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Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020

Author/s: 
Nelson, N.P., Weng, M.K., Hofmeister, M.G., Moore, K.L., Doshani, M., Kamili, S., Koneru, A., Haber, P., Hagan, L., Romero, J.R., Harris, A.M.

HEPATITIS A IS A VACCINE-PREVENTABLE, COMMUNICABLE DISEASE OF THE LIVER CAUSED BY THE HEPATITIS A VIRUS (HAV). THE INFECTION IS TRANSMITTED VIA THE FECAL-ORAL ROUTE, USUALLY FROM DIRECT PERSON-TO-PERSON CONTACT OR CONSUMPTION OF CONTAMINATED FOOD OR WATER. HEPATITIS A IS AN ACUTE, SELF-LIMITED DISEASE THAT DOES NOT RESULT IN CHRONIC INFECTION. HAV ANTIBODIES (IMMUNOGLOBULIN G [IGG] ANTI-HAV) PRODUCED IN RESPONSE TO HAV INFECTION PERSIST FOR LIFE AND PROTECT AGAINST REINFECTION; IGG ANTI-HAV PRODUCED AFTER VACCINATION CONFER LONG-TERM IMMUNITY. THIS REPORT SUPPLANTS AND SUMMARIZES PREVIOUSLY PUBLISHED RECOMMENDATIONS FROM THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) REGARDING THE PREVENTION OF HAV INFECTION IN THE UNITED STATES. ACIP RECOMMENDS ROUTINE VACCINATION OF CHILDREN AGED 12-23 MONTHS AND CATCH-UP VACCINATION FOR CHILDREN AND ADOLESCENTS AGED 2-18 YEARS WHO HAVE NOT PREVIOUSLY RECEIVED HEPATITIS A (HEPA) VACCINE AT ANY AGE. ACIP RECOMMENDS HEPA VACCINATION FOR ADULTS AT RISK FOR HAV INFECTION OR SEVERE DISEASE FROM HAV INFECTION AND FOR ADULTS REQUESTING PROTECTION AGAINST HAV WITHOUT ACKNOWLEDGMENT OF A RISK FACTOR. THESE RECOMMENDATIONS ALSO PROVIDE GUIDANCE FOR VACCINATION BEFORE TRAVEL, FOR POSTEXPOSURE PROPHYLAXIS, IN SETTINGS PROVIDING SERVICES TO ADULTS, AND DURING OUTBREAKS.

Vaccination of Adults in General Medical Practice

Author/s: 
Hunter, P., Fryhofer, S.A., Szilagyi, P.

In vaccinating adults, clinicians face 2 types of challenges: (1) staying current on recommendations for influenza, pneumococcal, hepatitis A and B, zoster, and other vaccines and (2) addressing systemic barriers to implementing practices that increase vaccination rates. Although adult immunization rates remain suboptimal, there has been much good news in adult vaccination recently. New high-dose and adjuvanted influenza vaccines help improve immune response and may reduce influenza complications in older adults. The new recombinant zoster vaccine offers significantly more efficacy against zoster outbreaks and postherpetic neuralgia than zoster vaccine live. Pertussis vaccine given during the third trimester of pregnancy may prevent between 50% and 90% of pertussis infections in infants. Shorter time for completion (1 vs 6 months) of new, adjuvanted hepatitis B vaccine may increase adherence. Clinicians can address systemic barriers to increasing vaccination rates in their clinics and health care systems by following the Centers for Disease Control and Prevention's Standards for Adult Immunization Practice. Clinicians can help increase vaccination rates by writing standing orders and by advocating for nurses or medical assistants to receive training and protected time for assessing and documenting vaccination histories and administration. Strong recommendations that presume acceptance of vaccination are effective with most patients. Communication techniques similar to motivational interviewing can help with vaccine-hesitant patients. Clinicians, as experts on providing preventive services, can educate community leaders about the benefits of immunization and can inform vaccine experts about challenges of implementing vaccination recommendations in clinical practice and strategies that can work to raise vaccination rates. 

Keywords 
adult immunization

Management of Hepatitis C in 2019.

Author/s: 
Kristen, Naggie, Susanna

In the United States, hepatitis C virus (HCV) infection affects more than 2 million adults and is the leading cause of liver-related mortality. Therapies that eradicate HCV may prevent progression to cirrhosis, liver decompensation, hepatocellular carcinoma, need for liver transplant, and death. HCV eradication also appears to reduce the risk of extrahepatic diseases, including cryoglobulinemic vasculitis and cardiovascularevents. Direct-acting antivirals (DAAs), oral drugs that target multiple mechanisms of the HCV lifecycle, have been usedincombination since 2013. Because of their efficacy and safety, the use of DAAshas substantiall yimproved HCV treatment and made HCV eradication possible for most patients, including patients with HIV infection, severe renal and hepatic impairment, and history of organ transplantation. Individuals living with HCV should be treated to reduce liver-related and all-cause morbidity and mortality and to prevent HCV transmission...

Keywords 
Pregnancy U.S. hepatitis vaccination RNA HIV Genotype liver

Sexually Transmitted Infections

This collection features the best content from AFP, as identified by the AFP editors, on sexually transmitted disease and related issues, including chlamydia, genital herpes, gonorrhea, human papillomavirus, and syphilis. New research may affect the interpretation and application of this material. Clinical judgment is advised. Note that AFP content published within the past 12 months is accessible to AAFP members and paid subscribers only. 
Note: This topic collection does not include human immunodeficiency virus (see separate topic collection on HIV/AIDS) or hepatitis (see separate topic collection on Hepatitis and Other Liver Diseases).

Keywords 
sexually transmitted infections human papillomavirus

Hepatitis (and Other Liver Diseases)

This collection features the best content from AFP, as identified by the AFP editors, on hepatitis and other liver disease and related issues, including cirrhosis, chronic liver failure, hemochromatosis, hepatitis A, hepatitis B, hepatitis C, jaundice, and nonalcoholic fatty liver disease. New research may affect the interpretation and application of this material. Clinical judgment is advised. Note that AFP content published within the past 12 months is accessible to AAFP members and paid subscribers only.

Keywords 
hepatitis
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