Speaking of Hepatitis, We Have 'A' Vaccine
Speaking of Hepatitis, We Have 'A' Vaccine
The major expressed barriers to hepatitis A vaccination are cost, fear, and durability of response.
Cost-effectiveness of childhood hepatitis A immunization. Several studies have evaluated the costs and benefits of potential immunization against HAV in healthy US children in regions with varying hepatitis A incidences. Nationally, vaccination prevents more than 75,000 cases of overt hepatitis A. Approximately two thirds of health benefits accrue to personal contacts rather than to vaccinees themselves. Childhood hepatitis A vaccination was viewed as being most cost-effective in areas with the highest incidence rates, but it also meets accepted standards of economic efficiency in most of the United States. These studies concluded that a national immunization policy prevents substantial morbidity and mortality, with cost-effectiveness similar to that of other childhood immunizations. However, physicians who provide vaccines to children and adolescents voice concerns. They report dissatisfaction with reimbursement levels and increasing financial strain from immunizations. Efforts to address the root causes of financial pressures should be undertaken. Continued partnerships among national, state, local, private, and public entities are needed to sustain current coverage levels and ensure that administration rates for the hepatitis A vaccine continue to increase for all children.
Fear of vaccines greater than fear of the disease. Because of the success of vaccines, most individuals today, thankfully, have no firsthand experience with devastating infectious illnesses. Therefore, concern about potential harmful effects of vaccines is one of the reasons for immunization noncompliance by parents and by individuals. Parents perceive that the most common vaccine-related harm is a child's pain from multiple injections. Concern has also been expressed about the potential for untoward effects. These fears have been documented to be largely unfounded. An Institute of Medicine committee found no evidence of major safety concerns associated with adherence to the recommended childhood vaccination schedule. Nonetheless, policies that mandate immunization remain somewhat controversial. A recent review critically examined the role of vaccine mandates and discussed ways that practitioners and public health officials might deal with vaccine refusal.
Durability of childhood HAV immunization. Data indicate that available hepatitis A vaccines are capable of providing protection for up to 15 years, as defined by currently accepted, conservative correlates of protection. One recent study documented protective hepatitis A antibody levels (anti-HAV ≥ 20 mIU/mL) in individuals aged 12-24 years who had been vaccinated with a 2-dose schedule in childhood. Another study similarly found that the seropositivity induced by hepatitis A vaccine given to children younger than 2 years persists for at least 10 years, regardless of the presence of maternal anti-HAV. These studies suggest that a booster dose is not needed at this time. Further monitoring is needed to continue to document the long-term protection afforded by HAV vaccines.
We have highly effective vaccines against hepatitis A that have clearly reduced the incidence of a disease that has been associated with high morbidity and, albeit uncommon, mortality. However, coverage must be maintained and broadened to further reduce the burden of disease and to prevent a resurgence of HAV infection, particularly in populations with lower vaccination coverage. Widespread education about the appropriate immunization strategies is needed.
"Knowing is not enough; we must apply. Willing is not enough; we must do." - Goethe
Barriers to Hepatitis A Vaccination
The major expressed barriers to hepatitis A vaccination are cost, fear, and durability of response.
Cost-effectiveness of childhood hepatitis A immunization. Several studies have evaluated the costs and benefits of potential immunization against HAV in healthy US children in regions with varying hepatitis A incidences. Nationally, vaccination prevents more than 75,000 cases of overt hepatitis A. Approximately two thirds of health benefits accrue to personal contacts rather than to vaccinees themselves. Childhood hepatitis A vaccination was viewed as being most cost-effective in areas with the highest incidence rates, but it also meets accepted standards of economic efficiency in most of the United States. These studies concluded that a national immunization policy prevents substantial morbidity and mortality, with cost-effectiveness similar to that of other childhood immunizations. However, physicians who provide vaccines to children and adolescents voice concerns. They report dissatisfaction with reimbursement levels and increasing financial strain from immunizations. Efforts to address the root causes of financial pressures should be undertaken. Continued partnerships among national, state, local, private, and public entities are needed to sustain current coverage levels and ensure that administration rates for the hepatitis A vaccine continue to increase for all children.
Fear of vaccines greater than fear of the disease. Because of the success of vaccines, most individuals today, thankfully, have no firsthand experience with devastating infectious illnesses. Therefore, concern about potential harmful effects of vaccines is one of the reasons for immunization noncompliance by parents and by individuals. Parents perceive that the most common vaccine-related harm is a child's pain from multiple injections. Concern has also been expressed about the potential for untoward effects. These fears have been documented to be largely unfounded. An Institute of Medicine committee found no evidence of major safety concerns associated with adherence to the recommended childhood vaccination schedule. Nonetheless, policies that mandate immunization remain somewhat controversial. A recent review critically examined the role of vaccine mandates and discussed ways that practitioners and public health officials might deal with vaccine refusal.
Durability of childhood HAV immunization. Data indicate that available hepatitis A vaccines are capable of providing protection for up to 15 years, as defined by currently accepted, conservative correlates of protection. One recent study documented protective hepatitis A antibody levels (anti-HAV ≥ 20 mIU/mL) in individuals aged 12-24 years who had been vaccinated with a 2-dose schedule in childhood. Another study similarly found that the seropositivity induced by hepatitis A vaccine given to children younger than 2 years persists for at least 10 years, regardless of the presence of maternal anti-HAV. These studies suggest that a booster dose is not needed at this time. Further monitoring is needed to continue to document the long-term protection afforded by HAV vaccines.
The Bottom Line
We have highly effective vaccines against hepatitis A that have clearly reduced the incidence of a disease that has been associated with high morbidity and, albeit uncommon, mortality. However, coverage must be maintained and broadened to further reduce the burden of disease and to prevent a resurgence of HAV infection, particularly in populations with lower vaccination coverage. Widespread education about the appropriate immunization strategies is needed.
"Knowing is not enough; we must apply. Willing is not enough; we must do." - Goethe
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