Epidemiology

Hepatitis A vaccine advised for contacts of some adopted children

Last Updated: 2009-09-17 17:55:11 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The Advisory Committee on Immunization Practices (ACIP) is recommending hepatitis A vaccination for close personal contacts of children who have been adopted from countries with high or intermediate rates of the disease.

The new recommendation, which was first issued earlier this year, complements prior ACIP recommendations that hepatitis A vaccine be given to persons traveling from the US to countries with high or intermediate rates of hepatitis A and that contacts of persons with the disease should receive postexposure prophylaxis.

The details of the updated recommendation appear in the Morbidity and Mortality Weekly Report for September 18.

"In making its recommendation, ACIP considered the likelihood that a child adopted by parents in the US might be actively infected with hepatitis A virus and shedding virus at the time of adoption," according to the report. The report goes on to note that roughly 99.8% of adopted children come from countries with high or intermediate hepatitis A endemicity, including Guatemala, China, Russia and Ethiopia.

The new recommendation applies only to persons who have not previously received the hepatitis A vaccine and are close contacts of the adopted child, such as household member or regular babysitter.

The hepatitis A vaccine is to be given in two doses, with the first administered when the adoption is planned, ideally at least 2 weeks before contact with the adoptee. The second dose should be given 6 to 18 months later.

The ACIP estimates the risk for hepatitis A in this situation to be 106 per 100,000 household contacts of international adoptees within 60 days of their arrival in the US. By comparison, according to the report, the estimated rate of symptomatic hepatitis A in the general US population in 2007 was 1 per 100,000 population.

MMWR 2009;58:1006-1007.