Vaccination Recommended For Children In High-Hepatitis States

Hepatitis A is a highly contagious virus that attacks the liver. Each year it infects up to 200,000 Americans. It is spread by the fecal-oral route through close person-to- person contact or by ingesting contaminated food or water. Symptoms can be debilitating and include fever, fatigue, loss of appetite, nausea, abdominal discomfort, jaundice and dark urine. Infected individuals can unknowingly infect others 2 weeks prior to feeling ill themselves. It is estimated that up to 22 percent of adult hepatitis A patients require hospitalization. Approximately 100 people in this country die every year from this disease. For more details visit the Hepatitis Center.

According to the Centers for Disease Control and Prevention (CDC), routine vaccination of children is the most effective way to reduce the incidence of hepatitis A nationwide. The CDC is encouraging implementation of routine hepatitis A vaccination programs for children in 17 states; which have the highest rates of hepatitis A. The CDC has incorporated the recommendations of its Advisory Committee on Immunization Practices (ACIP) into the Morbidity and Mortality Weekly Report (MMWR) titled, "Prevention of Hepatitis A Through Active or Passive Immunization." These recommendations are in response to the continuing high rates of hepatitis A in the United States.

The CDC recommends a shift in its immunization strategy in order to reduce the rate of hepatitis A. The Advisory Committee on Immunization Practices (ACIP) 1996 recommendations on the prevention of hepatitis A focused primarily on vaccinating persons in high risk groups. People at high risk of developing hepatitis A include: travelers to countries with high rates of hepatitis A, men who have sex with men, injecting drug users, persons with clotting-factor disorders, persons with chronic liver disease and children living in communities with high rates of hepatitis A. The CDC's review of national hepatitis A rates and results from community-based vaccination programs indicate that continued implementation of ACIP recommendations would not result in vaccinating high risk populations and would therefore have a limited impact on the overall incidence of disease. To achieve a sustained reduction in hepatitis A, the CDC recommends a shift from the present immunization strategy to one that achieves widespread routine vaccination of children to prevent infection in these age groups and eventually among older persons as this population ages.

According to the CDC, the states with the highest incidence of hepatitis A account for 50 percent of the reported cases. It is estimated that hepatitis A health care cost more that $450 million dollars annually. Experts view routine vaccination programs for children as a cost- effective way to reduce the spread of this disease.

The highest rate of hepatitis A is among children 5-14 years of age. Almost 30 percent of reported cases of hepatitis A occur among children under 15 years of age. The reason children are at high risk is that they frequently come into close contact with other children in school and at daycare. Approximately 15 percent of reported cases of hepatitis A occur among children or employees in daycare centers. Hepatitis A infection in very young children can be mild or without symptoms. It can be easily transmitted to older children and adults who are likely to develop severe symptoms and may require hospitalization.

States With High Rates Of Hepatitis A

The October 1, 1999 Morbidity and Mortality Weekly Report (MMWR) sent out by the CDC addresses the ACIP's recommendation for routine hepatitis A vaccination for children in states where the average annual hepatitis A rate during 1987 to 1997 was at least twice the national average rate--or 20 cases per every 100,000 people. Eleven states fall into this category: Arizona, Alaska, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah and Washington. The ACIP also recommends routine hepatitis A vaccination in counties or communities in any state where the average hepatitis A rate during 1987 to 1997 was at least 20 per 100,000.

The ACIP states that routine hepatitis A vaccination for children should be considered in states where the average annual hepatitis A rate during 1987 to 1997 was at least 10 per 100,000 people (ie., approximately the national average). These states include: Missouri, Texas, Colorado, Arkansas, Montana and Wyoming. The ACIP recommends that counties or communities with hepatitis A rates between 10 per 100,000 and 20 out of 100,000 should consider routine vaccination for hepatitis A.

The hepatitis A vaccines have been approved by the FDA and have been on the market since 1995. They are considered safe and effective (94% in clinical trials.) To learn more about hepatitis A, B, and C visit the Hepatitis Center.

According to the CDC, routine vaccination of children is the most effective way to reduce hepatitis A incidence nationwide over time. To further curb the spread of Hepatitis A individuals in high risk groups should also receive the hepatitis A vaccination. These high risks groups include: travelers to countries with high rates of hepatitis A, men who have sex with men, injecting drug users, persons with clotting-factor disorders, persons with chronic liver disease and children living in communities with high rates of hepatitis A.

SOURCE: Centers For Disease Control And Prevention (CDC), Morbidity And Mortality Weekly Report, "Prevention of Hepatitis A Through Active of Passive Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP), October 1, 1999, Vol. 48 No. RR-12


Last Editorial Review: 7/7/2004



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