Expanding Hepatitis A Vaccination for Children
An advisory committee to the Centers for Disease Control and Prevention (CDC) has recommended that all children in the United States receive hepatitis A vaccine. The previous recommendation of the Advisory Committee on Immunization Practices (ACIP) in 1999, called for vaccinations in states with the highest rates of hepatitis A.
About two-thirds of cases are now reported from states in which hepatitis A vaccination of children was not recommended. The ACIP recommendation is for children to receive the first dose of a two dose series of hepatitis A vaccine between 1 and 2 years of age and that the vaccine be integrated into the routine childhood vaccination schedule.
Hepatitis A is a liver disease caused by the hepatitis A virus. Hepatitis A can affect anyone. In the United States, hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics. Good personal hygiene and proper sanitation can help prevent hepatitis A. Vaccines are also available for long-term prevention of hepatitis A virus infection.
"Routine vaccination of children is the most effective way to reduce the incidence of hepatitis A," said Dr. Steve Cochi, acting director of CDC's National Immunization Program. "This recommendation is an important step toward the total elimination of the transmission of hepatitis A virus in the United States.".
Hepatitis A vaccine was first licensed in the United States in 1995. During the 1980s and 1990s, an average of 26,000 cases of hepatitis A was reported annually. The actual number of infections per year was estimated to be around 270,000 because there are a number of infections without symptoms and some people with symptoms do not see their clinician for diagnosis. In recent years, the number of hepatitis A cases has fallen dramatically. During 2004, there were a total of 5,683 cases nationwide, the lowest number of cases ever reported.
In 1999, the ACIP recommended routine hepatitis A vaccination for children living in 11 states with the highest rates of hepatitis A. During the period before vaccine was available, the average incidence of hepatitis A in these states (Alaska, Arizona, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah and Washington) had been at least 20 cases per 100,000 people, about twice the national average. In 1999, the ACIP also recommended that vaccination be considered in an additional six states (Arkansas, Colorado, Missouri, Montana, Texas and Wyoming) where the average incidence had been at least 10 but less than to 20 cases per 100,000 people. During the period before vaccine was available, each year about two thirds of all hepatitis A cases nationwide were reported in these 17 states.
The ACIP continues to recommend hepatitis A vaccination for travelers to countries with a high prevalence of hepatitis A, men who have sex with men, illegal drug users and persons with chronic liver disease.
Recommendations of the ACIP become recommendations of CDC once they are accepted by the director of CDC and the Secretary of Health and Human Services and are published in the Morbidity and Mortality Weekly Report.