From the Guidelines
Hepatitis A is a viral liver infection that should be diagnosed through blood tests that detect anti-HAV antibodies and managed with supportive care, while prevention is highly effective through vaccination and good hygiene practices. The diagnosis of hepatitis A is based on a positive serologic test for IgM anti-HAV in a person with clinical signs or symptoms of acute viral hepatitis, as serologic confirmation of HAV infection is required because hepatitis A cannot be distinguished from other forms of viral hepatitis on the basis of clinical presentation alone 1.
Treatment
Treatment is primarily supportive care, as the infection typically resolves on its own within 2-6 months. Patients should:
- Rest
- Maintain adequate hydration
- Avoid alcohol
- Take acetaminophen (up to 2000mg daily in divided doses) for symptom relief while avoiding NSAIDs due to potential liver stress In severe cases, hospitalization may be necessary for IV fluids and monitoring.
Prevention
Prevention is highly effective through vaccination, with two doses of hepatitis A vaccine given 6-12 months apart providing long-term immunity. The vaccine is recommended for:
- Children aged 12-23 months
- Travelers to endemic regions
- Men who have sex with men
- People with chronic liver disease
- During outbreaks Good hygiene practices like thorough handwashing, avoiding contaminated food and water, and proper sanitation also help prevent transmission. Hepatitis A spreads through the fecal-oral route, primarily through contaminated food, water, or close contact with infected individuals, making these preventive measures crucial in controlling its spread. Unvaccinated close contacts of a confirmed case of hepatitis A should be administered postexposure prophylaxis with 1 dose of IG (0.02 mL/kg body weight, intramuscular) as soon as possible, but not >2 weeks after the last exposure 1.
Special Considerations
Persons with chronic hepatitis C are at risk for increased morbidity from additional hepatic insults, and fulminant hepatitis caused by hepatitis A can be prevented by vaccination 1. Therefore, hepatitis A vaccination is strongly recommended for individuals with chronic liver disease.
From the Research
Diagnosis of Hepatitis A
- Hepatitis A is diagnosed using serologic testing for immunoglobulin M anti-hepatitis A antibodies 2
- The disease is usually self-limited, and diagnosis requires the use of serologic testing to confirm acute infection
Treatment of Hepatitis A
- Supportive care is often sufficient for treatment, as chronic infection or chronic liver disease does not occur 2
- In some cases, immune globulin can be used for postexposure prophylaxis, especially in patients who are too young to be vaccinated or if the vaccine is contraindicated 2
Prevention of Hepatitis A
- Routine hepatitis A immunization is recommended in children 12 to 23 months of age 2
- Immunization is also recommended for individuals at high risk of contracting the infection, such as persons who use illegal drugs, those who travel to areas endemic for hepatitis A, incarcerated populations, and persons at high risk of complications from hepatitis A, such as those with chronic liver disease or HIV infection 2
- Hepatitis A vaccine can be used for pre- and postexposure prophylaxis, and it has been shown to be effective in preventing hepatitis A when given within 2 weeks after exposure to the virus 3
- Immune globulin can also be used for postexposure prophylaxis, but hepatitis A vaccine may be a reasonable alternative in many situations 3
Special Considerations
- Screening for hepatitis A and B antibodies is recommended in patients with chronic liver disease to identify those who are already immune to these viruses and do not need to be vaccinated 4
- Selective hepatitis A vaccination is most cost-effective in areas where the local prevalence of hepatitis A is higher than the national prevalence and in populations with higher background rates of HAV exposure 4
- Serologic testing after hepatitis A vaccination is recommended in patients with decompensated or advanced end-stage liver disease due to lower seroconversion rates in these patients 4