[Hepatitis-A vaccination in children]

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.