That's the problem in only targeting high risk groups, he said.
Health officials should learn from the experience of hepatitis B, he said, where targeting the high-risk groups did not result in a substantial reduction in the frequency of hepatitis B. “We lost 10 years because we didn't start off with a universal vaccination program,” he said.
He gave the example of migrant children in Florida where 244 children were tested and on average half already had been infected. The numbers increased with age with 34% of the 2- to 5-year-olds testing positive for hepatitis A antibodies and 81% of the 14-year-old and over group testing positive.
“In a community that wasn't targeted, about half of the children already had been infected,” he said. “This is a missed opportunity.”
The biggest impediments to universal hepatitis A vaccination in children include cost, addition of yet another vaccination to a complex schedule, and the rising fear among some parents about vaccination.
But the vaccine has proved both safe and cost effective, he said. The cost of the vaccine under federal programs is $11.15 a dose while in private practice the cost is between $26 and $30 per patient. Administration fees are about $12 a dose.
“Children play an important role in the spread of hepatitis A,” said Dr. Balistreri. “There already is an immunization schedule in place for children, whereas trying to get adults immunized is another story. It makes great sense.”
One solution may be a combined hepatitis A and B vaccine for children, he said. Currently, the combined vaccine is approved for children in Europe, but approved only for adults in the United States.