From the Guidelines
Post-exposure prophylaxis (PEP) for Hepatitis A should be administered as soon as possible, ideally within 2 weeks of exposure, with the recommended regimen depending on the exposed person's age and health status. For healthy individuals aged 1-40 years, a single dose of monovalent Hepatitis A vaccine should be administered as soon as possible, ideally within 2 weeks of exposure 1. For persons over 40 years, immunocompromised individuals, those with chronic liver disease, and infants under 12 months, immune globulin is preferred (0.1 mL/kg body weight given intramuscularly) 1. In situations where IG is unavailable or contraindicated, Hepatitis A vaccine can be used for all age groups. Some key points to consider include:
- The vaccine works by stimulating the immune system to produce antibodies against the Hepatitis A virus before infection can become established, while IG provides immediate passive immunity through preformed antibodies 1.
- No specific antiviral treatment is needed alongside PEP, and exposed persons should be counseled about symptoms of Hepatitis A and advised to practice good hand hygiene to prevent further transmission 1.
- The provider’s risk assessment should determine the need for IG administration, and if both vaccine and IG are warranted, they should be administered simultaneously at different anatomic sites 1. Some specific recommendations based on age and health status are:
- For postexposure prophylaxis in healthy individuals aged 12 months to 40 years, a single dose of Hepatitis A vaccine is recommended, with no IG needed 1.
- For individuals over 40 years, a single dose of Hepatitis A vaccine and 0.1 mL/kg of IG may be recommended, based on the provider's risk assessment 1.
- For immunocompromised individuals or those with chronic liver disease, a single dose of Hepatitis A vaccine and 0.1 mL/kg of IG should be administered simultaneously at different anatomic sites 1. It is essential to follow the most recent guidelines for the administration of PEP for Hepatitis A, as outlined in the MMWR Recommendations and Reports 1.
From the Research
Post-Exposure Prophylaxis for Hepatitis A
The recommended post-exposure prophylaxis (PEP) for Hepatitis A (HA) includes:
- Hepatitis A vaccine administered within 14 days after exposure to the virus 2
- Immune globulin (IG) given within 14 days after exposure, especially for individuals over 40 years of age or those at risk of severe infection 3, 4
Comparison of Hepatitis A Vaccine and Immune Globulin
Studies have compared the efficacy of hepatitis A vaccine and immune globulin for PEP:
- A study published in The New England Journal of Medicine found that both hepatitis A vaccine and immune globulin provided good protection after exposure, although the vaccine may have a slightly lower efficacy 2
- Another study published in PloS one found that timely administration of HAV vaccine in PEP was feasible and the secondary attack rate was low in those under 40 years, but recommended IG for people over 40 years of age and those vulnerable to severe disease 3
Recommendations for Post-Exposure Prophylaxis
Recommendations for PEP vary depending on the individual's age and risk factors:
- For individuals under 40 years of age, hepatitis A vaccine is recommended for PEP 2, 4
- For individuals over 40 years of age, immune globulin is recommended for PEP, although hepatitis A vaccine may be considered in some cases 3, 4
- For individuals at risk of severe infection, immune globulin is recommended for PEP 3
Key Considerations
Key considerations for PEP include: