Recommendations for hepatitis A postexposure prophylaxis and pre-exposure protection, by age group and risk category

Indication and age group	Risk category and health status	HepA vaccine	IG*
Postexposure prophylaxis
<12 months	Healthy	No	0.1 mL/kg
12 months to 40 years	Healthy	1 dose^¶	None
>40 years	Healthy	1 dose^¶	0.1 mL/kg^Δ
≥12 months	Immunocompromised or chronic liver disease	1 dose^¶	0.1 mL/kg^◊
≥12 months	Vaccine contraindicated^§	No	0.1 mL/kg
Preexposure protection (eg, travel)^¥
<6 months	Healthy	No	0.1 to 0.2 mL/kg^‡
6 to 11 months	Healthy	1 dose^†	None
12 months to 40 years	Healthy	1 dose**	None
>40 years	Healthy	1 dose**	0.1 to 0.2 mL/kg^‡,^¶¶
>6 months	Immunocompromised or chronic liver disease	1 dose**	0.1 to 0.2 mL/kg^‡,^¶¶
>6 months	Persons who elect not to receive vaccine or for whom vaccine is contraindicated^§	No	0.1 to 0.2 mL/kg^‡

HepA: hepatitis A; IG: immune globulin; HAV: hepatitis A virus.
* Measles, mumps, and rubella vaccine should not be administered for at least 2 weeks before and 6 months after administration of IG.
¶ A second dose of HepA vaccine is not required for postexposure prophylaxis; however, for long-term immunity, the vaccination series should be completed with a second dose at least 6 months after the first dose.
Δ The provider's risk assessment should determine the need for IG administration. If the provider's risk assessment determines that both vaccine and IG are warranted, HepA vaccine and IG should be administered simultaneously in a different anatomic site (eg, separate limbs).
◊ Vaccine and IG should be administered simultaneously in a different anatomic site (eg, separate limbs).
§ Life-threatening allergic reaction to a previous dose of HepA vaccine or allergy to any vaccine component.
¥ IG should be considered before travel for persons with special risk factors for either HAV infection or severe disease from HAV infection.
‡ 0.1 mL/kg for travel up to 1 month; 0.2 mL/kg for travel up to 2 months, 0.2mL/kg every 2 months for travel of ≥2 months' duration.
† This dose should not be counted toward the routine 2-dose series, which should be initiated at age 12 months.
** For persons not previously vaccinated with HepA vaccine, administer dose as soon as travel is considered, and complete series according to routine schedule if the next dose is needed before travel.
¶¶ May be administered based on provider's risk assessment.

Reproduced from: Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020; 69:1.

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Recommendations for hepatitis A postexposure prophylaxis and pre-exposure protection, by age group and risk category