Hepatitis A resurgence: time to reconsider routine pediatric immunization

The shifting epidemiological landscape of hepatitis A virus (HAV) infection represents a growing concern across Europe, driven by a significant 2025 resurgence and widespread pediatric outbreaks. Although perceived as a mild childhood infection, HAV can cause severe clinical complications, including acute liver failure requiring emergency liver transplantation, and death. Furthermore, the clinical and financial burden is heavily compounded by atypical biphasic or relapsing courses occurring in up to 20% of cases, which inflate healthcare costs through prolonged hospitalizations. When a child is hospitalized, the resulting loss of parental working days drives up massive indirect societal costs. To mitigate this, the United States implemented a universal nationwide pediatric mandate in 2006, which reduced nationwide HAV incidence by over 95% through powerful herd immunity. In an era of escalating global migration and human mobility, infected individuals frequently cross borders undetected during the long asymptomatic incubation period, acting as active vectors that fuel widespread contagion. Integrating the safe, cost-acceptable HAV vaccine into routine European schedules through co-administration represents a scientifically validated approach to optimize delivery costs, improve family adherence, and eradicate this vaccine-preventable disease. It is essential to emphasize that vaccination in early childhood provides long-lasting protection that extends into adulthood, thereby also protecting those who, as adults, fall into high-risk categories and are usually opposed to vaccination.