SchoolNurse.com:Hepatitis A Vaccination

Infection with hepatitis A virus (HAV) is a reportable illness in all 50 states. It is one of the most reported vaccine-preventable illnesses and is a major public health problem. Hepatitis A can produce either asymptomatic or symptomatic infection. The incubation period is 28 days and usually lasts less than 2 months. Illness is marked by a sudden onset of fever, malaise, nausea, anorexia, abdominal discomfort, jaundice, and dark urine.

Though not usually life threatening to children, an estimated 100 deaths annually are attributed to acute liver failure due to hepatitis A in adults.   Among adults, 70% develop jaundice. In contrast, most infections in children under age 6 have no symptoms.

HAV is transmitted primarily from fecal-oral route by either person-to-person contact or ingestion of fecally-contaminated food or water. Transmission by saliva has not been demonstrated. To inactivate HAV, heat foods to >185?F for 1 minute or disinfect surfaces with 1:100 dilution of bleach in tap water.

Vaccination against HAV is recommended for those at high risk. Persons traveling in areas with high HAV rates are at 44 times increased risk. Male-male sex and anal-oral sexual partners, IV drug users, and non-IV illicit drug users are also at increased risk.   Children living in states with double the national average HAV incidence rate are considered to be at high risk and should be vaccinated.   These states include Alaska, Arizona, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah, and Washington. Vaccine should be considered among children in areas with rates greater than the national average but less than twice the national average. These states include Arkansas, Colorado, Missouri, Montana, Texas, and Wyoming. Inactivated hepatitis A vaccines are highly immunogenic and clinically effective in children 2 to 18 years and in adults (94% to 100% efficacy).

(Brown R, Cable K. Journal of Family Practice 2005;54(7):624 -- H.T.