What is the treatment for an unvaccinated child exposed to Hepatitis A (infectious liver disease)?

Treatment for Unvaccinated Child Exposed to Hepatitis A

For unvaccinated children exposed to hepatitis A, administer hepatitis A vaccine or immune globulin (IG) within 2 weeks of exposure, with specific recommendations based on age: children aged 12 months-40 years should receive the single-antigen hepatitis A vaccine, while children under 12 months should receive IG (0.02 mL/kg). 1

Age-Based Postexposure Prophylaxis Algorithm

Children Under 12 Months

• Administer IG (0.02 mL/kg) as soon as possible within 2 weeks of exposure 1
• IG is the only option as hepatitis A vaccine is not licensed for this age group
• If international travel is planned, infants 6-11 months may receive hepatitis A vaccine, but this dose should not count toward the routine 2-dose series 1

Children 12 Months to 40 Years

• Administer single-antigen hepatitis A vaccine at age-appropriate dose within 2 weeks of exposure 1
• Preferred over IG due to advantages of:
  • Long-term protection
  • Ease of administration
  • Greater acceptability and availability 1
• Complete the vaccine series with a second dose according to the licensed schedule 1

Special Populations (Any Age)

• Use IG instead of vaccine for:
  • Immunocompromised children
  • Children with diagnosed chronic liver disease
  • Children for whom vaccine is contraindicated 1

Exposure Scenarios Requiring Prophylaxis

1. Close personal contact: Household and sexual contacts of persons with confirmed hepatitis A 1
2. Child care settings: All unvaccinated attendees and staff if:
   • One or more cases identified in children or employees, OR
   • Cases identified in two or more households of center attendees 1
3. School settings: Not routinely indicated for a single case in an elementary or secondary school unless epidemiological investigation indicates transmission has occurred among students 1, 2

Important Clinical Considerations

• Timing is critical: Efficacy of prophylaxis not established if administered >2 weeks after exposure 1
• Serologic confirmation: Verify hepatitis A infection in index case through IgM anti-HAV testing before administering prophylaxis to contacts 1
• No pre-screening: Screening contacts for immunity before administering IG is not recommended as it causes delays 1
• Simultaneous administration: If both IG and vaccine are indicated, administer at different anatomic injection sites 1

Follow-up Care

• Monitor for symptoms of hepatitis A, which are more common in older children (fever, malaise, dark urine, jaundice) 3
• People are most infectious 14 days before and 7 days after jaundice develops 3
• Hepatitis A is usually self-limited with no chronic infection or chronic liver disease 3
• Supportive care is often sufficient for treatment 3

The effectiveness of hepatitis A vaccine for postexposure prophylaxis has been demonstrated, with one study showing only a slight difference in infection rates between vaccine (4.4%) and IG (3.3%) recipients, indicating good protection with both methods 4. The vaccine's advantages of long-term protection make it the preferred option for eligible age groups.