CDC committee recommends routine hepatitis A vaccination in homeless

The CDC’s Advisory Committee on Immunization Practices voted unanimously today to add homelessness as an indication for routine inactivated 2-dose hepatitis A virus vaccination.

The vote came amid an ongoing multistate outbreak of HAV during which 10 states have reported more than 6,500 infections, 3,800 hospitalizations and 70 deaths associated with person-to-person transmission.

A large percentage of cases during the current multistate HAV outbreak have occurred among the homeless, including 40% of cases in an outbreak in San Diego and more than 10% of cases in outbreaks in Kentucky, Michigan, Tennessee and West Virginia. It is the first reported large outbreak of HAV among homeless persons in the United States.

The ACIP viral hepatitis working group that made the recommendation said it would “allow homeless to be vaccinated using the services and facilities that already provide established health care for the homeless population.” The group said the recommendation makes it more likely that HAV vaccination will be considered by these providers.

“The benefit that we achieve by vaccinating homeless individuals is significant and the cost and risk of vaccinating the homeless is much lower vs. not vaccinating these individuals,” said Mona Doshani, MD, MPH, from the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

According to the working group, an unpublished analysis of HAV cases reported between November 2016 to May 2018 in San Diego showed that homelessness was independently associated with two to three times higher odds of infection and two to four times higher odds of severe outcomes from HAV infection, specifically hospitalization and death.

The study also showed that more than 25% of homeless patients did not have an existing recommended indication for HAV vaccination. – by Gerard Gallagher

Disclosures: Doshani and the voting ACIP members report no relevant financial disclosures.