Hepatitis A is the commonest vaccine preventable disease apart from influenza. Should it be included in the National Immunisation Program for children?

The Ministry of Health in Colombia (Medellin) has recently reported a large increase in Hepatitis A cases. More than 400 cases have been reported since the beginning of the year. This is double the number of cases compared to the same period in 2023.

Hepatitis A is a childhood disease in most low and low-middle-income countries with most of the population immune by 10 years of age. Most would experience asymptomatic disease and only know of their natural immunity if tested later.

Colombia is an upper middle-income country in South America. Environmental hygiene is improving but a high standard of water and sanitation would not be consistent across the country. A non-immune adolescent or adult is much more likely to experience symptomatic disease if exposed to the virus. Hepatitis A can be a very unpleasant disease for an adult and fatalities do occur.

The current situation demonstrates why Australian and New Zealand travellers should be vaccinated prior to travel to lower income destinations like Colombia.

Hepatitis A vaccine is not universally included under the National Immunisation Program in Australia. It is only funded for aboriginal children over 18 months. This group might have greater risk of exposure.

An asymptomatic child has the potential to spread the disease more widely.

The vaccine is certainly recommended for overseas travel and can be sourced privately.

Hepatitis A vaccination has been recommended from 12 months in the USA for many years (since 2006). It has been funded for children, 12 months to 23 months, since 2020. The recommendation is for 2 doses, 6 months apart.

UPDATE - Recent increases in cases across Europe (July 2025) raise additional questions about travel-specific risks and whether hepatitis A vaccination should be considered a routine part of travel preparation. Read more on why hepatitis A vaccination is worth considering for travellers.

This vaccination recommendation (from 2006) has been studied and shown to be very effective in reducing the rates of disease in a largely unvaccinated adult population.

Australia is a multicultural country with people from many different countries. Many of these countries would fit the profile of low or middle income. Children will often travel with their parents to stay with relatives for varying periods of time (sometimes months). Exposure to a disease like Hepatitis A would be common. It is to be expected that many might also return with the disease.

It is interesting to note that Hepatitis A notifications in Australia dropped noticeably during the pandemic years when our international borders were closed.

Should we follow the United States and recommend all children over 12 months to be vaccinated for Hepatitis A?