Hepatitis A Vaccination Coverage Levels Low vs Other Recommended Childhood Vacci

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Hepatitis A Vaccination Coverage Levels Low vs Other Recommended Childhood

Vaccinations

Laurie Barclay, MD

July 13, 2007 — Although hepatitis A virus (HAV) vaccination coverage levels

are low compared with those for other recommended childhood vaccinations,

the incidence of acute HAV infections has declined to the lowest level ever

recorded, according to a report in the July 13 issue of the Morbidity and

Mortality Weekly Report.

" After the licensure of hepatitis A vaccine in 1995 for children aged >24

months, the Advisory Committee on Immunization Practices (ACIP)

incrementally expanded the proportion of children for whom it recommended

the vaccine, " write I. , PhD, from the National Center for HIV/AIDS,

and colleagues. " In 1996, ACIP recommended vaccinating children in

communities that had high rates of hepatitis A virus (HAV) infection,

including American Indian/Alaska Native (AI/AN) communities and selected

Hispanic and religious communities. In 1999, ACIP extended the

recommendation to include routine vaccination for all children living in

states, counties, and communities with incidence rates twice the 1987–1997

national average of 10 cases per 100,000 population (i.e., >20 cases per

100,000 population). "

The 2003 National Immunization Survey provided the first national estimates

of hepatitis A vaccination coverage, indicating an overall national 1-dose

coverage level of 16.0% (range: 6.4% – 72.7%) in children aged 24 to 35

months. By including data for 2004 and 2005, the estimates in this report

update those findings.

In children aged 24 to 35 months, national 1-dose vaccination coverage

levels increased from 17.6% in 2004 to 21.3% in 2005. Coverage in states

where vaccination was recommended was lower than coverage for other

recommended childhood vaccinations, such as varicella. HAV coverage in 2005

was 56.5% (range: 12.9% – 71.0%) vs 87.5% for varicella coverage in 2004.

" Despite low hepatitis A vaccination-coverage levels compared with other

recommended childhood vaccinations, incidence of acute HAV infections have

declined to the lowest level ever recorded, " the authors write. " The 2005

licensure of the hepatitis A vaccine for use in younger children (aged >12

months) and the 2006 ACIP guideline for routine hepatitis A vaccination of

all children aged >12 months should result in improved vaccination coverage

and further reductions in disease incidence. "

An accompanying editorial notes that the decreased incidence of acute HAV

infections was especially apparent among racial/ethnic groups

disproportionately affected by hepatitis A, suggesting progress toward

eliminating racial/ethnic disparities previously observed in rates of acute

hepatitis A.

Limitations of the findings in this report include reliance on a telephone

survey and on provider-verified vaccination histories, children older than

24 to 35 months might have greater hepatitis A vaccination coverage, and

changes in vaccination coverage levels from 2004 to 2005 might be

underestimated because the sampled birth cohorts overlap.

" In August 2005, hepatitis A vaccine was licensed by the Food and Drug

Administration for use in younger children (aged >12 months), " an editorial

note concludes. " In 2006, ACIP recommended routine vaccination of all

children aged >12 months regardless of risk category or geographic location.

This recommendation should decrease hepatitis A incidence in states where

vaccination was not recommended previously and should sustain reductions in

places where hepatitis A vaccination has been recommended since 1999. "

MMWR Morb Mortal Wkly Rep. 2007;56(27):678–681.

http://www.medscape.com/viewarticle/559787?sssdmh=dm1.286634 & src=nldne

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