ATLANTA -- Hepatitis A vaccination should be given following exposure in all persons ages 12 months and older, the Advisory Committee on Immunization Practices (ACIP) said.
In a unanimous 14-0 vote, the ACIP voted that "hepatitis A vaccines should be administered as post-exposure prophylaxis," for this population, and immune globulin should be administered to adults ages 40 and older "depending on the provider's risk assessment."
After proposing yesterday to defer discussion on this issue until June, the committee was able to conduct a vote this morning. They voted on two questions -- the first about hepatitis A vaccines in persons 12 months and older, and the second on hepatitis A vaccines in infants ages 6 to 11 months who are traveling outside of the U.S. "when protection against hepatitis A is recommended." This also passed in a 14-0 vote.
The crux of the new guidance is mainly focused on an outbreak or suspected outbreak situation, such as food-borne outbreaks, and ongoing hepatitis A outbreaks in states such as California and Michigan. CDC researchers cited challenges with previous post-exposure prophylaxis recommendations -- for example, that due to increases in outbreaks, state and local health departments reported that timely receipt of intramuscular immune globulin is difficult, as most health departments do not routinely stock it, and some adults require more than one dose, due to recent increased dosing recommendations.
There were some questions about what constituted "provider discretion," but a representative from the National Association of County and City Health Officials assured the committee that any decision about treatment can be made in conjunction with public health departments, as hepatitis A is nationally notifiable.
The ACIP also voted on new language on infants ages 6 to 11 months to receive hepatitis A vaccine, noting that immune globulin cannot be given with the measles, mumps, and rubella (MMR) vaccine. The new guidance suggests that infants ages 6 to 11 months who are traveling internationally should receive a dose of hepatitis A vaccine, and then receive the two-dose series of MMR and hepatitis A vaccines at ages 12 months or older, as recommended.
This new language was also approved 14-0 for the Vaccines for Children program.
As always, all ACIP recommendations are not considered final until they appear in the CDC's Morbidity and Mortality Weekly Report.