Prevention of Hepatitis A after Exposure
to HAV and in International Travelers
Updated Recommendations
of the Advisory Committee
on Immunization Practices (ACIP)
Questions and Answers
On October 19, 2007,
updated ACIP recommendations for hepatitis A postexposure prophylaxis
(PEP) and preexposure protection against hepatitis A in travelers were published
in Morbidity and Mortality Weekly Report (MMWR). This document
answers commonly asked questions about the revised guidelines.
Postexposure Prophylaxis
The new recommendations incorporate a preference for hepatitis A vaccine over immune globulin (IG) among healthy persons aged 12 months� years. Previously, in the absence of an appropriately designed clinical trial comparing the postexposure efficacy of IG with hepatitis A vaccine, only IG was recommended for PEP.
Recommendations for the settings in which PEP is indicated and the timing of PEP administration remain unchanged.
- For healthy persons aged 12 months� years, single-antigen hepatitis A vaccine at the age-appropriate dose is preferred to IG because of vaccine advantages, including long-term protection and ease of administration, and the equivalent efficacy of vaccine to IG.
- For persons aged >40 years, IG is preferred because of the absence of information regarding vaccine performance in this age group and because of the more severe manifestations of hepatitis A in older adults. Vaccine can be used if IG cannot be obtained. The magnitude of the risk of HAV transmission from the exposure should be considered in decisions to use vaccine or IG in this age group.
- For children aged <12 months, immunocompromised persons, persons with chronic liver disease, and persons for whom vaccine is contraindicated, IG should be used.
Completion of the hepatitis A vaccine series according to the licensed schedule is necessary for long-term protection against hepatitis A.
Hepatitis A vaccine offers certain advantages over IG, including providing active immunity and long-term protection. Vaccine is easy to administer, readily available in the United States, has a similar cost per dose to IG, and might help increase the number of exposed individuals who receive prophylaxis.
Preexposure Protection Before International Travel
Previously, ACIP recommended that hepatitis A vaccine be administered at least 2�weeks before departure to an area with intermediate or high rates of hepatitis A; travelers who were departing in less than 2 weeks were recommended to receive IG for short-term protection.
Recently, ACIP judged that if hepatitis A vaccine alone can be recommended for prophylaxis after exposure to HAV, it also can be recommended for most healthy international travelers, regardless of how imminent the planned departure.
- One dose of single-antigen hepatitis A vaccine administered at any time before departure can provide adequate protection for most healthy persons.
- For optimal protection, older adults, immunocompromised persons, and persons with chronic liver disease or other chronic medical conditions who are planning to depart in <2 weeks should receive the initial dose of vaccine and also can simultaneously be administered IG (0.02 mL/kg) at a separate anatomic injection site.
- Completion of the hepatitis A vaccine series according to the licensed schedule is necessary for long-term protection.
- Travelers who elect not to receive vaccine, are <12 months of age, or are allergic to a vaccine component should receive a single dose of IG (0.02 mL/kg), which provides effective protection against hepatitis A for up to 3 months. Travelers whose travel period is >2 months should be administered IG at 0.06 mL/kg; administration must be repeated if the travel period is >5 months.
For More Information
Prevention
of Hepatitis A after Exposure to Hepatitis A Virus and in International
Travelers
MMWR 2007;56:1080�
Prevention
of Hepatitis A Through Active or Passive Immunization: Recommendations of
the Advisory Committee on Immunization Practices (ACIP)
MMWR 2006;55(RR-7)
Victor JC, Monto AS, Surdina TY, et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med 2007;357(17):1685-94
Health Information for International Travel: Hepatitis A
Page last modified: June 13, 2008
Content source:
Division of Viral Hepatitis
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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