to persons aged >40 years depending on the provider's risk assessment. ACIP also recommended that HepA vaccine be administered to infants aged 6–11 months traveling outside the United States when protection against HAV is recommended. The travel-related dose for infants aged 6–11 months should not be counted toward the routine 2-dose series. The dosage of IG has been updated where applicable (0.1 mL/kg). HepA vaccine for PEP provides advantages over IG, including induction of active immunity, longer duration of protection, ease of administration, and greater acceptability and availability.

Introduction

Postexposure prophylaxis (PEP) with hepatitis A (HepA) vaccine or immune globulin (IG) effectively prevents infection with hepatitis A virus (HAV) when administered within 2 weeks of exposure.[1,2] The efficacy of IG or vaccine when administered >2 weeks after exposure has not been established. Previous ACIP* recommendations for PEP included HepA vaccine for persons aged 1–40 years and IG for persons outside this age range; if IG was not available for persons aged >40 years, HepA vaccine could be administered.[1]

Preexposure prophylaxis against HAV infection through the administration of HepA vaccine or IG is also recommended for unvaccinated persons traveling to or working in countries that have high or intermediate HAV endemicity.[3] Because HepA vaccine is not licensed for use in children aged <1 year, IG has historically been recommended for travelers in this age group; however, IG cannot be administered simultaneously with measles, mumps, and rubella (MMR) vaccine, which is also recommended for infants aged 6–11 months traveling internationally from the United States.[4–6]

This report provides recommendations for PEP use of HepA vaccine and IG, and use of HepA vaccine and IG for preexposure protection for persons who will be traveling internationally, including infants aged 6–11 months. This report updates and supersedes previous ACIP recommendations for HepA vaccine for PEP and for international travel.[1]

* Recommendations for routine use of vaccines in children, adolescents, and adults are developed by the Advisory Committee on Immunization Practices (ACIP). ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the Director of CDC on use of vaccines and related agents for the control of vaccine-preventable diseases in the civilian U.S. population. Recommendations for routine use of vaccines in children and adolescents are harmonized to the greatest extent possible with recommendations made by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG). Recommendations for routine use of vaccines in adults are harmonized with the recommendations of AAFP, ACOG, and the American College of Physicians (ACP). ACIP recommendations approved by the CDC Director become agency guidelines on the date published in the Morbidity and Mortality Weekly Report (MMWR). https://www.cdc.gov/vaccines/acip.

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