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[Hepatitis-A vaccination in children]
1Hôpital Saint Vincent de Paul, Paris, France. dominique.gendrel@svp.ap-hop-paris.fr
Insights
Hepatitis A vaccination is recommended for children traveling to endemic areas. Early childhood immunization offers durable protection and can prevent family-wide outbreaks, even in young children.
Area of Science:
- Hepatitis A epidemiology
- Vaccinology
- Public health
Context:
- Hepatitis A vaccination is recommended in France for specific pediatric groups, including those in healthcare settings, with chronic liver disease, or traveling to endemic regions.
- Asymptomatic children under 5 years old can transmit Hepatitis A, posing a risk to family members and communities.
- Current French recommendations focus on travel, but post-exposure prophylaxis is a significant concern.
Purpose:
- To evaluate the effectiveness and tolerability of early childhood Hepatitis A vaccination for preventing transmission within families and closed communities.
- To highlight the need for recognizing post-exposure prophylaxis as a key indication for Hepatitis A vaccination in France.
- To inform pediatricians about the risks of Hepatitis A in children and the benefits of timely family prophylaxis.
Summary:
- Hepatitis A vaccination in early childhood provides long-lasting protection and is crucial for children traveling to endemic areas, preventing secondary infections within families.
- While routine vaccination is no longer needed in France due to decreased incidence, immediate post-exposure vaccination (within 7 days) is effective for prophylaxis around index cases in families and communities.
- Despite positive trial results and recommendations from other countries, this post-exposure indication is not officially recognized in France, necessitating pediatrician advocacy for family protection.
Impact:
- Early and potentially lifelong protection against Hepatitis A for children and their families.
- Effective control of localized outbreaks and prevention of severe secondary infections.
- Potential to influence public health policy regarding Hepatitis A vaccination indications in France.
Abstract:
In France, immunization against hepatitis A is recommended for children attending health-care institutions, presenting chronic liver disease, and traveling to endemic areas. This recommendation is based on the fact that, while more than 80% of cases of hepatitis A occurring in children less than 5 years of age are asymptomatic, infected children without jaundice can shed the virus and serve as a source of infection for others. Immunization of children traveling to endemic areas protects the whole family from secondary infection that often leads to severe manifestations. Because the cost of the vaccine is not covered by health insurance, African families living in France must have children vaccinated in advance before travel to Africa. Vaccination early in childhood is possible since the protective effect is durable and perhaps definitive. The dramatic decrease of incidence in France has eliminated the need for routine vaccination except in children traveling to international destinations. The main problem is prophylaxis around index cases in situations involving single family units, small closed communities and localized outbreaks. Immediate vaccination within 7 days after exposure to the index case should be considered since the immunoglobulins are not available in France. Limited trials in families and closed communities show that this vaccination approach is effective and well tolerated even by young children attending nurseries. However this indication is currently not recognized in France even though it has often been applied and has been recommended by the British advisory board. It is the responsibility of pediatricians to inform parents of this risk and propose individual prophylaxis for the family.
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