VHPB consensus statement on the control of hepatitis A. (December 1999)

Source : Viral Hepatitis 8.1 (see publications)

• Hygiene and adequate sanitary measures are the most important tools to prevent the spread of hepatitis A.
• The decision whether to adopt a routine hepatitis A vaccination of children should take into consideration:
  • prevalence and incidence of hepatitis A cases
  • frequency of outbreaks
  • health impact of hepatitis A compared to other health priorities
  • programmatic feasibility of a HA vaccination programme
  • economic evaluation of the different HA prevention strategies.
• Universal hepatitis A childhood vaccination should be considered in communities with repeated outbreaks or where the hepatitis A incidence rate is substantially higher than in the overall country.
• If implementation of effective hygiene measures is not achievable, hepatitis A vaccination can be effective and should be considered in controlling an outbreak in small, self-contained communities if :
  • vaccination can be started early in the outbreak
  • high coverage levels in the target population can be achieved
  • multiple age cohorts are vaccinated.

  The vaccination efforts should preferably focus on children. The upper age limit, however, will be determined by the local epidemiology.

• Universal HA childhood vaccination programmes that are currently implemented in some regions of European countries should be followed up and evaluated.
• The VHPB endorses HA vaccination for :
  • Travellers (born in low endemic countries) visiting high endemic countries, including people who travel frequently as part of their occupation.
  • Children of immigrant parents, born in Western Europe (low endemicity) visiting their parents' country of origin (high endemicity).
• Hepatitis A vaccination is recommended for persons at increased risk for hepatitis A or an adverse disease outcome, such as men who have sex with men, intravenous drug users, staff and residents in institutions for the mentally retarded, persons with chronic liver disease (regardless of its aetiology), and haemophiliacs.
• Further studies are needed to document the occupational risk of hepatitis A for health care workers.
• Post-exposure prophylaxis for hepatitis A :
  • IgG are still very effective for post-exposure prophylaxis.
  • The effectiveness of HA vaccine compared to IgG has not yet been evaluated.
  • In countries where IgG are not routinely used after exposure or where IgG is unavailable, administration of hepatitis A vaccine can be considered and is likely to provide protection.