Who is at highest risk for getting Hepatitis A?
United States public health officials state that, while anyone can become infected with hepatitis A, those most at risk include:1 2
- Men who have sexual relations with other men
- Persons having sexual relations with an infected individual
- Individuals using recreational drugs, whether they are injected or not
- Persons residing in or traveling to countries where Hepatitis A is endemic
- Caregivers or household members who are living with someone who is infected with hepatitis A
- Hemophiliacs or persons with a similar blood clotting disorder
- HIV-positive individuals
- Families who may be adopting a child from countries considered to have intermediate or high hepatitis A infection rates
- Persons working with the hepatitis A virus including those working with hepatitis A infected primates
- Homeless individuals
A 2015 published study found that adults, rather than children, were at a higher risk of developing hepatitis A infection and that infections were not limited to high risk groups, primarily due to the increasing number of foods imported to the United States as some have been found to be the source of hepatitis A infections.3 4 Infection rates in the United States and other developed countries are considered to be very low due to proper sanitation and hygiene practices, and most outbreaks tend to end very quickly.5 However, since 2016, many U.S. states have experienced hepatitis A outbreaks, primarily among persons who use drug or who are experiencing homelessness and as of March 2019, multiple states continue to be impacted by the ongoing outbreaks.6
In developing countries, however, 90 percent of children will develop hepatitis A prior to the age of ten due to poor personal hygiene practices and inadequate sanitation. The majority of these infected children will show no clinical symptoms of disease and exposure to the virus will result in lifelong hepatitis A immunity. As a result, the rates of symptomatic disease in developing countries are very low and epidemics are rare. In developing countries where personal hygiene practices and proper sanitation are variable, symptomatic outbreaks may be much more common. In these countries, children may not become exposed to the hepatitis A virus at a young age and this may result in a higher rate of adults without immunity to the illness. In these countries, hepatitis A disease rates may be much higher. 7
IMPORTANT NOTE: NVIC encourages you to become fully informed about Hepatitis A and the Hepatitis A vaccine by reading all sections in the Table of Contents, which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.
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1 CDC Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness MMWR Feb.15, 2019; 68(6);153–156
2 Kahn, A Hepatitis A - Who is at risk of getting hepatitis A? Healthline May 7, 2018
3 Ly KN, Klevens, RM, Trends in disease and complications of hepatitis A virus infection in the United States, 1999-2011: a new concern for adults. J Infect Dis. 2015 Jul 15;212(2):176-82.
4 Gould L, Kline J, Monahan C, Vierk K. Outbreaks of Disease Associated with Food Imported into the United States, 1996–2014. Emerg Infect Dis. 2017;23(3):525-528.
5 WHO Hepatitis A Sep. 19, 2018
6 CDC Emergency Preparedness and Response - Update: Widespread Outbreaks of Hepatitis A among People Who Use Drugs and People Experiencing Homelessness across the United States. Health Alert Network. Mar. 25, 2019
7 WHO Hepatitis A Sep. 19, 2018