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Hepatitis A Vaccine

By William D. Surkis, MD, Clinical Associate Professor of Medicine; Director, Internal Medicine Residency Program, Jefferson Medical College; Lankenau Medical Center
Jerome Santoro, MD, Clinical Professor of Medicine; Chief, Department of Medicine, Jefferson Medical College; Lankenau Medical Center

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For more information, see Hepatitis A ACIP Vaccine Recommendations.


Hepatitis A (HepA) vaccines are prepared from formalin-inactivated, cell culture–derived hepatitis A virus. There are 2 hepatitis A vaccines (Havrix® and Vaqta®); both are available in pediatric and adult formulations.

A vaccine that combines hepatitis A and hepatitis B vaccine (Twinrix®) is also available.


The HepA vaccine is a routine childhood vaccination (see Table: Recommended Immunization Schedule for Ages 0–6 yr).

HepA vaccine is indicated when any of the following is present:

  • A desire for protection from hepatitis A in people not previously vaccinated

  • Travel to or work in endemic areas

  • Occupational exposure (eg, working with primates infected with hepatitis A virus [HAV] or HAV in a research laboratory)

  • Sex between men

  • Use of illicit drugs (injected or not), such as methamphetamine

  • Treatment with clotting factor concentrates

  • A chronic liver disorder

  • Anticipated close personal contact (eg, as members of the household or as regular babysitters) with an adopted child during the first 60 days after the child's arrival in the US from an endemic area

The combination HepA and HepB vaccine can be used in people ≥ 18 yr who have indications for either hepatitis A or hepatitis B vaccine and who have not been previously vaccinated with one of the vaccine components.

Contraindications and Precautions

The main contraindication is

  • A severe allergic reaction (eg, anaphylaxis) after previous dose or to a vaccine component

The main precaution is

  • Moderate or severe illness with or without a fever (vaccination is postponed until the illness resolves)

Dose and Administration

The dose is 0.5 mL IM up to age 18 yr or 1 mL IM for adults (age ≥ 19 yr).

Children are given a 2-dose series typically at age 12 to 23 mo and 6 to 18 mo after the 1st dose.

Adults are given the vaccine in a 2-dose series at either 0 and 6 to 12 mo (Havrix®) or 0 and 6 to 18 mo (Vaqta®).

Or adults may be given the combination HepA and HepB vaccine on a 3-dose schedule: at 0, 1, and 6 mo. The 1st and 2nd doses should be separated by ≥ 4 wk, and the 2nd and 3rd doses should be separated by ≥ 5 mo. Alternatively, the vaccine may be given on a 4-dose schedule: on days 0, 7, and 21 to 30, followed by a booster 12 mo after the 1st dose.

As soon as an adoption of a child from an endemic area is planned, close contacts should be given the 1st dose of the 2-dose HepA vaccine series, ideally ≥ 2 wk before the adopted child arrives.

Adverse Effects

No serious adverse effects have been reported.

Mild effects include pain, erythema, swelling, and occasionally induration at the injection site.

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