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Advisory committee revises hepatitis A vaccine guidance

With a unanimous vote, the Advisory Committee on Immunization Practices is recommending that anyone over the age of 12 months, who hasn’t been vaccinated for hepatitis A, should receive the vaccine after the fact if they are exposed to the highly contagious virus.

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Post-exposure immune globulin should be administered to unvaccinated adults aged 40 and older depending on their doctors’ risk assessments, according to the recommendation from the committee that advises federal agencies. The Secretary of the Department of Health and Human Services appoints the committee members. They provide recommendations for the department and the Centers for Disease Control and Prevention.

Hepatitis A infections can be contracted in a variety of ways, including close personal contact with an infected person, sharing needles, and the consumption of contaminated food or beverages. The virus can survive in frozen food for long periods of time.

The committee considered two questions this past week regarding hepatitis A vaccines. One question regarded post-exposure hepatitis A vaccines for people 12 months and older. The other concerned hepatitis A vaccines in infants ages 6 to 11 months who are traveling outside of the U.S.

Both questions earned unanimous approval with 14-0 votes. Much of the committee’s discussion focused on the ongoing hepatitis A outbreak, including foodborne cases, in several states. More than 1,200 people have been infected, with almost 50 deaths reported in the current outbreak. The majority of infected people are homeless, substance abusers, or both. However, depending on the state, 20 percent to 30 percent of cases are neither homeless nor substance abusers.

The committee recommended that infants ages 6 to 11 months who are traveling internationally should receive a dose of hepatitis A vaccine. Committee members noted that immune globulin cannot be given with the measles, mumps, and rubella (MMR) vaccine.

The new guidance recommends that infants ages 6 to 11 months who are not traveling outside the U.S. should receive the two-dose series of MMR and hepatitis A vaccines at ages 12 months or older.

Foodborne threat
Food and food handlers, servers and other foodservice workers can spread the hepatitis A virus.

In 2016 almost 150 people in nine states developed confirmed cases of hepatitis A infection traced to frozen strawberries from Egypt that were used in beverages served at Tropical Smoothie restaurants.

Also in 2016, a hepatitis A outbreak traced to frozen, imported scallops sickened 292 people, mostly in Hawaii. Two victims died.

The CDC reports there were more than 90 hepatitis outbreaks from 1998-2016 in the United States.

Advisory committee recommendations are not considered final until they are published in the CDC’s Morbidity and Mortality Weekly Report.

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