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Hepatitis A Vaccine – Should Older Adults Receive the Vaccine?
By Christian Davis Furman, MD, MSPH, AGSF
Medical Director, Exceptional Senior Living, Prospect
Professor, Geriatric and Palliative Medicine, University of Louisville School of Medicine

With the recent outbreak of Hepatitis A in Kentucky, older adults should consider receiving the vaccine.  Recently, Indiana public health officials recommended everyone traveling to the Kentucky Derby receive the vaccine.  In Kentucky, there have been over 400 cases of Hepatitis A with three deaths since August.  The reason for the outbreak is the opioid epidemic, with the homeless and drug-using populations being the most effected.  The Hepatitis A outbreak has occurred in Kentucky, Michigan and California, among other states.

Hepatitis A is a liver disease caused by the Hepatitis A virus (HAV).  It can cause fever, weakness, loss of appetite, nausea, abdominal pain, dark urine, and jaundice.  The symptoms usually last less than 2 months, but some people have symptoms for up to 6 months.  Once you have had the virus and recovered, there is no chance that you will get it again.  People do die of Hepatitis A; however, it is only 0.9% of the cases.  Older adults and people with chronic liver disease have the highest chance of dying of Hepatitis A virus. 

Hepatitis A is transmitted through the fecal-oral route.  The best way to prevent the spread of Hepatitis A is through good hand washing after using the restroom and before eating. International travel produces many cases of Hepatitis A. It is recommended that people traveling to countries with high rates of Hepatitis A are vaccinated before they travel.  Casual contact, as in the usual office, factory, or school setting does not transmit the virus. Cooked foods also can transmit HAV if the temperature during food preparation is inadequate to kill the virus or if food is contaminated after cooking, as occurs commonly in outbreaks associated with infected food handlers.

Since older adults are more at risk of severe illness and dying of Hepatitis A, it is recommended that frail older adults receive the Hepatitis A vaccine.  The Centers for Disease Control and Prevention (CDC) recommends that the vaccine be given to children at age one, persons who are at increased risk of infection, persons who are at increased risk for complications from Hepatitis A and anyone who would like to gain immunity (protection).  Frail older adults are at increased risk for complication from Hepatitis A; therefore, it is recommended that older adults receive the vaccine.

The only contraindication to receiving the vaccine is for people with a history of a severe allergic reaction to a previous dose of hepatitis A vaccine or to a vaccine component. As with all vaccines, there is a precaution when giving it to anyone who is moderately or severely ill. No serious adverse events have been attributed definitively to hepatitis A vaccine. Among adults, the most frequently reported side effects are soreness at the site of the injection and headache.  Since it is not a live vaccine, people with a weakened immune system (immunocompromised patients) can still receive the vaccine.  The vaccine requires a booster dose 6 months after the original dose. This is especially important for older adults because older adults have a weakened immune system and need the booster shot to improve their immunity to the virus.  Some Medicare Part D plans pay for the vaccine, but not all plans.