|
Health advisory: New Recommendations for Hepatitis A Virus (HAV) Post-exposure Prophylaxis, and Pre-exposure Prophylaxis for International Travelers
October 24, 2007 |
ACTION REQUESTED:
- Patients recently exposed to hepatitis A virus should receive either single antigen hepatitis A vaccine or immune globulin (IG) as soon as possible
- Single antigen vaccine is preferred for healthy patients age 12 months to 40 years
- IG is preferred for patients under 12 months, over 40 years, and those with immune compromise, chronic liver disease, or contraindication to vaccine
- Patients 12 months to 40 years traveling to countries with high rates of HAV should receive one dose of single antigen vaccine anytime before departure
|
Background: Previously, immune globulin (IG) was recommended for postexposure prophylaxis of HAV. Based on results of a randomized, double-blind noninferiority clinical trial comparing the efficacy of hepatitis A vaccine and IG after exposure to HAV, the Advisory Committee on Immunization Practices (ACIP) now recommends single antigen hepatitis A vaccine instead of IG for healthy patients age 12 months to 40 years. Because no data is available comparing the efficacy of single antigen vaccine vs. IG for postexposure prophylaxis in patients over 40 years and those with chronic medical conditions, IG is still recommended for those groups.
Persons administered IG for whom hepatitis A vaccine also is recommended for other reasons should receive a dose of vaccine simultaneously with IG. For persons who receive vaccine, the second dose should be administered according to the licensed schedule to complete the series. The efficacy of IG or vaccine when administered >2 weeks after exposure has not been established.
For persons age 12 months to 40 years traveling to countries with high rates of HAV infection, one dose of single antigen vaccine administered anytime before departure (but ideally as soon as travel is considered) is recommended. For optimal protection, older adults, immunocompromised persons, and persons with chronic liver disease or other chronic medical conditions planning to depart to an area in less than 2 weeks should receive the initial dose of vaccine and also simultaneously can be administered IG at a separate anatomic injection site. Infants under 12 months should be given IG. Travelers for whom IG is recommended who will be in an area of endemic HAV for more than 2 months require a larger dose of IG.
Resources
Full text of the ACIP recommendations is in MMWR 56(41);1080-1084, October 19, 2007.
|
