From the Guidelines
For hepatitis A prevention in adolescents, vaccination is the primary recommendation, with the hepatitis A vaccine administered as a two-dose series, with doses given 6-18 months apart, as recommended by the Advisory Committee on Immunization Practices 1.
Key Recommendations
- All adolescents aged 12-23 months should receive routine vaccination, and catch-up vaccination is recommended for older unvaccinated adolescents, particularly those at increased risk of exposure or severe disease.
- Post-exposure prophylaxis with hepatitis A vaccine should be given within 2 weeks of exposure for unvaccinated individuals; immune globulin may be used for those who cannot receive the vaccine.
- Treatment for hepatitis A is primarily supportive care, as there is no specific antiviral therapy, including adequate hydration, nutritional support, and avoiding hepatotoxic medications including acetaminophen.
- Management involves monitoring liver function tests and preventing transmission through good hygiene practices, with infected adolescents excluded from school, food handling, and direct patient care until 1-2 weeks after symptom onset or jaundice appearance.
High-Risk Groups
- Adolescents with chronic liver disease, those administered clotting factors, users of injectable or noninjectable drugs, and males who have sex with males should be vaccinated against hepatitis A, as recommended by the Advisory Committee on Immunization Practices 1.
- Unvaccinated adolescents who plan to travel to or work in a country with high or intermediate endemicity of HAV infection should also receive hepatitis A vaccine.
Vaccine Effectiveness
- The hepatitis A vaccine is highly effective, stimulating the immune system to produce antibodies against the hepatitis A virus and providing long-lasting immunity that prevents infection upon future exposure, with a protective efficacy of 94-100% after two doses 1.
From the FDA Drug Label
The presence of antibodies to HAV confers protection against hepatitis A infection. Protective efficacy with HAVRIX has been demonstrated in a double-blind, randomized controlled study in school children (aged 1 to 16 years) in Thailand who were at high risk of HAV infection. In 6 clinical studies, 762 subjects aged 2 to 18 years received 2 doses of HAVRIX (360 EL.U.) given 1 month apart (GMT ranged from 197 to 660 mIU/mL). Ninety-nine percent of subjects seroconverted following 2 doses. Immune Response to HAVRIX 720 EL.U./0.5 mL at Age 11 to 25 Months (Study HAV 210)
The hepatitis A vaccine (IM) is recommended for the prevention of hepatitis A infection in adolescents.
- The vaccine has been shown to be 94% effective in preventing clinical hepatitis A in a study of school children aged 1 to 16 years.
- Two doses of the vaccine are recommended, given 1 month apart, with a 99% seroconversion rate in subjects aged 2 to 18 years.
- The vaccine can be administered concomitantly with other routinely recommended U.S.-licensed vaccines, such as DTaP, Hib conjugate vaccine, PCV-7, MMR, and varicella vaccines, without evidence of reduced antibody response 2.
- The duration of immunity following a complete schedule of immunization with HAVRIX has not been established 2.
From the Research
Hepatitis A Prevention and Management in Adolescents
- Hepatitis A infection can cause severe disease among adolescents and adults 3.
- The Advisory Committee on Immunization Practices (ACIP) has instituted incremental recommendations for hepatitis A vaccination, including universal vaccination at 1 year of age, with vaccination through 18 years of age based on risk or desire for protection 3, 4.
Vaccination Coverage and Recommendations
- National 1-dose HepA coverage among adolescents was 42.0% in 2009, with 70% of vaccinees completing the 2-dose series 3.
- By 2016, national vaccination coverage for 1 and ≥2 doses of HepA vaccine among adolescents had increased to 73.9% and 64.4%, respectively 4.
- Factors associated with increased vaccine initiation include race/ethnicity, military payment source, and provider recommendation for HepA vaccination 4.
- The ACIP recommends hepatitis A vaccination for all children at 1 year of age, as well as for adolescents who have not been previously vaccinated 3, 4.
Post-Exposure Prophylaxis
- Hepatitis A vaccine and immune globulin (IG) are effective in preventing hepatitis A cases in susceptible exposed people, with an effectiveness of 97.6% for HAV vaccine and 98.3% for IG 5.
- The use of HAV vaccine for post-exposure prophylaxis is supported by its high effectiveness and long-term protection, and is preferred over IG in many cases 5, 6.
- Immune globulin is recommended for postexposure prophylaxis, particularly for contacts of cases in the home, child care centers, and other selected sites 7.
Special Considerations
- Adolescents living in areas with high endemic rates of hepatitis A or who are at increased risk of infection should receive hepatitis A vaccination 3, 4.
- Patients with chronic liver disease should also receive hepatitis A vaccination to prevent fulminant hepatitis 7.
- Travelers to areas with intermediate to high rates of endemic hepatitis A should receive hepatitis A vaccination or immune globulin as prophylaxis 7.