Introduction

Risk Assessment

Diagnosis

Counseling

Clinical Features

Reporting

MMWR

FAQS

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Implementation of these recommendations should significantly lower the incidence of hepatitis A in the United States. When this occurs, the opportunity will be present to eliminate HAV transmission ( 93 ). However, to achieve this goal, children throughout the United States will need to be vaccinated against hepatitis A. This effort would be facilitated by the availability of a vaccine formulation or schedule for use in infants or children in the second year of life and combination vaccines that include hepatitis A vaccine. In the interim, a number of issues should be addressed through clinical trials and other studies:

• Further evaluation of vaccine safety with increased use of hepatitis A vaccine;
• Determining vaccine doses or schedules to overcome the reduced immune response among infants who have passively acquired maternal anti-HAV;
• Developing vaccines that combine HAV antigen with other antigens to more readily integrate hepatitis A vaccine into childhood vaccination schedules;
• Evaluating the cost-effectiveness of integrating hepatitis A vaccine into the routine childhood vaccination schedule;
• Determining whether hepatitis A vaccine will provide an adequate level of postexposure protection against hepatitis A;
• Determining the long-term protection afforded by hepatitis A immunization and the development of diagnostic assays that can distinguish between vaccine-induced antibody and antibody produced in response to natural infection.

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