The following proposed recommendation was presented to the Advisory Committee on Immunization Practices (ACIP) at its October 2018 meeting: all persons aged 1 year and older experiencing homelessness should be routinely immunized against hepatitis A. This recommendation was approved unanimously by voting ACIP members.
On February 15, 2019, the Centers for Disease Control and Prevention published in the Morbidity and Mortality Weekly Report, hepatitis A (HepA) vaccine recommendations for persons experiencing homelessness. This report also updates previous ACIP recommendations for HepA vaccine.
Because of the difficulty in distinguishing the type of homelessness a person is experiencing (e.g., sheltered vs. unsheltered) and the associated risks for HAV infection, all persons experiencing homelessness should routinely receive HepA vaccine. Multiple definitions of homelessness have been published in the U.S.; however, the definitions are similar in content. The U.S. Department of Health and Human Services' definition is used for the purpose of this recommendation. This definition is listed in Box 2 of the report.
Rationale for the Recommendation
“Persons experiencing homelessness might have difficulty implementing recommended nonvaccine strategies to protect themselves from exposure (e.g., access to clean toilet facilities, regular handwashing, and avoidance of crowded living conditions). For this reason, vaccination is the most reliable protection from HAV infection for persons experiencing homelessness. HepA vaccination of persons experiencing homelessness will provide individual protection and increase herd immunity over time, reducing the risk of large-scale, person-to-person outbreaks in this population. The recommendation facilitates routine HepA vaccination of persons experiencing homelessness through facilities that already provide healthcare services for the homeless population.”
As of February 20, there have been 910 confirmed cases of hepatitis A in the state since the beginning of the outbreak in August 2016, resulting in 731 hospitalizations and 28 deaths. Although the number of confirmed cases has recently slowed down in Michigan, the Michigan Department of Health and Human Services reports that neighboring states, as well as communities across the country, are still experiencing an increase in cases. It is important that healthcare professionals continue to follow the standards of care for immunizations and assess at every visit, ensure adequate supply, and administer all needed vaccines at each visit.