Childhood Hepatitis A vaccination

In honor of the one-year anniversary of an advisory body to the Centers for Disease Control and Prevention’s (CDC) landmark recommendation encouraging states with high incidence rates of hepatitis A to implement routine vaccination programs for children, today the Hepatitis Foundation International (HFI) issued a report card grading the progress made by each of the 17 high endemic states. In addition to the CDC, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend routine hepatitis A vaccination for children residing in high endemic areas and have recently included hepatitis A vaccination for children in their 2000 immunization schedules. These recommendations were developed in response to the continuing high rates of hepatitis A in the United States and the frequency of community-wide outbreaks.

Together, these high incidence states contain only 22 percent of the United States population but account for 50 percent of reported hepatitis A cases. Hepatitis A is a significant drain on the United States economy, costing more than $450 million annually. Experts consider routine vaccination programs for children a cost-effective way to reduce the spread of the disease and, in turn, decrease an unnecessary economic burden.

“The most effective way to ensure protection against hepatitis A, a disease that is passed with frequency and increased severity from child to adult, is through vaccination,” said Thelma King Thiel, chairman and CEO of Hepatitis Foundation International. “We strongly encourage all of the high incidence states to abide by the recommendations of the CDC, AAP and AAFP to protect children from this serious, debilitating disease.”

CDC’s ACIP Recommendations: Encouraging Step Towards Reducing Spread of Hepatitis A

CDC’s Advisory Committee on Immunization Practices (ACIP) recommended that states where the average annual hepatitis A rate during 1987 to 1997 was at least twice the national average hepatitis A incidence rate — or 20 cases out of every 100,000 people — implement routine hepatitis A vaccination programs for children. Eleven states fall under this category: Arizona, Alaska, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah and Washington. ACIP also recommended routine hepatitis A vaccination in counties or communities in any state where the average hepatitis A rate during 1987 to 1997 was at least 20 per 100,000.

ACIP also stated that routine hepatitis A vaccination for children should be considered in states where the average annual hepatitis rate during that 10-year period was at least 10 per 100,000 people but less than 20 out of 100,000. These six states include: Arkansas, Colorado, Missouri, Montana, Texas and Wyoming. In addition, counties or communities in any state with hepatitis A rates between 10 per 100,000 and 20 out of 100,000 should also consider routine vaccination.

“In order to achieve a significant and lasting reduction in hepatitis A incidence across the country, we must implement widespread, routine childhood immunization particularly in high incidence states,” said William Schaffner, M.D., member of the CDC’s ACIP working group and professor and chairman of the department of preventive medicine, Vanderbilt University Medical Center in Nashville, TN. “Through these efforts, we can interrupt the transmission of hepatitis A, potentially eliminating the disease from an entire state and eventually throughout the country.”

Report Card Tracks Progress in Putting Vaccination Programs Into Practice

Hepatitis Foundation International closely tracked the progress of the 17 high endemic states in implementing childhood hepatitis A vaccination programs since ACIP issued its recommendations in February 1999. The report card was based on the following criteria: a state received a grade of “A” if hepatitis A vaccination is required for school-age children (e.g., kindergarteners, first graders, seventh graders) statewide; a state received a “B” if school-age children residing in certain counties or communities are required to be vaccinated against hepatitis A or if it has targeted vaccination requirements against hepatitis A (e.g., for licensed daycare programs or pre-school); a state received a “C” if it has pending requirements for school-entry or targeted childhood vaccination programs; a state received a “D” if it has made minimal effort to conform to ACIP’s recommendations (i.e., established voluntary vaccination programs or vaccine advisory committees); a state received an “F” if it has not made any effort to conform to ACIP’s recommendations.

“Hepatitis Foundation International continues to encourage public health officials, state legislators and pediatricians to embrace these important recommendations and extend the reach of hepatitis A vaccination programs to protect at-risk children across the United States,” said Ms. Thiel.

Hepatitis A: A Serious Vaccine-Preventable Disease

Hepatitis A, which infects up to 200,000 Americans each year, is a highly contagious virus that attacks the liver. It is spread by the fecal-oral route through close person-to-person contact, or by ingesting contaminated food or water. Symptoms can be debilitating and include fever, fatigue, loss of appetite, nausea, abdominal discomfort, jaundice and dark urine. Infected individuals can unknowingly infect others 2 weeks prior to feeling ill themselves. Up to 22 percent of adult hepatitis A patients require hospitalization and approximately 100 people in this country die every year from the disease.

The highest incidence of hepatitis A is among children 5-14 years of age with almost 30 percent of reported cases occurring among children younger than 15 years of age. Children are at high risk because they often come into close contact with other children in school and daycare settings. In fact, approximately 15 percent of reported cases of hepatitis A occur among children or employees in daycare centers. Although hepatitis A infection in very young children can be mild or asymptomatic, the virus is easily transmitted to older children and adults who are likely to develop severe symptoms.

While scientists have identified at least five different hepatitis viruses, hepatitis A, B and C are the most common. Hepatitis A is mainly transmitted through the fecal-oral route, while hepatitis B and C are spread through blood or other body fluids. Hepatitis A and B are both preventable by vaccination. However, as each type of hepatitis is different, vaccination against hepatitis B does not prevent infection from hepatitis A. The hepatitis A vaccines have been approved by the FDA and have been on the market from 1995. They are considered safe and very effective (94% in clinical trials).

The Hepatitis Foundation International focuses exclusively on bringing viral hepatitis under control by supporting research to find cures; through education programs and materials to inform health professionals, patients and the public about new diagnostic and treatment methods; and by providing a support network for those who are infected with viral hepatitis. For more information on hepatitis A, visit the Hepatitis Foundation International website at or call the HFI hotline at: 800-891-0707.

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