TABLE 4. Recommendations for hepatitis A postexposure prophylaxis and pre-exposure protection, by age group and risk category — Advisory Committee on Immunization Practices, 2020.
| Indication and age group | Risk category and health status | Hepatitis A vaccine | IG* |
|---|---|---|---|
|
Postexposure prophylaxis
| |||
| 0–11
mos |
Healthy |
No |
0.1 mL/kg body
weight |
| 12 mos to 40
yrs |
Healthy |
1
dose† |
None |
| >40
yrs |
Healthy |
1
dose† |
0.1 mL/kg body
weight§ |
| ≥12
mos |
Immunocompromised or chronic
liver disease |
1
dose† |
0.1 mL/kg body
weight¶ |
| ≥12
mos |
Vaccine
contraindicated** |
No |
0.1 mL/kg body
weight |
|
Pre-exposure protection (e.g.,
travel)††
| |||
| <6
mos |
Healthy |
No |
0.1–0.2 mL/kg body
weight§§ |
| 6–11
mos |
Healthy |
1
dose¶¶ |
None |
| 12 mos to 40
yrs |
Healthy |
1 dose*** |
None |
| >40
yrs |
Healthy |
1 dose*** |
0.1–0.2 mL/kg body
weight§§,††† |
| >6
mos |
Immunocompromised or chronic
liver disease |
1 dose*** |
0.1–0.2 mL/kg body
weight§§,††† |
| >6 mos | Persons who elect not to receive vaccine or for whom vaccine is contraindicated** | No | 0.1–0.2 mL/kg body weight§§ |
Source: Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020;69(No. RR-5).
Abbreviations: HAV = hepatitis A virus; IG = immune globulin.
* Measles, mumps, and rubella vaccine should not be administered for ≥2 weeks before and 6 months after administration of IG.
† A second dose of hepatitis A vaccine is not required for postexposure prophylaxis; however, for long-term immunity, the vaccination series should be completed with a second dose ≥6 months after the first dose.
§ The provider’s risk assessment should determine the need for IG administration. If the provider’s risk assessment determines that both vaccine and IG are warranted, hepatitis A vaccine and IG should be administered simultaneously at different anatomic sites (e.g., separate limbs).
¶ Vaccine and IG should be administered simultaneously at different anatomic sites (e.g., separate limbs).
** Life-threatening allergic reaction to a previous dose of hepatitis A vaccine or allergy to any vaccine component.
†† IG should be considered before travel for persons with special risk factors for either HAV infection or severe disease from HAV infection.
§§ 0.1 mL/kg body weight for travel ≤1 month; 0.2 mL/kg body weight for travel ≤2 months; 0.2 mL/kg every 2 months for travel of ≥2 months’ duration.
¶¶ This dose should not be counted toward the routine 2-dose series, which should be initiated at age 12 months.
*** For persons not previously vaccinated with hepatitis A vaccine, administer dose as soon as travel is considered and complete the series according to routine schedule if the next dose is needed before travel.
††† Can be administered on the basis of the provider’s risk assessment.