Alexander the Great
If children and adults are vaccinated against whooping cough to protect infants, and infants get vaccinated against rubella to protect unborn infants, in case of the hepatitis A, infants get vaccinated to protect adults.
CDC Pinkbook Hepatitis A
70% of hepatitis A cases in children under the age of 6 years are asymptomatic. In older children and adults, the disease is symptomatic and in 70% of the cases is accompanied by jaundice. Having had the infection produces lifelong immunity.
Groups at risk for hepatitis A include homosexuals, drug addicts, travelers to endemic countries and people working with infected primates.
Two vaccines are available in the USA: Havrix (GSK) and Vaqta (Merck), which were licensed in 1995-6. There also is a combination vaccine with Hepatitis B (Twinrix).
Both vaccines contain aluminum (225-250 μg). Havrix contains aluminum hydroxide, and Vaqta has AAHS (the same type of aluminum as Gardasil). Both vaccines are produced in human fibroblast cells (MRC-5).
Unlike hepatitis B and C, hepatitis A is an intestinal infection, transmitted through fecal-oral route, and does not have a chronic form.
Less than 10% of infected children under the age of 6 years get diagnosed with hepatitis A.
Indians get infected 19 times more often than white people, and Latin Americans – 3 times more often.
WHO position paper on hepatitis A vaccines - June 2012
Wkly Epidemiol Rec
Hepatitis A incidence depends on socio-economic conditions. With higher income, access to clean water and adequate sanitation, the incidence decreases.
In endemic counties, almost everyone suffers from asymptomatic infection in childhood, which effectively prevents clinical hepatitis in teenagers and adults. The WHO does not recommend universal vaccination in these countries.
Type A viral hepatitis: epidemiology, diagnosis, and prevention.
70-80 people die each year from hepatitis A in the USA, and those are almost exclusively people over 50 years old. Severe cases of hepatitis A are more likely to occur in people with alcoholic liver disease or chronic hepatitis.
Some of the vaccinated people developed Guillain-Barre syndrome, but it is unclear whether this is due to vaccination.
Hospitalization and mortality due to hepatitis A in Taiwan: a 15-year nationwide cohort study.
J Viral Hepat
Aboriginal people are getting vaccinated against hepatitis A in Taiwan since 1995. The study found that the hepatitis A incidence decreased by more than 3 times due to vaccination, despite the fact that only 2% of the population was vaccinated, and most of them lived in the mountains or on isolated islands.
Another study found that only 0.4% of unvaccinated population had hepatitis A antibodies, which led the authors to conclude that it is hygiene, and not vaccination, that is responsible for the decrease in the incidence of hepatitis A. Improved hygiene shifted hepatitis A incidence from children to older-aged people.
Seroprevalence of Hepatitis A Twelve Years After the Implementation of Toddlers Vaccination: A Population-Based Study in Israel.
Pediatr Infect Dis J
Israel was the first country in the world to add hepatitis A vaccine to the national immunization schedule in 1999. Within three years, hepatitis A incidence decreased by more than 98% among the vaccinated, and by 95% among the general population.
Before the beginning of vaccination, 47% of the Jewish population had antibodies, and 12 years later it was already 67%. Among the Arab population, 83% had antibodies before the beginning of vaccination, and 88% had them 12 years later. That is, same as in Taiwan, it is not clear whether vaccination was the only factor responsible for reducing the incidence.
Only two European countries have hepatitis A vaccine on their national immunization schedule (Greece and Austria), and only in Greece, the vaccine is funded by the government.
Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travellers.
Hepatitis A and typhoid vaccines for those who travel to endemic countries are not economically feasible, but the malaria pills are. Only 1 in 2,000 people gets infected with hepatitis A during travel, and in 90% of the cases the disease is mild. It is estimated that hepatitis A vaccination in England prevented 0.29 deaths in one year.
Cross sectional retrospective study of prevalence of atopy among Italian military students with antibodies against hepatitis A virus.
Recruits in Italy, who had antibodies for hepatitis A, suffered from asthma and allergic rhinitis 2 times less often, than the soldiers who did not have antibodies. Recruits, who had older brothers, also suffered from allergic diseases less frequently, which means that hepatitis A is not the only infection that decreases the risk of allergic diseases.
Hepatitis A was an endemic disease in Italy in the 1970s. It was usually an asymptomatic childhood disease.
Other studies in recent decades also reveal an inverse relationship between hepatitis A antibodies and allergies in different countries. In the 1970s in the USA, hepatitis A antibodies were more often detected in the older generation than in the younger one, whereas younger generation had more atopic diseases.
The prevalence of atopy in children with antibodies against hepatitis A virus and hepatitis B virus.
Turk J Pediatr
Children who did not have hepatitis A antibodies suffered from asthma and allergic rhinitis 9 times more often. Those who did not have hepatitis B antibodies suffered from allergic diseases 5.9 times more often. More: .
Clearance of HCV RNA following acute hepatitis A superinfection.
Dig Liver Dis
It is considered that hepatitis A superinfection (an infection that develops on top of another infection), in hepatitis B and C chronic patients, leads to liver failure and high probability of death. However, it is also reported that hepatitis A infection can cause a full or temporary recovery from chronic hepatitis. The mechanisms of this phenomenon are unknown.
A case of a 24-year-old drug addict with chronic hepatitis is described here. He ate raw fish and got hepatitis A, after curing which, he no longer had chronic hepatitis C. It was most likely due to interferon gamma (a cytokine secreted by Th1 cells), the level of which increased significantly after infection.
Cases of hepatitis B suppression during hepatitis A are also reported: , , .
Studies in Hodgkin's syndrome, the association of viral hepatitis and Hodgkin's disease; a preliminary report.
Until 1966, all types of hepatitis were simply called “viral hepatitis.”
3 cases of viral hepatitis in Hodgkin’s lymphoma patients are described here. In two of them lymphoma got cured together with hepatitis A, but the third one died.
Inspired by this discovery, the authors infected 21 volunteer Hodgkin’s lymphoma patients with hepatitis. According to preliminary results, at the time of writing this article, 13 of them got hepatitis and 7 of those who got hepatitis had improvements in their lymphomas. At the time of writing this article, no one died.
Before the licensing of the vaccine, the incidence of hepatitis A in USA was approximately 1 in 10,000, and mortality rate was 1 in 3 million. In 1999, vaccination was introduced in 11 states, where the incidence was higher than 1 in 5,000.
In 2006, the vaccine was added to the national immunization schedule. Hepatitis A incidence at that moment was 1 in 100,000, and mortality rate was 1 in 10 million; and almost all lethal cases were in people over 50 years of age with comorbidities.
Autoimmunity and hepatitis A vaccine in children.
J Investig Allergol Clin Immunol
There are no accepted diagnostic criteria for autoimmune disease resulting from vaccination. Autoimmune diseases develop a long time after vaccination, and because of this, it is hard to conclude of a causal relationship. Vaccines contain adjuvants, preservatives, antigens and other ingredients, each of which can cause or exacerbate autoimmune reactions.
The authors vaccinated 40 children against hepatitis A, and 25% of them developed autoantibodies (antibodies to own antigens), and one of them developed a temporary leukopenia (a decrease in the number of white blood cells). Two years after the vaccine, two children still had autoantibodies.
Aluminum was used as placebo in Vaqta clinical trials.
In 1-10% of vaccinated children, conjunctivitis, otitis media, anorexia, insomnia and other diseases were observed within 14 days after vaccination. Adults also experienced menstrual irregularities and back pains.
Serious adverse events were registered in 0.7% of those vaccinated, and 0.1% were vaccine-related, according to the researchers.
Hepatitis B vaccine was used as placebo in Havrix clinical trials.
Serious adverse events were observed in 0.9% of those vaccinated.
Hepatitis A virus infections and outbreaks in asylum seekers arriving to Germany, September 2015 to March 2016.
Emerg Microbes Infect
The number of hepatitis A cases in Germany, which was continuously decreasing, increased by 45% in 2015-16, while the average age of patients decreased significantly. It turned out to be because of the million refugees that Germany took in.
Hepatitis A outbreak in the USA.
Lancet Infect Dis
In 2001, the advisory committee of San Diego (California) emphasized the need to increase the number of public toilets in the city center.
In 2010, a plan to finance these toilets was developed.
In 2016, two toilets were installed. One of them was later closed due to operating costs and concerns about crime, and only one toilet remained open in 2017. Altogether, there were 8 public toilets in San Diego, but only three of them were available 24 hours a day.
In San Francisco, where the number of homeless people is comparable to San Diego, there are 25 public toilets and they are all open 24 hours a day.
In 2017, a hepatitis A outbreak began in the USA, affecting mainly homeless people of San Diego, where more than 500 people got sick and 20 people died. Thus, 16 portable toilets were opened.
Due to the fear of hepatitis A, the authorities arrest those who distribute food to homeless people in San Diego suburbs.
Outbreak of hepatitis A associated with men who have sex with men (MSM), England, July 2016 to January 2017.
In 2016-17, major European cities were overwhelmed with hepatitis A outbreaks. The vast majority of cases were homosexuals. 37 cases were registered in England.
Hepatitis A outbreak in Barcelona among men who have sex with men (MSM), January-June 2017: A hospital perspective.
46 cases were registered in a Barcelona hospital. 96% of them were men, and 67% identified themselves as homosexuals. The authors write that the main risk factor is the oral-anal contact during sex, that most recent outbreaks in Europe happened between 2008 and 2011, and that because of these outbreaks, hepatitis A was classified as an STD.
Ongoing outbreaks of hepatitis A among men who have sex with men (MSM), Berlin, November 2016 to January 2017 - linked to other German cities and European countries.
Outbreak in Berlin. 38 cases, 37 men, 30 reported homosexual relationships. The woman also reported same-sex relationships. One of the patients was vaccinated 11 months prior to the onset of the disease.
Outbreak in Rome and surrounding area. 513 cases, 87.5% of them men.
Outbreak in Tel Aviv. 19 cases, 17 of them homosexuals. 
Altogether, 1,500 cases of hepatitis A were registered in 16 European countries, and 2,600 unconfirmed cases, mainly among homosexuals.
11,212 cases of disease were registered in Europe between January and August, 2017, mainly among homosexuals.
The WHO also reports an outbreak among homosexuals in Chile.
Hepatitis A outbreak among men who have sex with men (MSM), predominantly linked with the EuroPride, the Netherlands, July 2016 to February 2017.
It all started with a gay parade in Amsterdam in 2016, which attracted half a million visitors. A total of 48 cases were registered among men in Netherlands.
Outbreak in Osaka, Japan, in 2018. 13 cases, all homosexual. Linked with the gay parade in Amsterdam.
Hepatitis A outbreak in HIV-infected MSM and in PrEP-using MSM despite the high level of immunity, Lyon, France, January to June 2017.
Hepatitis A outbreak in Lyon in the first half of 2017. 46 cases, 38 of them men, 33 homosexuals, and 15 HIV positive. Most of them have been vaccinated or had antibodies.
According to the existing model, 70% of those with immunity would be enough to prevent hepatitis A infection among homosexuals. The authors conclude that 70% is not enough.
It is also reported that since contracting hepatitis A is also possible from needle sharing, slamming (intravenous drug use during anal contact), a practice that is gaining popularity among certain homosexual groups, can also increase the risk of infection. More: , .
Hepatitis A Outbreak Among Men Who Have Sex With Men in a Country of Low Endemicity of Hepatitis A Infection.
J Infect Dis
Outbreak of hepatitis A in Taiwan. More than 1,000 cases, 70% of them homosexuals, 60% HIV positive, and more than 60% infected with syphilis, gonorrhea or shigellosis.
There are no mentions of deaths from hepatitis A in any of these outbreaks.
131 death cases from hepatitis A have been registered with VAERS, 773 disability cases, and 3,888 cases of serious adverse events. Before the introduction of vaccination, there were almost no cases of children dying from hepatitis A.
Benefits of hepatitis A