HAV vaccination: how long will it take?

Despite the availability of a safe and effective vaccine, immunization rates in the U.S. remain poor (Pediatrics 2012; 129: 213-221).

In this study which included data from the 2009 National Immunization Survey-Teen, hepatitis A virus (HAV) vaccination  coverage was examined in adolescents 13-17 years of age.  The national coverage for at least 1 dose was 42%; 70% of these vaccinees completed the 2-dose series.  For Georgia, the rates were similar to national data: the 1-dose receipt % was 42.5% and the 2-dose receipt % was 26.3%; 62% completion of 2 doses.

More specific breakdown of coverage rates:

  • 74.3% from 11 states that recommended universal HAV vaccination since 1999
  • 54% from 6 states that recommended consideration of HAV vaccination since 1999 & universal coverage since 2006
  • 27.8% for 33 states that recommended universal vaccination since 2006

While acute HAV rates have been declining, in 2009 there were 1987 reported cases; the CDC estimates that the total number of cases was 21,000 (due to underreporting and asymptomatic cases).  The highest rates of disease were in young adults between 20-29 years of age.

This data is disappointing. Yet, extrapolation from this data indicates that national coverage in seven years, when all states will have had 10 years to implement universal vaccination to young children, could be markedly better.

Additional references:

  • -NEJM 2007; 357: 1685. HAV vaccine effective in preventing cases of HAV after exposure (as good as IVIG). Low rates of HAV c postexposure prophylaxis c HAV vaccine (4.4%) or immune globulin (3.3%). n=1090.
  • -MMWR 2007; 56: 1080-84. Updated recs for IVIG -use only for exposures in infants <12months, immunocompromised persons, persons with chronic liver disease, or persons w contraindications to HAV vaccine.
  • -Pediatrics 2007; 120: 189. Recs from AAP. Recs for vaccine — all children at 1 year of age in US w 2-dose regimen; w/in 1 mo of 1st dose 97% of children & 95% of adults develop protective antibody. VAERS (adverse rxns) 800-822-7967 for forms.
  • -Pediatrics 2007; 119; e12, e22. HAV vaccine is cost-effective.
  • -MMWR 2007; 56: No. SS-3. drop in new infections by 80% compared to previous nadir; HAV 1.5/100,000 & HBV 1.8/100,000
  • -Hepatology 2006; 44: 1589. Decreasing incidence of fulminant HAV ; between 1988-2005, decrease of HAV in UNOS database from 0.7% to 0.1%. Risk factors for severe disease: creatinine >2, ALT <2600, intubation, pressors.
  • -J Pediatr 2004; 144: 327. Maternal antibody decrease HAV vaccine response when administered at 2, 4 & 6 months.
  • -Am J Gastroent 2002; 97: 721-8. ? cost-effective to vaccinate HCV pts; however, ~35% FHF risk if secondarily infected.

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