Is Hepatitis A (Hepatitis A) vaccination mandatory?

From the Guidelines

Hepatitis A vaccination is not universally mandatory, but it is highly recommended for individuals at high risk of exposure, such as travelers to endemic areas, men who have sex with men, and people with chronic liver disease, as stated in the 2021 guidelines by the Advisory Committee on Immunization Practices 1. The vaccine is typically recommended rather than required for the general population, but certain situations may necessitate vaccination, such as healthcare settings or military service.

• Key groups that should receive hepatitis A vaccination include:
  • Men who have sex with men
  • Persons who use injection or noninjection illicit drugs
  • Persons working with HAV-infected primates or with HAV in a research laboratory setting
  • Persons with chronic liver disease and persons who receive clotting factor concentrates
  • Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A
  • Unvaccinated persons who anticipate close personal contact with an international adoptee during the first 60 days after arrival in the United States from a country with high or intermediate endemicity, as outlined in the 2014 advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older: United States, 2014 1. The standard regimen consists of two doses of hepatitis A vaccine given 6-12 months apart, providing long-term protection for most individuals, with a second dose recommended for long-term immunity, as stated in the 2021 guidelines by the Advisory Committee on Immunization Practices 1.
• For postexposure prophylaxis, the recommended dose is one dose of hepatitis A vaccine, with a second dose recommended for long-term immunity, and immune globulin may be considered in certain situations, such as for individuals over 40 years old or with chronic liver disease, as outlined in the 2021 guidelines by the Advisory Committee on Immunization Practices 1. It is essential to note that the vaccine is highly effective and works by stimulating the immune system to produce antibodies against the hepatitis A virus, preventing infection upon exposure, and hepatitis A is transmitted through the fecal-oral route, often via contaminated food or water.

From the Research

Hepatitis A Vaccine Mandatory Status

• The hepatitis A vaccine is not universally mandatory, but it is recommended for certain groups of people, such as travelers to areas with high or intermediate endemicity 2, children living in areas with high endemic rates 3, and patients with chronic liver disease 3.
• The vaccine is also recommended for postexposure prophylaxis, although immune globulin is still considered effective for this purpose 4, 5.
• The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) provide guidelines for the use of hepatitis A vaccine, but these guidelines do not make the vaccine mandatory for the general population 3, 5.

Recommendations for Hepatitis A Vaccination

• The AAP recommends hepatitis A vaccination for children aged 2 years and older who are at increased risk of infection, including travelers to areas with high or intermediate endemicity, children living in areas with high endemic rates, and patients with chronic liver disease 3.
• The CDC recommends hepatitis A vaccination for adults who are at increased risk of infection, including travelers to areas with high or intermediate endemicity, men who have sex with men, and users of illicit drugs 2.
• Healthcare providers should assess the risk of hepatitis A infection for their patients and recommend vaccination accordingly 2, 5.

Efficacy and Safety of Hepatitis A Vaccine

• The hepatitis A vaccine has been shown to be highly effective in preventing hepatitis A infection, with seroconversion rates of 88-100% after a single dose 3, 6.
• The vaccine has also been shown to be safe and well-tolerated, with few adverse reactions reported 6.
• The vaccine provides long-term protection against hepatitis A infection, making it a reasonable alternative to immune globulin for postexposure prophylaxis in many situations 4.