HEPATITIS A VACCINES

Recommendations for use The hepatitis A vaccine may be offered to all healthy children with special emphasis in risk groups as enumerated below Patients with chronic liver disease Carriers of Hep B & Hep C Congenital or acquired immunodeficiency Transplant recipients Adolescents seronegative for HAV who are leaving home for residential schools Travelers to countries with high endemicity for Hepatitis A Household contacts of patients with acute Hep A virus infection within 10 days of onset of illness in the index case. It may not always be effective under such circumstances when the contact has had the same source of infection as the index patient. If a decision to administer the vaccine is taken any of the licensed vaccines may be used as all have nearly similar efficacy and safety (exception post exposure prophylaxis, immunocompromised patients where only inactivated vaccines may be used). Two doses 6 months apart are recommended for all vaccines. The manufacturers of the live attenuated vaccine claim that a single dose is sufficient for long term protection. Since controlled studies from China demonstrate superiority of two dose schedule vs single dose schedule and since long term serologic data from India with single dose of the live vaccine is still not available, the IAPCOI recommends two doses of even the live attenuated vaccine. All Hep A vaccines are licensed for use in children aged 1 year or older. In its earlier publications the committee had recommended initiation of hepatitis A vaccination at the age of 18 months, so that interference with maternal antibodies is minimized. However new data suggests decline in the adult seropositivity rates especially in those belonging to the high socioeconomic status. Consequently babies may be born with no maternal antibodies. Immunogenicity studies also show that antibody titres achieved with vaccination at 12 months are comparable to those achieved at 18 mths- 2 years. In light of these facts, the committee now recommends initiating Hepatitis A vaccine at the age of 12 months. For catch up vaccination, pre vaccination screening for Hepatitis A antibody is recommended in children older than 10 years as at this age the estimated seropositive rates exceed 50%.