People with chronic liver disease of any aetiology are recommended to receive hepatitis A vaccine

Hepatitis A vaccination is recommended for people with chronic liver disease of any aetiology, if they are not immune to hepatitis A.^2,3 This includes:

• people with chronic liver disease
• people who have received a liver solid organ transplant
• people with chronic hepatitis B 
• people with chronic hepatitis C 

2 doses are required, with a recommended minimum interval between doses of 6 months.

See Table. Recommended doses and schedules for monovalent hepatitis A vaccines. 

People with chronic liver disease should receive the vaccine as early in the course of the disease as possible. Immune responses to vaccination in these people can vary — for example:

• people with chronic liver disease of mild to moderate severity usually mount a good immune response
• people with end-stage liver disease do not respond as well 
• liver transplant recipients may not respond at all ^4,5

People with chronic hepatitis C or hepatitis B are recommended to receive hepatitis A vaccine because of the high case-fatality rate in this group if they acquire hepatitis A.²

If the person is also at risk of acquiring hepatitis B, they can receive a combination hepatitis A/hepatitis B vaccine. This is usually given in 3 doses. People aged 1 to <16 years can receive a 2-dose schedule using Twinrix 720/20.

See Table. Recommended doses and schedules for combination hepatitis A and hepatitis B vaccines. 

For more details, see:

• Hepatitis B
• Groups with special vaccination requirements