Hepatitis A (HepA) Vaccine

HepA vaccines are prepared from formalin-inactivated, cell culture–derived hepatitis A virus. Both HepA vaccines are available in pediatric and adult formulations.

The combined HepA/HepB vaccine is also available in many countries.

HepA vaccine is a routine childhood vaccination (1).

HepA vaccine is indicated for any person who is not fully vaccinated and requests vaccination (identification of risk factor not required).

HepA vaccine also is indicated for any of the following risk factors (2):

• Travel to or work in endemic areas

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

• Men who have sex with men

• Injection or noninjection drug use, such as methamphetamineInjection or noninjection drug use, such as methamphetamine

• Homelessness

• HIV infection

• A chronic liver disease (eg, people with hepatitis B, hepatitis C, cirrhosis, fatty liver disease, alcohol-related liver disease, autoimmune hepatitis, or alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal)

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

• Risk of HAV infection during pregnancy (eg, pregnant people who are international travelers, who use injection or noninjection drugs, who have occupational exposure risk, who anticipate close personal contact with an international adoptee, or who are experiencing homelessness) or risk of having a severe outcome resulting from HAV infection (eg, pregnant people who have chronic liver disease or HIV infection)

During HepA outbreaks, people ≥ 1 year of age who are at risk of HAV infection should be vaccinated.

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

The main contraindication for HepA vaccine is:

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

The main precaution with HepA vaccine is:

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

The HepA vaccine dose is 0.5 mL IM up to age 18 years or 1 mL IM for adults ≥ 19 years.

Children are given a 2-dose series typically at age 12 to 23 months and again 6 to 18 months after the first dose.

Depending on the manufacturer, adults are given the vaccine in a 2-dose series at 0 and 6 to 12 or 6 to 18 months.

Alternatively, adults may be given the combination HepA/HepB vaccine on a 3-dose schedule: at 0, 1, and 6 months. The first and second doses should be separated by ≥ 4 weeks, and the second and third doses should be separated by ≥ 5 months. Alternatively, the vaccine may be administered on an accelerated 4-dose schedule: on days 0, 7, and 21 to 30, followed by a booster dose 12 months after the first dose.

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

Common adverse reactions include pain, erythema, swelling, and occasionally induration at the injection site. Other common adverse reactions include fever in children age 12 to 23 months and headache in adults.

For more information about adverse effects of these vaccines, refer to the prescribing information.

The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.

1. Advisory Committee on Immunization Practices (ACIP): ACIP Recommendations: Hepatitis A Vaccine

2. Centers for Disease Control and Prevention (CDC): Hepatitis A Vaccination

3. European Centre for Disease Prevention and Control (ECDC): Hepatitis A: Recommended vaccinations