Vaccine Academy › Vaccine School › Routine adult
Content current as of October 11, 2026. AI-assisted draft; not yet reviewed by a licensed pharmacist. Current CDC schedules: immunization schedules.
- The disease and why it matters
- Video and figures
- Get CE credit
- Products available
- Who should get it
- Dosing and schedule, including catch-up
- Administration
- Storage and handling
- Contraindications and precautions
- Safety and adverse events
- Special populations
- Counseling pearls for the pharmacy counter
- Common patient questions
- References
The disease and why it matters
Hepatitis A is a highly contagious liver infection caused by hepatitis A virus (HAV), spread primarily through the fecal-oral route; it causes an acute infection and does not become a chronic, long-term infection. [1]
Transmission occurs through close person-to-person contact with an infected person, sexual contact, or ingestion of contaminated food or water; depending on environmental conditions the virus can live outside the body for months. The average incubation period is 28 days (range 15 to 50 days). [1]
Most adults with hepatitis A have symptoms (fatigue, low appetite, stomach pain, nausea and jaundice), while most children younger than 6 years do not; an infected person can transmit the disease even without symptoms. Most people feel sick for several weeks and recover completely, but in rare cases hepatitis A can cause liver failure and death, which is more common in people older than 50 years and in people with other liver diseases. [2]
In 2023, 1,648 hepatitis A cases were reported in the United States (experts estimate about 3,300 actual cases); since 2016 there have been multi-state outbreaks from person-to-person transmission primarily among people who use drugs and people experiencing homelessness, and the 2023 case count remained 1.2 times higher than in 2015. [1]
Video and figures
Video
Get CE credit
- CDC You Call the Shots: Hepatitis A module (CDC TRAIN course WB4449R) — CDC · Free (CDC states no fees for its CE activities) · accredited by CDC, jointly accredited by ACCME, ACPE and ANCC; pharmacy UAN JA4008229-0000-23-027-H06-P. CDC's listing shows credit expiring 05/11/25, so confirm on CDC TRAIN that credit is still available · link confirmed October 11, 2026
RxEvidence is not an accredited continuing education provider and does not award CE credit. These are links to activities offered by others.
Products available
FDA has licensed two single-antigen hepatitis A vaccines (Havrix and Vaqta) and one combination hepatitis A and hepatitis B vaccine (Twinrix); all three are inactivated vaccines and contain an aluminum adjuvant. [3]
| Vaccine | Manufacturer (FDA page) | FDA-approved use | Initial U.S. approval |
|---|---|---|---|
| Havrix | GlaxoSmithKline Biologicals (GSK) [4] | Active immunization against hepatitis A in persons 12 months of age and older; primary immunization at least 2 weeks before expected exposure [5] | 1995 [5] |
| Vaqta | Merck Sharp & Dohme Corp. [6] | Prevention of disease caused by HAV in persons 12 months of age and older; primary dose at least 2 weeks before expected exposure [7] | 1996 [7] |
| Twinrix | GlaxoSmithKline Biologicals [8] | Active immunization against disease caused by hepatitis A virus and infection by all known subtypes of hepatitis B virus in persons 18 years of age or older [9] | 2001 [9] |
The Vaqta label posted on FDA's page carries a placeholder revision date ("XX/20XX") and the product page is marked content current as of 10/26/2020. FDA's own package insert link for Havrix returned a "page not found" error on the access date, so the Havrix label was read from NLM DailyMed (revision 5/2026); FDA's Havrix product page lists a May 14, 2026 supplement approval that added "Protect from Light" language and other minor revisions to the package insert. [7] [6] [4]
Who should get it
CDC / ACIP (hepatitis A vaccine administration page, January 31, 2025)
As of January 31, 2025
CDC recommends hepatitis A vaccination for all children 12 to 23 months, unvaccinated children and adolescents 2 to 18 years, people at increased risk of infection (international travelers, men who have sex with men, people who use or inject drugs, people with occupational risk, people anticipating close contact with an international adoptee, people experiencing homelessness), people at increased risk for severe disease (chronic liver disease, HIV), pregnant patients at risk, any person who requests vaccination, and unvaccinated people exposed to HAV within the past 2 weeks. [3]
AAFP (its adopted adult schedule; page checked 2026-10-11, no version date shown on the page)
As of October 11, 2026
Lists the same routine entry (any person not fully vaccinated who requests vaccination, with no risk factor identification required: a 2-dose HepA series or 3-dose HepA-HepB series) and the same special-situations list of risk factors. [10]
CDC: January 2026 schedule revision and its legal status (hepatitis A)
As of June 11, 2026
On January 5, 2026 the CDC Acting Director approved a revised childhood and adolescent schedule that changed the recommendation type for hepatitis A, meningococcal ACWY and RSV vaccines from a full recommendation for all children to a risk-based recommendation for children at high risk, with shared clinical decision-making for other children; the schedule's first category (recommended for all children) lists measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Hib, pneumococcal disease, HPV and varicella. A federal district court stayed that schedule on March 16, 2026 and reverted it to the version as of May 2025, and CDC's schedule page continues to show the July 2, 2025 addendum edition. [11] [12] [13]
American Academy of Pediatrics 2026 schedule (endorsed by AAFP, ACOG, AMA, IDSA, APhA and others)
As of January 26, 2026
The AAP published its own 2026 schedule on January 26, 2026, which continues to recommend routine immunization for protection against 18 diseases, including RSV, hepatitis A, hepatitis B, rotavirus, influenza and meningococcal disease, and differs from the schedule recently issued by CDC; the AAP schedule is formally endorsed by 12 organizations, including AAFP, ACOG, AMA, IDSA and the American Pharmacists Association. [14]
CDC's notes list the risk factors: chronic liver disease (including hepatitis B, hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, or ALT or AST more than twice the upper limit of normal), HIV infection, men who have sex with men, injection or noninjection drug use, persons experiencing homelessness, work with HAV in a research laboratory or with nonhuman primates with HAV infection, travel in countries with high or intermediate endemic hepatitis A, close personal contact with an international adoptee in the first 60 days after arrival, pregnancy with risk for infection or severe outcome, and settings for exposure including health care settings serving persons who use drugs and group homes and nonresidential day care facilities for developmentally disabled persons. [15]
CDC lists groups at low risk who do not need routine vaccination: people with clotting-factor disorders, food handlers, workers exposed to sewage, health care personnel and child care center staff. [3]
Vaccine effectiveness: CDC states hepatitis A vaccines are highly effective, that the IgG anti-HAV produced after vaccination confers long-term immunity although the exact duration of protection is unknown, and that anti-HAV has been shown to persist for at least 20 years in people who received a complete series. [3]
Dosing and schedule, including catch-up
| Vaccine | Adult dose and schedule |
|---|---|
| Havrix | 1 mL primary dose and a 1 mL booster dose given between 6 and 12 months later (individuals 19 years and older). [5] [15] |
| Vaqta | 1 mL primary dose and a 1 mL booster dose 6 to 18 months later (adults 19 years and older); a Vaqta booster may be given 6 to 12 months after a primary dose of Havrix. [7] |
| Twinrix | Standard: 3 doses (1 mL each) at 0, 1 and 6 months (CDC minimum intervals: dose 1 to dose 2 of 4 weeks, dose 2 to dose 3 of 5 months); accelerated: 4 doses (1 mL each) on days 0, 7 and 21 to 30, followed by a booster dose at month 12. [9] [15] |
For travelers, the primary dose should be given at least 2 weeks before expected exposure to HAV, and Twinrix may be given on an accelerated schedule before travel or other potential exposure. [5] [3]
People who are unvaccinated and have direct contact with someone with hepatitis A should receive hepatitis A vaccine as soon as possible and within 2 weeks after exposure. [2]
Infants 6 through 11 months old traveling outside the United States when protection is recommended should receive 1 dose of hepatitis A vaccine and still receive 2 additional doses at the recommended ages (CDC's VIS). [2]
Administration
Administer intramuscularly; clinicians should administer the vaccine into the anterolateral aspect of the thigh or the deltoid muscle. Do not give Havrix in the gluteal region, because such injections may result in suboptimal response; Havrix may be given concomitantly with immune globulin using different syringes and at different sites. [3] [5]
Shake Havrix well before use; with thorough agitation it is a homogeneous, turbid, white suspension, and it should not be given if it appears otherwise. Shake Vaqta well to obtain a slightly opaque, white suspension, and discard if the suspension does not appear homogenous or contains particulate matter or discoloration. [5] [7]
Do not mix Vaqta or Twinrix with any other vaccine in the same syringe or vial; hepatitis A vaccine may be given at the same time as other vaccines. [7] [9] [2]
Storage and handling
| Vaccine | Storage |
|---|---|
| Havrix | Store refrigerated between 2° and 8°C (36° and 46°F); do not freeze, discard if frozen, protect prefilled syringes from light, and do not dilute. [5] |
| Vaqta | Store at 2°C to 8°C (36°F to 46°F); do not freeze, since freezing destroys potency. [7] |
| Twinrix | Store refrigerated between 2° and 8°C (36° and 46°F); do not freeze, discard if frozen. [9] |
Latex: the Vaqta vial stopper and the syringe plunger stopper and tip cap contain dry natural latex rubber that may cause allergic reactions in latex-sensitive individuals; the Twinrix and Havrix prefilled syringe tip cap and rubber plunger stopper are not made with natural rubber latex. [7] [9] [5]
Contraindications and precautions
- Havrix: severe allergic reaction (e.g., anaphylaxis) after a previous dose of any hepatitis A-containing vaccine, or to any component of Havrix, including neomycin. [5]
- Vaqta: history of immediate and/or severe allergic or hypersensitivity reactions (e.g., anaphylaxis) after a previous dose of any hepatitis A vaccine, or an anaphylactic reaction to neomycin. [7]
- Twinrix: severe allergic reaction (e.g., anaphylaxis) after a previous dose of any hepatitis A-containing or hepatitis B-containing vaccine, or to any component, including yeast and neomycin. [9]
- CDC advises clinicians to ask about an allergic reaction after a previous dose of or any component of hepatitis A vaccine, and about an allergic reaction to neomycin or yeast (a contraindication for Twinrix); people who are moderately or severely ill should wait until they recover, though minor illness such as a cold is fine. [3]
Safety and adverse events
CDC states that scientific evidence overwhelmingly supports the safety of hepatitis A vaccines, and that the most frequently reported adverse events associated with hepatitis A vaccination are fever, injection site reactions and rash. [3]
| Vaccine | Reactions reported |
|---|---|
| Havrix, adults and children 2 years and older | Injection-site soreness 56% of adults and 21% of children; headache 14% of adults and less than 9% of children. [5] |
| Vaqta, adults 19 years and older | Injection-site pain, tenderness or soreness 67.0%, injection-site warmth 18.2% and headache 16.1%. [7] |
| Twinrix | After any dose, injection site soreness 35% to 41% and redness 8% to 11%; headache 13% to 22% and fatigue 11% to 14%. [9] |
Hepatitis A vaccine components cannot cause hepatitis A infection: the Havrix label advises emphasizing that Havrix contains non-infectious killed viruses. [5]
Syncope can occur with injectable vaccines, including Havrix and Twinrix; procedures should be in place to avoid injury from fainting. [5] [9]
Special populations
Pregnancy: CDC lists pregnant patients at risk for HAV infection or severe outcome from HAV infection as a group recommended for vaccination. [3]
Chronic liver disease and HIV: people with chronic liver disease or HIV infection are at increased risk for severe disease from HAV infection, and CDC recommends vaccination for these groups. [3]
Altered immunocompetence and hepatic impairment are addressed in the Havrix label (sections 5.3 and 8.6); consult the label for current wording. [5]
Children: CDC recommends routine vaccination of all children 12 to 23 months and catch-up vaccination of unvaccinated children and adolescents 2 to 18 years; CDC's VIS describes the pediatric schedule (first dose 12 through 23 months, second dose at least 6 months later). Pediatric schedules are in CDC's child and adolescent schedule and are not reproduced here. [3] [2]
Counseling pearls for the pharmacy counter
- Hepatitis A vaccine has made the disease much less common in the United States, but outbreaks among unvaccinated people still happen. [2]
- Tell the vaccination provider about an allergic reaction after a previous dose or any severe, life-threatening allergy. [2]
- Travelers should be vaccinated at least 2 weeks before exposure; the second dose completes the series 6 to 12 months later with Havrix or 6 to 18 months later with Vaqta. [5] [7]
- Report suspected adverse events to VAERS at 1-800-822-7967. [5]
Common patient questions
Can any adult who asks for hepatitis A vaccine receive it?
Yes. CDC's adult schedule notes say any person who is not fully vaccinated and requests vaccination should receive it, and identification of a risk factor is not required. [15]
A patient was exposed to a hepatitis A case yesterday. What now?
An unvaccinated person with direct contact should receive hepatitis A vaccine as soon as possible and within 2 weeks after exposure. [2]
How long until the booster dose?
Havrix: between 6 and 12 months after the first dose; Vaqta: 6 to 18 months after the first dose (CDC minimum interval 6 months). [15]
Is Twinrix an option before travel?
Yes, Twinrix may be given on an accelerated schedule (3 doses at 0, 7 and 21 to 30 days, followed by a booster at 12 months) for travel to countries with high or intermediate endemic hepatitis A. [15]
Do health care workers need hepatitis A vaccine?
CDC lists health care personnel as a low-risk group that does not need routine vaccination, though any person can receive it on request. [3]
References
- Centers for Disease Control and Prevention. Clinical overview of hepatitis A. Accessed October 11, 2026. https://www.cdc.gov/hepatitis-a/hcp/clinical-overview/index.html. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. Hepatitis A vaccine: what you need to know. Vaccine Information Statement, January 31, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/current-vis/hepatitis-a.html. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. Hepatitis A vaccine administration. Page dated January 31, 2025. Accessed October 11, 2026. https://www.cdc.gov/hepatitis-a/hcp/vaccine-administration/index.html. Accessed October 11, 2026.
- U.S. Food and Drug Administration. HAVRIX product page (content current as of 05/15/2026). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/havrix. Accessed October 11, 2026.
- HAVRIX (hepatitis A vaccine) injectable suspension, for intramuscular use: prescribing information, revised 5/2026, GlaxoSmithKline Biologicals SA, as published by the National Library of Medicine DailyMed (FDA's own package insert link for HAVRIX returned a "page not found" error on the access date). Accessed October 11, 2026. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f9499a4d-1288-4bd3-9d59-1d72092c38cd. Accessed October 11, 2026.
- U.S. Food and Drug Administration. VAQTA product page (content current as of 10/26/2020). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/vaqta. Accessed October 11, 2026.
- VAQTA (hepatitis A vaccine, inactivated) suspension for intramuscular injection: prescribing information as posted on FDA's product page (revision date shown as a placeholder, "XX/20XX"). Merck Sharp & Dohme Corp. U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/74519/download?attachment. Accessed October 11, 2026.
- U.S. Food and Drug Administration. TWINRIX product page (content current as of 05/15/2026). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/twinrix. Accessed October 11, 2026.
- TWINRIX (hepatitis A and hepatitis B [recombinant] vaccine) injectable suspension, for intramuscular use: prescribing information. GlaxoSmithKline Biologicals; revised 4/2023. U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/119351/download?attachment. Accessed October 11, 2026.
- American Academy of Family Physicians. Adults 19 and older immunization schedules (adopted version; page shows no version date). Accessed October 11, 2026. https://www.aafp.org/clinical-insights/immunizations-and-vaccines/immunizations-schedules-resources/adult-immunization-schedules. Accessed October 11, 2026.
- Congressional Research Service. The 2026 Childhood Immunization Schedule (R48982). June 11, 2026. Accessed October 11, 2026. https://www.congress.gov/crs_external_products/R/PDF/R48982/R48982.1.pdf. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. CDC acts on Presidential Memorandum to update childhood immunization schedule. News release, January 5, 2026. Accessed October 11, 2026. https://www.cdc.gov/media/releases/2026/2026-cdc-acts-on-presidential-memorandum-to-update-childhood-immunization-schedule.html. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. Healthcare professionals: immunization schedules. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html. Accessed October 11, 2026.
- American Academy of Pediatrics. AAP releases recommended childhood and adolescent immunization schedule for 2026. HealthyChildren.org news. Accessed October 11, 2026. https://healthychildren.org/English/news/Pages/AAPs-recommended-childhood-and-adolescent-immunization-schedule-for-2026.aspx. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. Adult immunization schedule notes: recommendations for ages 19 years or older, United States, 2025. July 2, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-notes.html. Accessed October 11, 2026.
For professional education. Check current labeling and guidance before acting. Not medical advice.
