ACIP updates hepatitis A vaccination recommendation for contacts of international adoptees

Members of the Advisory Committee on Immunization Practices have updated the current hepatitis A vaccination recommendation for close contacts of international adoptees to now include unvaccinated, non-traveling people “who anticipate close contact with an international adoptee during the first 60 days following arrival, when the adoptee is from a country of high or intermediate endemicity.”

The ACIP said that optimally, the first dose of hepatitis A vaccine will be administered at least two weeks prior to the arrival of the adoptee.

“International adoption as a source for infection with hepatitis A is underestimated because hepatitis A associated with international adoptees is underreported,” Sandra Chaves, MD, of the division of viral hepatitis at the CDC, said during the ACIP meeting. “A significant amount of cases are underreported and the current hepatitis A surveillance system does not capture international adoption as risk factors.”

Chaves said about 18,000 internationally adopted children arrive in the United States each year. Based upon 2006-2008 data on anti-HAV IgM testing, it is estimated that about 1% to 6% of these children have hepatitis A upon arrival, and 70% of these children present without jaundice.

“The risk for infection may vary by age and by country of origin though it will be very difficult to predict the risk ... we assumed that 18,000 children will arrive each year from endemic countries and each adoptee has at least seven close household contacts that are at high risk for hepatitis A,” Chaves said. “Death and hospitalization due to hepatitis A is more likely to occur among infected adults — about 60% of adults aged 20 years to 59 years are susceptible to hepatitis A, and this is the age group that is most likely to be adoptive parents.” – by Jennifer Southall

For more information:

Chaves S. Hepatitis A vaccination among contacts of internationally adopted children. Presented at: the ACIP meeting; Feb. 25-26, 2009; Atlanta.