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US considers routine childhood hepatitis A vaccination in high risk states

BMJ 1999; 318 doi: (Published 06 March 1999) Cite this as: BMJ 1999;318:626
  1. James Ciment
  1. New York

    Routine vaccination against hepatitis A for US children in 14 states with a high risk—largely in the western United States—has been recommended by the advisory committee on immunisation at the Centers for Disease Control (CDC) in Atlanta.

    Vaccination has been recommended for all states where the rate of hepatitis infection exceeds 20 cases in every 100 000 persons, which is roughly twice the national average. Last year, nearly 200 000 Americans developed the disease, including about 60 000 children aged under 15 years. In rare cases, the disease can be fatal. The CDC estimates that hepatitis A costs the country about $450m (£282m) annually in treatment costs and lost productivity.

    Currently, no state offers routine hepatitis A vaccinations for children. This is in part because of cost—estimated at about $90 per adult and $50 per child—and the public antipathy to mass vaccinations. In addition, there is concern that greater use of vaccine may increase the prevalence of vaccine resistant forms.

    The chair of the Hepatitis Foundation International (which is based in Cedar Grove, New Jersey), Thelma King Thiel, dismissed these concerns. She argued: “Vaccinating children against hepatitis A is one of the most … cost effective strategies for building long term immunity against hepatitis A and preventing further spread of the disease.” She highlighted the particular importance of vaccinating children, as some do not have symptoms and thus can transmit the disease unwittingly.

    Of the 14 states involved, only New Mexico has responded to the CDC, saying that it will continue its policy of vaccinations in “hot spot” areas only.

    Charlis Thompson, a spokesperson for the CDC, pointed out that the independent committee's report is not an official recommendation of the CDC. “The advisory board meets periodically and makes recommendation, and we [the CDC] review them before making official recommendations,” she said.