From the Guidelines
Management of recent hepatitis A infection focuses on supportive care as the disease is typically self-limiting and resolves without specific antiviral therapy. Patients with positive Hepatitis A antibody (Hep A ab) and IgM should maintain adequate hydration and nutrition while avoiding hepatotoxic substances, particularly alcohol and medications that can stress the liver (such as acetaminophen) 1.
Key Recommendations
- Rest is recommended during the acute phase, with gradual return to normal activities as symptoms improve.
- No specific medications are required for uncomplicated hepatitis A infection.
- Hospitalization is only necessary for severe cases with complications like dehydration or fulminant hepatic failure, which are rare.
- Patients should be advised about proper hygiene measures to prevent transmission, including thorough handwashing after using the bathroom and before handling food.
- Close contacts of the infected individual should receive hepatitis A vaccination or immune globulin within two weeks of exposure for post-exposure prophylaxis, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1.
Post-Exposure Prophylaxis
The use of immune globulin (IG) for post-exposure prophylaxis is supported by evidence, with a dose of 0.02 mL/kg body weight, intramuscular, administered as soon as possible, but not more than 2 weeks after the last exposure 1.
Outcome
After recovery, patients develop lifelong immunity against hepatitis A virus, and no follow-up testing is typically needed unless complications are suspected. The infection typically resolves completely within 4-8 weeks with no long-term liver damage.
From the Research
Management and Treatment of Hepatitis A Infection
The management and treatment of a patient with recent hepatitis A infection, indicated by positive Hepatitis A antibody (Hep A ab) and IgM, typically involves supportive care, as the disease is usually self-limited 2.
Symptoms and Diagnosis
- The symptoms of hepatitis A infection may include fever, nausea/vomiting, fatigue, abdominal pain, and jaundice, although rarer manifestations such as maculopapular skin rash and polyarthralgia may be observed 3.
- Diagnosis of acute infection requires the use of serologic testing for immunoglobulin M anti-hepatitis A antibodies 2.
- The disease is usually self-limited, and chronic infection or chronic liver disease does not occur 2.
Treatment and Prevention
- Supportive care is often sufficient for treatment, and 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.
- The vaccine is usually recommended for pre- and postexposure prophylaxis, but immune globulin can be used in patients who are too young to be vaccinated or if the vaccine is contraindicated 2, 4, 5.
Prognosis and Recovery
- Nearly all adult patients with clinically apparent disease experience complete clinical recovery with restoration of normal serum bilirubin and aminotransferase values by 6 months 6.
- Relapses and prolonged cholestasis are unusual manifestations of hepatitis A, and even in these circumstances, recovery is the rule and chronic hepatitis is not seen 6.