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Hepatitis A Vaccines for Children Recommended

November 3, 2005 -- A panel has recommended immunizing toddlers with hepatitis A vaccine and adults with booster shots of whooping cough (pertussis) vaccine according to a report in the New York Times online on 27 October 2005.

The panel, called the Advisory Committee on Immunization Practices, unanimously made its recommendations to the federal Centers for Disease Control and Prevention (CDC) on 26 October.

Recommendations included the following:

  • The vaccine for hepatitis A, a highly contagious, rarely fatal liver disease, "should be integrated into the routine childhood vaccination schedule" and given at age 1-2 years, according to the panel.
  • A booster shot of against pertussis should be given to adults aged 19-65 years, 10 years after their last pertussis shot.

Researchers suggest adults receive the pertussis booster at the same time as they receive their booster against tetanus and diphtheria, as Adacel -a newly licensed vaccine by Sanofi Pasteur - offers protection against all three diseases, according to the New York Times report.

Effects of the Recommendation

The CDC and various professional groups usually adopt the recommendations of this panel, and doctors usually follow them, although the recommendations are not binding. Adverse reactions to the whooping cough vaccine are reportedly rare.

Basing their estimates on disease-center statistics, the panel predicted that routine hepatitis A immunization would prevent up to 180,000 infections and 30,000 illnesses each year among children and adults, thus advancing the goal of eliminating the hepatitis A from the US population.

The two-fold goal of each vaccine is 1) to protect the recipient from illness and 2) to prevent transmission of infection to other people. More specifically, the pertussis booster is intended to reduce the likelihood of contagion from adults to infants who are either too young for immunization or who are still incompletely immunized. Whooping cough can be fatal in infants.

According to the panel, current whooping-cough vaccine recommendations for children remain unchanged. Children currently receive a series of five vaccinations, starting at age two months and continuing until preschool.

"By protecting personal and public health, they are vaccines at their best," Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University, said in an interview, according to the New York Times. Dr. Schaffner represented the National Foundation for Infectious Diseases and the Infectious Diseases Society of America at the meeting.

The incidence of whooping cough has steadily declined for many years in the United States. However, decreasing immunity is being blamed for recent outbreaks in schools. Moreover, many adults who have developed whooping cough have suffered rib fractures leading to life-threatening conditions such as a collapsed lung, and severe coughing may last for months in adults, according to the New York Times.

Current Statistics

Currently, about 65% of younger adults receive the tetanus-diphtheria boosters. Among middle-aged adults the figure is 50% and among adults aged 65 years and older, 35%. Adults often receive boosters after getting cuts on rusty metal or other wounds.

Hepatitis A infects approximately 180,000 people annually, and up to 30,000 of these infections lead to illnesses such as nausea, vomiting, jaundice and fever. Other people who are infected may not exhibit recognizable symptoms, but are still able to transmit the virus to others.

The hepatitis A vaccine received its first license in 1995, and the US Food and Drug Administration has since approved two versions for children aged one year.

In support of their recommendation that toddlers receive hepatitis A shots, the panel cited the success of a vaccination program in 17 states that had previously had a high incidence of hepatitis A: Alaska, Arizona, Arkansas, California, Colorado, Idaho, Missouri, Montana, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington and Wyoming.

Since the hepatitis A vaccine program started, the incidence of hepatitis A in the 17 states has decreased to levels below those in what are considered low-incidence states, according to the New York Times. In 1999, two-thirds of hepatitis A cases occurred in the 17 high-incidence states, compared with one-third of cases now.

However, the policy of recommending immunizations only in certain states may no longer be sustainable, according to Dr. Tracy Lieu, a panel member from Harvard Pilgrim Health Care in Boston. Because hepatitis A has declined so much in those states, "the rationale for continued vaccination does not make sense to people. Anecdotal evidence suggests that states may lose support for continued vaccination."

According to computer models, the incidence of hepatitis A will increase if all children are not immunized, said Dr. Lieu. Children are instrumental in hepatitis A virus transmission, and the virus can also spread through contaminated food and water.

In addition to recommending hepatitis A vaccines for younger children, the panel recommended that older, unvaccinated children receive hepatitis the A vaccine in a "catch-up" plan.

Panel Recommends Hepatitis A Vaccine for Children and Whooping Cough Shots for Adults, New York Times Online, 27 October 2005.

Posted: November 2005