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CDC Letter – Updated Recommendations for Hepatitis A Vaccinations

In this letter from the CDC, the agency encourages public health professionals to review new and updated hepatitis A vaccine recommendations.

The below message was sent by the Centers for Disease Control (CDC) to partners regarding updates to hepatitis A vaccination recommendations:

July 6, 2020

Dear Public Health Professionals,

Recently, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) published in CDC’s MMWR, Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. Hepatitis A vaccines were first recommended by ACIP in 1996 for children who lived in communities with a high rate of hepatitis A virus (HAV) infection, populations at increased risk of HAV infection or adverse consequences of infection, and in outbreak settings. In 2006, ACIP expanded the hepatitis A vaccine recommendations to include routine hepatitis A vaccination of all children aged 12–23 months. The new ACIP recommendations are the first full update in 14 years and expands the recommendations further to include more age groups and populations. Health care providers can use these recommendations to update their current practice for providing hepatitis A vaccines for the prevention of HAV infection in the United States.

The hepatitis A virus (HAV) is most frequently transmitted via the fecal-oral route, usually through direct person-to-person contact or consumption of contaminated food or water. Illness is usually mild and self-limited when healthy persons are infected; however, disease severity increases in persons who are older or immunocompromised, have chronic liver disease, or have other underlying health conditions.

A 95% decrease in reported hepatitis A cases was reported during 1996–2011 after the recommendation for the hepatitis A vaccine was implemented and followed. Small increases in cases occurred in 2013 and 2016, attributed to foodborne outbreaks associated with contaminated food. However, beginning in 2016, the number of reported cases across the United States increased dramatically, primarily from ongoing multistate outbreaks of hepatitis A associated with person-to-person transmission, causing a sharp increase in cases from 2,007 (incidence 0.62) in 2016 to 12,474 (incidence: 3.81) in 2018. Increases continue today because of low adult hepatitis A vaccination coverage and high population susceptibility to HAV infection. Therefore, implementation of the new hepatitis A recommendations, in addition to continued implementation of previous recommendations targeting populations at highest risk for HAV infection (e.g., persons who use drugs, persons experiencing homelessness, and men who have sex with men), is critical to decrease HAV incidence and prevent future outbreaks.

The new and updated ACIP recommendations include, but are not limited to:

  • Vaccination during hepatitis A outbreaks of persons aged ≥1 year who are at risk for HAV infection or who are at risk for severe disease from HAV
  • Vaccination in settings providing services to adults in which a high proportion of persons have risk factors for HAV infection (e.g., health care settings with a focus on those who use injection or non-injection drugs, group homes, and nonresidential day care facilities for developmentally disabled persons)
  • Vaccination of all children and adolescents aged 2–18 years who have not previously received hepatitis A vaccine (catch-up vaccination)
  • Vaccination of all persons aged ≥1 year infected with human immunodeficiency virus (HIV)
  • Vaccination of pregnant women who are identified to be at risk for HAV infection during pregnancy or for having a severe outcome from HAV infection

We encourage you to review and share these vaccine recommendations with your colleagues.


Carolyn Wester, MD
Division of Viral Hepatitis
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Centers for Disease Control and Prevention

/Melinda Wharton/
Melinda Wharton MD, MPH
Director, Immunization Services Division
National Center for Immunization and Respiratory Disease
Centers for Disease Control and Prevention 

Posted In: 
Prevention and Wellness
Public Health and Safety
Tagged: Hepatitis A