Do I need a Hepatitis A (Hep A) vaccine?

Hepatitis A Vaccination Recommendations

Yes, you need a Hepatitis A vaccine if you fall into any of the risk categories established by the Advisory Committee on Immunization Practices (ACIP), including international travelers, men who have sex with men, drug users, persons with chronic liver disease, or those who want protection against the infection. 1

Who Should Receive Hepatitis A Vaccination

Hepatitis A vaccination is recommended for:

1. All children at 1 year of age (12-23 months) as a 2-dose regimen 1

2. Persons at increased risk for infection or severe disease:

   • International travelers to countries with high or intermediate hepatitis A endemicity 1
   • Men who have sex with men 1
   • Users of injection or non-injection illicit drugs 1
   • Persons with chronic liver disease (including hepatitis B, hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis) 1
   • Persons with HIV infection 1
   • Persons experiencing homelessness 1
   • Persons who work with hepatitis A virus in a laboratory setting 1
   • Persons with clotting-factor disorders 1
   • Close contacts of international adoptees 1

3. Any person who wants protection against hepatitis A infection, even if not in a high-risk group 1

Vaccination Schedule and Timing

• For optimal protection, the first dose of hepatitis A vaccine should be administered as soon as travel or risk is identified 1
• Protection is reliably present by 4 weeks after the first dose 1
• Some protection may be present as early as 2 weeks after vaccination 2
• A 2-dose series is recommended for complete protection:
  • Second dose of Havrix: 6-12 months after first dose
  • Second dose of Vaqta: 6-18 months after first dose 1

Special Considerations

For International Travelers

• If traveling to areas with high/intermediate hepatitis A endemicity in less than 2 weeks:
  • Adults should receive the vaccine
  • Older adults, immunocompromised persons, and those with chronic liver disease may also receive immune globulin (0.02 mL/kg) at a separate injection site for optimal protection 1

For Persons with Chronic Liver Disease

• Vaccination is strongly recommended as hepatitis A can cause more severe disease in those with underlying liver conditions 3
• Early vaccination is important as response to vaccination decreases as liver disease progresses 3

For Pregnant Women

• Hepatitis A vaccines are inactivated and considered safe during pregnancy 4
• Vaccination is recommended if the pregnant person is at risk for infection or severe outcomes 1

Common Pitfalls to Avoid

1. Delaying vaccination for international travel: Even last-minute travelers should receive the vaccine, as it can provide protection even when given shortly before departure 2

2. Assuming low-risk destinations are completely safe: While risk is highest in areas with high/intermediate endemicity, cases have been reported in travelers to low-endemicity regions including Western Europe, the Caribbean, and North America 5

3. Skipping vaccination due to mild liver disease: Patients with chronic liver disease should be vaccinated regardless of disease severity, and vaccination should be given early as response decreases with disease progression 3

4. Assuming immunity without testing or vaccination: Without documented vaccination or prior infection, individuals should not assume immunity to hepatitis A, especially when traveling internationally 5

Hepatitis A vaccination is highly effective at preventing infection and subsequent liver disease, with seroconversion rates exceeding 95% in healthy adults 4. Given the potential severity of hepatitis A infection, particularly in those with underlying liver disease, vaccination represents an important preventive health measure for at-risk individuals.