[Vaccination against hepatitis A in children]

Hepatitis A is usually considered as a mild disease and is asymptomatic in more than 80% of children less than 5 years of age. Furthermore, incidence of the disease decreased dramatically in France during the past decades. For these reasons mass routine vaccination is not required in our country. However, infected children shed the virus in the community and are responsible for secondary cases, sometimes severe. That is why, despite the cost and the absence of reimbursement of the vaccine, immunisation against hepatitis A is recommended in children attending health-care institutions, in children with chronic liver disease and in those travelling in endemic areas. Prophylaxis around an index case is the main problem because non-specific immunoglobulins, although recommended, are not available in France for this indication. Vaccination in the few days following exposition has been reported to be efficient in household contacts and small communities, including nurseries. This strategy is recommended by the British Advisory Board within the 7 days following exposition, but not in France. However, it can be proposed to the family by paediatricians.