Winter 1998-99 Volume 3, Number 4		ACIP approves expanded hepatitis A vaccination in highest-rate states (Atlanta) At its February meeting, the federal Advisory Committee on Immunization Practices (ACIP) approved a new policy for hepatitis A vaccination in the highest-rate U.S. states (for a review of deliberations on this issue, see the Hepatitis Control Report, Fall 1998 issue). The new statement recommends routine vaccination of children in states where the average annual incidence rate during the period 1987 to 1997 was greater than or equal to 20 per 100,000 per year (approximately twice the national average). The affected states are Arizona, Alaska, Oregon, New Mexico, Utah, Washington, Oklahoma, South Dakota, Nevada, California, and Idaho. The recommendation also applies to counties or communities in the U.S. that had a 1987-1997 average rate of greater than or equal to 20 per 100,000. ACIP also said that in states, counties, and communities where the average 1987-1997 rate was 10 to 20 per 100,000, routine hepatitis A vaccination of children "may be considered." States that meet this criterion are Missouri, Texas, Colorado, Arkansas, Montana, and Wyoming. In addition, ACIP approved use of the federal Vaccines for Children (VFC) entitlement to implement the new policy, which means that federal hepatitis A vaccine can be used to immunize children in areas that meet the new criteria. A few states are already vaccinating children routinely against hepatitis A: Oklahoma, Alaska, Texas (32 counties), and Arizona (day care centers in Maricopa County). A handful of other states and large counties are considering the move. In a related action, the Committee authorized the use of VFC hepatitis A vaccine for eligible children traveling to countries that have a high or intermediate endemicity of hepatitis A infection. This is a sizeable expansion of VFC, because it encompasses thousands of children who cross the U.S.-Mexico border every year.