The Advisory Committee on Immunization Practices Hepatitis Vaccines Work Group has updated recommendations for hepatitis A vaccination for postexposure prophylaxis (PEP) and international travel. The new recommendations update and supersede previous advice and have been published in the Morbidity and Mortality Weekly Report.

The committee reviewed the evidence for administering the vaccine for PEP to persons aged >40 years, as well as the hepatitis A vaccine efficacy and safety in infants, along with the benefits of protection against hepatitis A virus before international travel, before updating the recommendations. The committee now states that hepatitis A vaccine should be given to all persons aged ≥12 months for PEP, and that in addition to the vaccine, immune globulin may be given to persons aged >40 years, depending on the provider’s risk assessment. 

For infants aged 6 to 11 months, the hepatitis A vaccine is recommended when traveling outside the United States, where protection against the virus is recommended, but this travel dose in infants should not count toward the routine 2-dose series. Also, the dosage of immune globulin has been updated to 0.1 mL/kg where applicable.

PEP with the hepatitis A vaccine or immune globulin can effectively prevent infection when administered within 2 weeks of exposure, but the hepatitis A vaccine provides several advantages compared to immune globulin. The vaccine induces active immunity, has a longer duration of protection, is easy to administer, and has greater acceptability and availability. Immune globulin should, however, be considered before travel for patients with special risk factors for infection with hepatitis A virus or an increased risk for complications linked to exposure.

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Reference

Nelson NP, Link-Gelles R, Hofmeister MG, et al. Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for postexposure prophylaxis and for preexposure prophylaxis for international travel. MMWR Morb Mortal Wkly Rep. 2018;67:1216-1220.