Ask the Experts: Hepatitis A

Results (17)

People who are at increased risk for acquiring HAV infection include the following:

  • Travelers to countries that have high or intermediate endemicity of HAV infection
  • Men who have sex with men (MSM)
  • Users of injection and non-injection drugs (in other words, all who use illegal drugs)
  • People with occupational risk of exposure (those who work with HAV-infected non-human primates or researchers handling hepatitis A virus)
  • People who anticipate close contact with an international adoptee coming from a country with high or intermediate endemicity of HAV infection
  • People living with HIV infection
  • People experiencing homelessness, including temporary shelters and other unstable living arrangements
  • People living in group settings for those with developmental disabilities and other settings where hygiene is difficult to maintain
  • People who are incarcerated
Last reviewed: June 25, 2023
Recommended dosages and schedules of hepatitis A vaccines
Vaccine Age group Dose Volume # Doses Schedule
Havrix
(GSK)		 1–18 years 720 El.U.* 0.5 ml 2 0, 6–12 mos.
19 years and older 1440 El.U.* 1.0 ml 2 0, 6–12 mos.
Vaqta
(Merck & Co.)		 1–18 years 25 U** 0.5 ml 2 0, 6–18 mos.
19 years and older 50 U** 1.0 ml 2 0, 6–18 mos.

*El.U. = Elisa Units **U = Units

 

Combination vaccine using hepatitis A and hepatitis B vaccines
Vaccine Age group Antigens used Volume # Doses Schedule
Twinrix
(GSK)		 18 years and older Havrix (720 El.U.)
combined with
Engerix-B (20 mcg)		 1.0 ml 3 0, 1, 6 mos.
4 0, 7, 21-30 days, 12 months**

** Accelerated schedule may be used for rapid protection prior to travel or for rapid protection of an unexposed but at-risk person who also would benefit from hepatitis B protection. Twinrix is not recommended for use as post-exposure prophylaxis.

Last reviewed: June 25, 2023

The Advisory Committee on Immunization Practices (ACIP) recommends routine HepA vaccination for the following groups:

  • All children at age 1 year (12–23 months)
  • All children and adolescents age 2 through 18 years who have not previously received HepA should be vaccinated (i.e., routine catch-up vaccination)
  • People living with HIV infection
  • Travelers age 12 months and older to areas of the world with intermediate or high hepatitis A virus (HAV) endemicity. Low endemicity regions include the United States, Canada, Western Europe, Japan, New Zealand, and Australia. For more information, see the CDC travel health website for current information about specific countries at https://wwwnc.cdc.gov/travel or the CDC Yellow Book. (wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/hepatitis-a). When in doubt, vaccinate.
  • Infants age 6 through 11 months traveling outside the United States should receive 1 dose when protection against HAV infection is recommended. The travel dose does not count toward the routine HepA series which should be initiated at age 1 year with the appropriate dose and schedule. In these instances, the child will receive a total of 3 doses of HepA vaccine.
  • Men who have sex with men
  • Users of illegal drugs, injectable or noninjectable
  • People who are homeless or in unstable living arrangements, including shelters
  • Previously unvaccinated people who anticipate having close personal contact with an international adoptee from a country of high or intermediate endemicity during the first 60 days following the adoptee’s arrival in the U.S.
  • People who work with HAV-infected nonhuman primates or with HAV in a research laboratory setting
  • People with chronic liver disease (including but not limited to people with hepatitis B infection, hepatitis C infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, or an ALT or AST level persistently greater than twice the upper limit of normal)
  • People identified during pregnancy to be at risk for HAV infection due to presence of a specific risk factor for exposure or at risk for severe outcome from HAV infection (for example, those with chronic liver disease or with HIV infection).
  • During an outbreak, any unvaccinated person who is identified as at risk for HAV infection or at risk for severe disease from HAV
  • Any person who wishes to be immune to hepatitis A

HepA vaccination is not routinely recommended for healthcare personnel, food handlers, sewage workers, or day care providers because there is no evidence that their occupational risks of HAV exposure are significantly higher than the general population. However, any person who desires protection from HAV infection may be vaccinated.

For details about CDC recommendations for the prevention of hepatitis A, see the 2020 recommendations of the Advisory Committee on Immunization Practices (ACIP): www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Last reviewed: June 25, 2023

Because of measles. Measles is highly communicable and poses a serious threat to the health of unvaccinated infants. For this reason, all infants age 6 through 11 months who travel internationally are recommended to receive a dose of measles, mumps, and rubella vaccine (MMR) to reduce the risk of measles infection during travel.

The antibodies in immune globulin (IG) typically used to prevent HAV infection in infants before the first birthday can interfere with the effectiveness of MMR vaccine. An infant who is given IG should not be vaccinated with MMR or varicella vaccines for at least 6 months after IG administration. If an infant age 6 through 11 months is traveling to a destination where protection from infection with HAV is desired, ACIP recommends off-label use of HepA vaccine (not IG) in addition to MMR. The HepA and MMR doses administered before the first birthday do not count toward the routine vaccination series of either vaccine: these infant travelers will still need two doses of HepA and two doses of MMR when age appropriate.

Last reviewed: June 25, 2023

Twinrix (GSK) is an inactivated combination vaccine containing both hepatitis A virus (HAV) and hepatitis B virus (HBV) antigens. The vaccine contains 720 EL.U. of hepatitis A antigen (half of the Havrix adult dose) and 20 mcg of hepatitis B antigen (the full Engerix-B adult dose).

In the U.S., Twinrix is licensed for use in people who are age 18 years or older. It can be administered to people who are at risk for both hepatitis A and hepatitis B, such as certain international travelers, people with HIV infection, people with chronic liver disease not caused by hepatitis B, men who have sex with men, people who use drugs, or to people who simply want to be immune to both diseases. Primary immunization consists of 3 doses given intramuscularly on a 0-, 1-, and 6-month schedule. In 2007, the FDA also approved a 4-dose schedule for Twinrix. It consists of 3 doses given within 4 weeks, followed by a booster dose at 12 months (0, 7 days, 21–30 days, and 12 months). The 4-dose schedule could benefit individuals needing rapid protection from hepatitis A and hepatitis B, such as people traveling to high-prevalence areas imminently.

Twinrix cannot be used for postexposure prophylaxis.

Last reviewed: June 25, 2023

Please see details of the recommendations for the use of IG for the prevention of hepatitis A provided in Table 4 (page 19) and Appendices A and B of the 2020 ACIP recommendations for the prevention of hepatitis A infection: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Below is a brief summary of the recommendations:

Preexposure prophylaxis with IG for travel to areas of intermediate or high hepatitis A endemicity:

  • Infants younger than age 6 months and other travelers for whom HepA vaccine is declined or contraindicated
  • Previously unvaccinated people with chronic liver disease vaccinated within 2 weeks of departure may consider IG in addition to vaccination, based upon the clinician’s risk assessment
  • Previously unvaccinated people who are immunocompromised may consider IG in addition to vaccination, regardless of the timing of vaccination, based upon the clinician’s risk assessment
  • Previously unvaccinated people who are over age 40 years and vaccinated within 2 weeks of departure may consider IG in addition to vaccination, based upon the clinician’s risk assessment

Postexposure prophylaxis with IG within 2 weeks after exposure to hepatitis A virus (HAV):

  • Infants under age 12 months
  • Previously unvaccinated immunocompromised adults (including HIV+), in addition to vaccination
  • Previously unvaccinated adults with chronic liver disease, in addition to vaccination
  • Previously unvaccinated adults over age 40 years, consider IG in addition to vaccination, based upon clinician risk assessment
  • People with HIV infection, previously vaccinated, consider IG following a high-risk exposure (household or sexual contact), based upon clinician risk assessment
Last reviewed: June 25, 2023

Hepatitis A vaccination is recommended for people age 6 months or older who are traveling to or working in an area of the world at intermediate or high risk of hepatitis A transmission. Areas of low risk include the United States, Canada, Japan, New Zealand, Australia and Western Europe. Visit the CDC’s Traveler Health website for more information about specific destinations and current outbreaks or travel notices (https://wwwnc.cdc.gov/travel/). When in doubt, vaccinate.

Last reviewed: June 25, 2023

For details on preexposure protection of international travelers age 12 months and older, refer to Appendix A on page 35 of the current ACIP recommendations for the prevention of hepatitis A: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Healthy people age 12 months through 40 years who are planning travel to an area with high or intermediate HAV endemicity and have not received HepA vaccine should receive a single dose of HepA vaccine as soon as travel is considered and should complete the 2-does series according to the routine schedule.

People with chronic liver disease as well as adults older than 40 years of age, immunocompromised people, and people with other chronic medical conditions planning to depart to an area with high or intermediate HAV endemicity in less than 2 weeks should receive the initial dose of HepA vaccine and may also simultaneously be administered immune globulin (IG) at a separate anatomic injection site (for example in separate limbs).

ACIP revised its recommendations for preexposure hepatitis A vaccination for travelers in 2018 to include vaccination of infants 6 through 11 months of age. All infants of this age traveling internationally should be given a dose of measles, mumps, rubella vaccine (MMR) before travel. Due to the potential interference of hepatitis A IG with MMR vaccine effectiveness, an off-label dose of HepA vaccine is recommended instead of IG in this situation. The travel-related dose for infants 6–11 months of age should not be counted toward the routine 2-dose series. The routine 2-dose HepA and MMR vaccination series should be initiated at age 12 months according to the routine, age-appropriate vaccination schedule.

Infants younger than 6 months and travelers who elect not to receive vaccine or for whom vaccine is contraindicated should receive a single 0.1 mL/kg dose of IG before travel when protection against HAV is recommended. If travel is for more than 1 month, a dose of 0.2 mL/kg should be administered. A 0.2 mL/kg dose can be repeated every 2 months for travel of more than 2 months duration.

Last reviewed: June 25, 2023

Yes. If time allows, use the standard Twinrix schedule of 3 doses given intramuscularly on a 0-, 1-, and 6-month schedule. If travel is imminent the accelerated 4-dose Twinrix schedule can be used, which is 3 doses given on days 0, 7, and 21-30 days and a booster dose at 12 months.

Last reviewed: June 25, 2023

No. There is no recommendation for a booster dose of HepA if a patient has completed the 2-dose series at any age.

Last reviewed: June 25, 2023

Yes. Data have shown that people acquire hepatitis A virus infection even in such places as 4-star hotels located in Latin America.

Last reviewed: June 25, 2023

No. Just give the final dose of HepA vaccine prior to travel.

Last reviewed: June 25, 2023

Possibly. Since IG protects against hepatitis A infection for only 1 to 2 months, depending on the dosage given, additional IG may be needed if the infant is not yet age 6 months. Once the child has reached six months of age, HepA vaccine should be given.

Last reviewed: June 25, 2023

Yes. ACIP recommends that all children age 1 year through 18 years should be vaccinated against hepatitis A. VFC HepA vaccine may be administered to any eligible child, including those recommended for vaccination at 6 through 11 months of age as a result of travel to an HAV-endemic area.

Last reviewed: June 25, 2023

It depends on whether that person has a history of HAV infection. Unless there are medical records that document prior HAV infection, serologic testing for immunity (positive test for total anti-HAV) is the only way to determine if vaccination is necessary. For people from countries with high rates of HAV infection, such as Vietnam and Mexico, serologic testing might be done to prevent unnecessary vaccination. The cost effectiveness of serologic testing, however, should be balanced against the possibility of delaying needed vaccination while awaiting test results.

Last reviewed: June 25, 2023

No, as long as there are medical records that document that the person was previously infected with HAV (i.e., positive test for total anti-HAV). If there is any doubt that the person actually was infected with HAV, HepA vaccine and/or IG should be given. The vaccine or IG will not harm a person who is already immune.

Last reviewed: June 25, 2023

Yes. All people age 1 year or older living with HIV infection should be vaccinated against hepatitis A if they have not been vaccinated, regardless of their CD4+ count.

If any immunocompromised person has a risk factor that places them at increased risk of hepatitis A (e.g., international travel, drug use), they should be vaccinated with HepA vaccine.

Last reviewed: June 25, 2023

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