ACIP: Hepatitis A Vaccine for All

[Guest guest]

A disease that is rarely a problem - 70% of kids who get hepatitis A are

asymptomatic (no symptoms)

From the Merck Manual, vaccine manufacturer itself:

Hepatitis A spreads primarily by fecal-oral contact; blood and secretions may

also be infectious. Fecal shedding of the virus occurs during the incubation

period and usually ceases a few days after symptoms begin; thus, infectivity

often has already ceased when hepatitis A is diagnosed. Waterborne and

foodborne epidemics occur, especially in underdeveloped countries. Eating

contaminated raw shellfish is sometimes responsible. Sporadic cases are also

common, usually as a result of person-to-person contact. Most infections are

subclinical or unrecognized, and population surveys of anti-HA have revealed

remarkably widespread exposure that varies with age, socioeconomic class,

geography, and other factors. In some countries, > 75% of adults have been

exposed.

Hepatitis usually resolves spontaneously after 4 to 8 wk. A favorable

prognosis is less certain in Hepatitis B than in Hepatitis A infection,

especially in the elderly and after transfusion, when mortality (for HepA)may

reach 10 to 15%. Except for rare fulminant cases, hepatitis A invariably

resolves, although early recrudescences occasionally occur; progressive

chronic disease or cirrhosis does not develop.

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http://www.pediatricnews.com/article/PIIS0031398X05706871/fulltext

Volume 39, Issue 11, Pages 1-8 (November 2005)

ACIP: Hepatitis A Vaccine for All

NANCY WALSH (New York Bureau)

Article Outline

• Copyright

ATLANTA — All children should receive hepatitis A vaccine beginning at age

12–23 months, and the vaccine should be integrated into the routine

childhood immunization schedule, the Centers for Disease Control and

Prevention's Advisory Committee on Immunization Practices voted at its fall

meeting.

In voting for inclusion in the routine childhood immunization schedule, the

committee specified that all children in a single age cohort should be

given the vaccine, and that those who are not vaccinated at 1–2 years can

be vaccinated at subsequent visits during the preschool years.

ACIP's recommendation for nationwide use of the hepatitis A vaccine—which

does not become official until approved and published by the CDC—reflects

both the success of the vaccine and the limitations of current practice.

When it was licensed in 1995, the vaccine initially was recommended for use

in areas with high rates of hepatitis A. Currently, it is being routinely

given to children in 17 states, according to Beth Bell, M.D., of the CDC's

division of viral hepatitis.

Overall rates of hepatitis A have been falling, primarily because of a

precipitous decline in areas where the vaccine has been used.

“The overall rate of 1.9 cases per 100,000 is certainly the lowest rate

since we've been measuring,” she said.

But this policy of selective vaccination of children is no longer

sustainable because, in an epidemiologic reversal, the highest rates of

hepatitis A are now being seen in what were formerly considered

low-incidence communities, according to committee member A. Lieu,

M.D., of Harvard Pilgrim Health Care and Harvard Medical School, Boston.

“Our recommendation for vaccination in high-incidence states was an interim

step, and our intention has always been to implement hepatitis A

vaccination nationwide,” Dr. Lieu said.

Aside from the geographic shift in incidence rates, reasons why selective

vaccinations can no longer be considered sustainable are that racial

disparities exist and that without universal vaccination, models predict

that the incidence of hepatitis A will once again increase. The highest

rates now are among Hispanic children in areas not using the vaccine, Dr.

Lieu said.

Recent approval of the vaccine for use among 1-year-olds provides a further

impetus for changing the recommendations at this time.

Currently, 5,000–7,000 cases of symptomatic hepatitis A cases are reported

each year, and an estimated 20,000–30,000 cases occur nationwide.

Usage of the vaccine today prevents 81,000 cases annually. Nationwide use

with vaccination at 1 year would prevent 180,000 cases of disease,

according to Dr. Lieu.

And while the $22 million annual direct costs of vaccination under the

status quo would increase to $134 million, the cost-effectiveness ratio is

still “very reasonable,” she said.

A further question on epidemiology was raised by Temte, M.D., who

is liaison representative to ACIP from the American Academy of Family

Physicians. “How many of the adult cases are due to transmission from

children?” asked Dr. Temte of the department of family medicine at the

University of Wisconsin Medical School, Madison.

“We have indirect evidence that a lot of adult cases are due to

transmission from children,” said the CDC's Dr. Bell.

Those areas of the country where children have been immunized have seen

enormous declines in cases among adults as well, Dr. Bell said.

“And a large part of what I think of as a child-driven disease that

affected both children and adults in communitywide outbreaks we don't see

in that part of the country anymore. There's little reason not to assume

that we would see similar benefits by herd immunity in unvaccinated areas

of the country.”

Two vaccines now are approved for use in children 1 year and older, Havrix

(GlaxoKline) and Vaqta (Merck). A minimum interval of 6 months between

doses is recommended.

PII: S0031-398X(05)70687-1

doi:10.1016/S0031-398X(05)70687-1

© 2005 Elsevier Inc.. All rights reserved.

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Sheri Nakken, R.N., MA, Classical Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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OR LEGAL ADVICE. THE DECISION TO VACCINATE IS YOURS AND YOURS ALONE.

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Doctors destroy health, lawyers destroy justice, universities destroy

knowledge, governments destroy freedom, the major media destroy information

and religions destroy spirituality " .... Ellner