What are the new Hepatitis A immunization recommendations for the United States?

Hepatitis A is a vaccine-preventable disease typically acquired through fecal-oral transmission ¹⁰. While infection rates dropped significantly after pediatric vaccines were introduced, a major shift has occurred since 2016. Outbreaks have moved from contaminated food to large community spread driven by person-to-person transmission ¹⁰. This change has led to new immunization recommendations that prioritize vaccinating adults who are at higher risk of exposure or infection ².

What the research says

Since 2016, hepatitis A outbreaks have been reported in 37 states, involving tens of thousands of cases and hundreds of deaths ¹⁰. Research indicates that most infections now occur among persons reporting injection or noninjection drug use or experiencing homelessness ¹⁰. Consequently, the new recommendations specifically target these groups for vaccination ².

The epidemiology of the virus has changed from point-source outbreaks to large community outbreaks associated with person-to-person transmission ¹⁰. Because children can be important in transmission through unrecognized or asymptomatic infection, monitoring incidence rates remains critical ¹¹. However, the current strategy emphasizes vaccinating adults living in areas with consistently elevated rates or those with specific risk factors ¹¹.

Preventive vaccines for hepatitis A are recommended for women who are at risk of acquisition, including during pregnancy ⁹. The most effective means to prevent and control these outbreaks is through hepatitis A vaccination ¹⁰. This approach addresses the reality that the virus is excreted in high concentrations in stool, making the fecal-oral route the principal mode of transmission ¹¹.

What to ask your doctor

• Am I at risk for hepatitis A based on my travel history, food preferences, or sexual contacts?
• Should I get the hepatitis A vaccine if I use drugs or experience homelessness?
• Is the hepatitis A vaccine safe for me if I am pregnant or have chronic liver disease?
• What are the signs of hepatitis A I should watch for, such as fatigue or jaundice?