Should a male receive the hepatitis A vaccine?

Should a Male Receive the Hepatitis A Vaccine?

Yes, males should receive the hepatitis A vaccine, with universal vaccination recommended for all children starting at 12-23 months of age, and targeted vaccination for adult males in high-risk groups including men who have sex with men, injection or non-injection drug users, travelers to endemic areas, those with chronic liver disease, persons experiencing homelessness, and anyone seeking protection from hepatitis A. 1

Universal Pediatric Vaccination

• All male children in the United States should receive hepatitis A vaccine at 12-23 months of age as a 2-dose regimen, integrated into routine childhood immunization. 1
• The vaccine series can be completed with either Havrix or Vaqta, and the vaccines are interchangeable if needed, though using the same vaccine for both doses is preferable. 1
• Catch-up immunization should be considered for unimmunized children and adolescents aged 2-18 years, particularly in areas with increasing incidence or ongoing outbreaks. 1

High-Risk Adult Males Requiring Vaccination

Men who have sex with men (MSM): Both adolescent and adult males who have sex with men should be immunized against hepatitis A virus, as this population experiences higher rates of HAV infection and outbreaks. 1

Substance users: Immunization is recommended for users of either injectable or non-injectable illicit drugs, as this represents a significant transmission route. 1

Travelers: Males traveling to or living in areas with intermediate or high endemicity for hepatitis A should be immunized before departure, with protection reliably present by 4 weeks after the first dose. 1

Chronic liver disease: Males with any chronic liver disease (including hepatitis B, hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, or elevated liver enzymes >2x upper limit of normal) should receive vaccination. 1

HIV-infected individuals: All males with HIV infection aged 1 year or older should be routinely vaccinated with hepatitis A vaccine. 1

Persons experiencing homelessness: All males aged 1 year and older experiencing homelessness should be routinely immunized, as this population faces higher risk for HAV infection and severe outcomes. 1, 2

Occupational exposure: Males working with hepatitis A virus in laboratory settings or with HAV-infected primates should be immunized. 1

Vaccine Efficacy and Protection

• Hepatitis A vaccines are highly immunogenic, with >95% of immunocompetent adults developing protective antibody within 4 weeks of receipt of one dose. 2
• The vaccine demonstrates 94-100% efficacy in preventing HAV infection in clinical trials. 1
• Post-exposure prophylaxis with hepatitis A vaccine is 79% effective in preventing secondary household infections when administered after exposure. 3

Dosing Schedules

For children aged 12 months to 18 years:

• Havrix 720 EL.U./0.5 mL: Two doses given 6 months apart 1, 4
• Vaqta: 0.5 mL (25 U) initially, followed by booster 6-18 months later 5

For adults:

• Havrix: 1.0 mL (1440 ELISA units) initially, followed by 1.0 mL booster 6-12 months later 5
• Vaqta: 1.0 mL (50 U) initially, followed by booster 6-12 months later 5
• Twinrix (combined hepatitis A and B): 3-dose series at 0,1, and 6 months 1

Important Clinical Considerations

• Preimmunization serologic testing is NOT recommended for adolescents or young adults, as universal vaccination is more cost-effective than testing in populations with low seroprevalence. 1
• Immunocompromising conditions (including HIV) are NOT a contraindication to receiving hepatitis A vaccine, as it is an inactivated virus preparation. 1
• The vaccine should not be administered to individuals with hypersensitivity to vaccine components such as aluminum hydroxide or phenoxyethanol. 1
• Protection may be present as soon as 2 weeks after immunization, though reliable protection occurs by 4 weeks. 1

Rationale for Vaccination

• Hepatitis A can cause significant morbidity, with 10-15% of symptomatic patients experiencing prolonged or recurrent disease lasting up to 6 months. 6
• The overall mortality rate is 0.3-0.6%, but increases to 1.8% in adults over 50 years of age. 6
• Vaccination prevents both individual disease and reduces community transmission, as persons are most infectious during the 2 weeks before symptom onset. 6
• The incidence of hepatitis A in the United States decreased by more than 90% after vaccine introduction, demonstrating population-level effectiveness. 7

Universal Vaccination Consideration

• Hepatitis A vaccine may be considered for all other non-immune males (those negative for anti-HAV antibody) who desire protection, even without specific risk factors. 1
• Any person seeking protection from HAV infection may be vaccinated, as the vaccine is safe and effective. 1