The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention has recommended that all children in the United States between the ages of 1 and 2 years receive a two dose vaccination against the hepatitis A virus.
Hepatitis A vaccines were first licensed in 1995. Since 1999 the government has recommended hepatitis A vaccinations for children in 17 states where rates of the disease were highest. But the success of these campaigns seems to have levelled off, and health officials fear rates might rebound.
About a quarter of hepatitis A cases occur in children, but many adults contract the disease from infected youngsters. The virus is sometimes caused by eating food contaminated with faeces. In 2003, nearly 600 people were sickened by hepatitis and three died in the nation's largest outbreak, caused by infected onions served at a Pennsylvania restaurant (BMJ 2003;327:1188).
An important contributing factor in the committee's recommendation was an economic analysis by RTI International, an independent non-profit research organisation, and the Centers for Disease Control and Prevention's division of viral hepatitis. The study indicated that expanding the vaccination programme would result in substantial reductions in disease at a cost that is in line with other vaccination programmes.
It is believed the new policy would prevent 100 000 hepatitis A virus infections and 20 deaths over the lifetimes of each group of children vaccinated. The direct costs of the vaccine programme, currently $22m (£13m; €19m) would increase to $134m a year, but because the new immunisation recommendation would prevent 90% of infections, the net cost of hepatitis A over the life of each group of children vaccinated would only increase by $45m.
“The study demonstrates that expanding the hepatitis A vaccination program nationwide will result in substantial health benefits at a reasonable cost,” said David Rein, the economic evaluations principal investigator for RTI International.
“Cost effectiveness studies allow us to estimate the relative value of a health policy. Nationwide vaccination for young children is a good value when compared to other recent vaccination recommendations.”
At the same time, the committee unanimously recommended that pertussis, or whooping cough, vaccine be added to the tetanus-diphtheria booster shot for adults. The action was an attempt to help prevent whooping cough deaths of infants who can catch it from adults who might not know they are infected.
Children are routinely vaccinated against whooping cough starting at 2 months, although the protectiveness wanes after five years. Although pertussis is now considered rare, with reports of it levelling off, there has been a rebound in this decade. About 26 000 cases were reported in 2004, up from fewer than 10 000 in 2000.