What is the treatment and prevention of Hepatitis A (Hep A)?

Hepatitis A: Treatment and Prevention

Hepatitis A requires no specific treatment as it is self-limited, but prevention through vaccination is highly effective and should be prioritized for all children aged 12-23 months and high-risk adults.

Treatment

Hepatitis A is managed with supportive care only, as the infection is self-limited and does not progress to chronic disease. 1, 2

• The disease typically resolves spontaneously without chronic sequelae 2
• Symptomatic treatment addresses fever, malaise, nausea, and jaundice 1
• Up to 20% of patients may experience a prolonged or relapsed course, but this still resolves without specific intervention 2
• Acute liver failure occurs in <1% of cases 2
• No antiviral therapy exists or is needed for hepatitis A 1

Prevention: Vaccination Strategy

Routine Childhood Vaccination

All children aged 12-23 months should receive routine hepatitis A vaccination. 3

• Catch-up vaccination is recommended for all children and adolescents aged 2-18 years who have not previously received the vaccine 3
• The vaccine series must be completed according to the licensed schedule for long-term protection 4
• Vaccine-induced antibodies confer long-term immunity 2, 3

High-Risk Adult Populations Requiring Vaccination

The following adult groups should be vaccinated: 4, 3

• Men who have sex with men (MSM) - both adolescents and adults 4
• Users of injection and non-injection illicit drugs 4
• Travelers to endemic areas - vaccine should be given as soon as travel is considered 4
• Persons with chronic liver disease - including those awaiting or who have received liver transplants 4
• Persons with clotting-factor disorders receiving clotting-factor concentrates 4
• Occupational exposure - persons working with HAV-infected primates or HAV in research laboratories 4
• Adults requesting protection without acknowledgment of a specific risk factor 3

Important caveat: Persons with chronic HBV or HCV infections without evidence of chronic liver disease do not require routine vaccination 4

Pre-Travel Vaccination Timing

For travelers to endemic areas, optimal protection requires starting vaccination as soon as travel is considered: 4

• Protection can be assumed within 4 weeks after the first vaccine dose 4
• For travelers departing in <4 weeks, consider adding immune globulin (IG) 0.02 mL/kg at a different injection site for optimal protection 4
• Travelers departing in <4 weeks who cannot receive IG should still receive the vaccine but be informed protection may not be complete for 2-4 weeks 4

Alternative for vaccine-ineligible travelers: 4

• Single dose of IG (0.02 mL/kg) provides protection for up to 3 months
• For travel >2 months, use IG 0.06 mL/kg; repeat if travel exceeds 5 months

Postexposure Prophylaxis

Persons recently exposed to HAV who have not previously received hepatitis A vaccine should receive IG (0.02 mL/kg) as soon as possible. 4

• IG must be administered within 2 weeks of exposure for efficacy 4
• Persons who received ≥1 dose of hepatitis A vaccine >1 month before exposure do not need IG 4
• Previously unvaccinated children receiving postexposure IG should also receive hepatitis A vaccine 4
• Serologic confirmation of HAV infection in the index patient by IgM anti-HAV is essential before administering prophylaxis 4

Outbreak Control

During community outbreaks, accelerated vaccination programs should be considered as an additional control measure. 4

• Routine childhood vaccination programs have dramatically reduced large community outbreaks 4
• Limited outbreaks among high-risk adults (illicit drug users, MSM) require focused vaccination efforts 4
• In child care center outbreaks, IG is effective in limiting transmission to employees and families 4

Key Clinical Pitfalls

• Do not delay vaccination waiting for "optimal timing" - start as soon as indicated 4
• Do not routinely test for prevaccination immunity in adolescents and young adults - testing may be warranted only in older adults in high-risk groups 4
• Do not confuse hepatitis A with hepatitis B or C - hepatitis A never causes chronic infection or chronic liver disease 1, 2
• Remember that patients are most infectious 14 days before and 7 days after jaundice develops - the window for postexposure prophylaxis is narrow 1