What are the indications for the Hepatitis A (Hep A) vaccine?

Hepatitis A Vaccine Indications

All children in the United States should receive hepatitis A vaccine starting at 12-23 months of age, and vaccination is indicated for specific high-risk groups including travelers to endemic areas, men who have sex with men, persons who use illicit drugs, those with chronic liver disease, and persons experiencing homelessness. 1

Universal Childhood Vaccination

• All children should receive hepatitis A vaccine at 1 year of age (12-23 months) as a 2-dose series, integrated into routine childhood immunization schedules. 1
• Catch-up vaccination should be considered for unimmunized children aged 2-18 years, particularly in areas with increasing incidence or ongoing outbreaks. 1
• The vaccine series can be completed with either Havrix (doses at 0 and 6-12 months) or Vaqta (doses at 0 and 6-18 months), and the vaccines are interchangeable. 1

Medical Indications

Persons with chronic liver disease should be vaccinated, as they are at higher risk for severe complications and mortality from hepatitis A infection. 1

• Persons who receive clotting factor concentrates should be vaccinated, though modern preparation practices have reduced transmission risk. 1
• Persons with end-stage renal disease and those on hemodialysis should receive vaccination. 1
• HIV-infected persons should be vaccinated as close to diagnosis as possible. 1

Behavioral Indications

Men who have sex with men (MSM) should be routinely vaccinated, as this population has consistently higher hepatitis A infection rates. 1

• All users of injection and noninjection illicit drugs should receive vaccination. 1
• Prevaccination serologic testing is not recommended for adolescents and young adults in these risk groups. 1
• Healthcare providers should proactively offer vaccination in primary care and specialty settings serving these populations, using standing orders to overcome barriers. 1

Travel-Related Indications

All persons traveling to or working in countries with high or intermediate hepatitis A endemicity should be vaccinated before departure. 1

• Protection is reliably present by 4 weeks after the first dose and may provide protection as early as 2 weeks. 1
• For travelers departing in less than 4 weeks, the vaccine should still be administered; immune globulin (0.02 mL/kg) may be added at a different injection site for those departing in less than 4 weeks. 1
• Unvaccinated persons anticipating close contact with international adoptees from endemic countries should receive the first dose as soon as adoption is planned, ideally 2 or more weeks before the adoptee's arrival. 1
• Even travelers to low-endemicity regions (Western Europe, Caribbean, North America) have acquired hepatitis A, so vaccination should be offered to all travelers regardless of destination. 2

Occupational Indications

Persons working with hepatitis A virus-infected primates or with HAV in research laboratory settings should be vaccinated. 1

• No other occupational groups have been demonstrated to be at increased risk solely from occupational exposure. 1

Persons Experiencing Homelessness

All persons aged 1 year and older experiencing homelessness should be routinely vaccinated against hepatitis A. 3

• This population is at higher risk for HAV infection and severe outcomes due to living conditions that make hand hygiene and sanitation difficult. 3
• Integrating routine vaccination into health services for this population can reduce outbreak risk over time. 3

Additional Considerations

Any person seeking protection from hepatitis A infection can receive the vaccine, even without specific risk factors. 1

• Immunocompromising conditions are not a contraindication to receiving hepatitis A vaccine, as it is an inactivated virus preparation. 1
• The vaccine should not be administered to persons with hypersensitivity to vaccine components such as aluminum hydroxide or phenoxyethanol. 1
• Despite high vaccine effectiveness (>95% develop protective antibodies within 4 weeks of one dose), vaccination coverage remains suboptimal even among travelers to endemic areas (only 26.6% coverage in 2010). 3, 4