Hepatitis A Vaccination Rates in Children by ACIP Recommendation Status, 2006 and 2007
Check with your doctor about Hepatitis A vaccine for your toddler age 12 months or older.
Hepatitis A virus typically has an abrupt onset that can include fever, malaise, lack of appetite, nausea, abdominal discomfort, dark urine, and jaundice. The likelihood of having symptoms of the disease increases with age. More than 90% of infections among children (0–4 years) are non-jaundiced; this drops to 10%-20% in adults (18 years and older). (1) Children are a major source of infection, and non-jaundice hepatitis A virus infected children can transmit the virus to others. The severity of hepatitis A infection increases with age. Among adults > 50 years of age, the chances of disease resulting in death is three times higher than among those < 50 and is also higher among persons with chronic liver disease who are at increased risk for acute liver failure (2).
Since 2005 the Advisory Council on Immunization Practices (ACIP) has recommended vaccination with two doses of of hepatitis A vaccine for all children age one and older. The age recommendation was updated from children ≥ 24 months of age to children ≥ 12 months of age because of vaccine licensing developments, which included children age 12–23 months. (4) Distinct from other childhood vaccine recommendations, since 1996 hepatitis A vaccination recommendations were geographic, based on the severity of disease in a particular area of the country. (2) Now the vaccine recommendation is the same for all children regardless of where they live. The 2005 recommendation was updated because regional differences in disease were no longer significant. (3) The age recommendation was updated because of vaccine licensing developments.
Based on National Immunization Survey (NIS) data for 2006 and 2007, (5) estimated national hepatitis A vaccination coverage levels among children aged 24–35 months who received at least 1 dose of hepatitis A vaccine increased from 26.3% in 2006 to 47.4% in 2007. (6)
The largest increase in vaccination coverage (from 7.2% to 32.7%) was observed in states (33 states plus the District of Columbia) where the vaccine had not been recommended previously. Vaccination coverage also increased (from 62.8% to 74.1%) in the 11 states where the vaccine had been recommended since 1999 and increased (from 48.8% to 66.6%) in 6 other states where the vaccine had been recommended since 1999 for children aged ≥ 24 months. (8) The estimated 21.1% increase in 2007 (from 26.3% to 47.4%) in one dose hepatitis A vaccination coverage among children age 24–35 months occurred among the 33 states with no previous hepatitis A recommendation. (5)
These increases resulted in large part from the 2006 ACIP recommendations that expanded hepatitis A vaccination to include all children ≥ 12 months. (5). The percentage of children following the American Academy of Pediatrics well-child visit recommendations has been found substantially higher among infants and children aged <24 months, when well-child visits are more frequent, than children aged ≥ 24 months, when such visits occur annually (7).
Incorporating the hepatitis A vaccine into the routine early childhood schedule was an important strategy to improve vaccination coverage. (6)
The number of cases and rates of acute hepatitis A in the United States have declined substantially compared to the pre-vaccination era. In 2007, a total of 2,979 acute symptomatic cases of hepatitis A were reported, the lowest national incidence (1.0 per 100,000 population) ever recorded. However, hepatitis A vaccination rates remained below levels observed for other vaccines in the childhood immunization schedule. (9)
The 2006–2007 NIS data for 1-dose coverage of hepatitis A vaccine provides some insight into the impact of expanding the recommendation to include 2 doses of hepatitis A vaccine for all children ≥ 12 months of age. (10)
The 2008 NIS data were released in August 2009. A majority (96%) of the children included in the 2008 survey were under 12 months of age in May 2006 when the ACIP 2005 revised recommendations were published. Thus, the 2008 survey was the first time vaccination coverage for 2 or more doses of hepatitis A vaccine among children 19–35 months of age was reported. (8) National coverage for ≥ 2 doses of hepatitis A vaccine was 40.4%. (10)
References:
- CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996;45(No. RR-15).
- CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-12).
- CDC. Surveillance for acute viral hepatitis---United States, 2006. MMWR 2008;57(No. SS-2).
- CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;55(No. RR-7).
- CDC. National Immunization Survey, 2004-2008.
- Smith JPG, Hoagland DC, Battalion MP, Hare M, Barker LE. Statistical methodology of the National Immunization Survey, 1994--2002. Vital Health Stat 2 2005(138).
- Selden TM. Compliance with well-child visit recommendations: evidence from the Medical Expenditure Panel Survey, 2000--2002. Pediatrics 2006;118:e1766--78.
- CDC. Surveillance for acute viral hepatitis---United States, 2007. MMWR 2009;58(No. SS-3).
- CDC. Hepatitis A vaccination coverage among children aged 24--35 months---United States, 2006 and 2007. MMWR 2009;58:689--94.
- CDC. Prevention of hepatitis A through active or passive immunization: recommendation of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;55(No. RR-7).
Data Source:
CDC. Hepatitis A Vaccination Coverage Among Children Aged 24--35 Months --- United States, 2006 and 2007. MMWR 58(25);689-694.
CDC. National, State, and Local Area Vaccination Coverage among Children Aged 19—35 months — United States, 2008. MMWR;58(33):921-6.
