Treatment of Foodborne Hepatitis A
Treatment for Hepatitis A acquired through foodborne illness is entirely supportive, as HAV infection is self-limited and does not result in chronic infection or chronic liver disease. 1
Primary Management Approach
Supportive care is the mainstay of treatment for all patients with hepatitis A, regardless of transmission route. 1, 2 The infection resolves spontaneously in the vast majority of cases without specific antiviral therapy.
Outpatient Management
For most patients, treatment consists of:
- No specific medications are required for uncomplicated hepatitis A infection 1
- Avoid hepatotoxic medications and drugs metabolized by the liver during the acute illness 1
- No dietary restrictions are necessary 1
- No activity restrictions are required 1
- Most patients recover within 3-4 weeks, with complete resolution of elevated liver enzymes 1
Hospitalization Criteria
Hospitalization is necessary only for patients who develop:
- Dehydration from severe nausea and vomiting that prevents adequate oral intake 1
- Fulminant hepatitis A with signs of acute liver failure 1
Monitoring for Complications
Relapsing Disease
- 10-15% of patients experience relapsing disease lasting up to 6 months 1, 3
- Approximately 20% of those with relapsing disease have multiple relapses 1, 3
- Even with relapses, overall outcomes remain very good 1
- For cholestatic hepatitis with prolonged jaundice, a short course of rapidly tapered corticosteroids can reduce symptoms 1
Fulminant Hepatitis A
Monitor high-risk patients closely for signs of fulminant disease:
- Patients >50 years old have a case fatality rate of 1.8% (compared to 0.3% overall) 1, 3
- Patients with chronic liver disease (including hepatitis B or C) are at significantly increased risk for fulminant hepatitis A 1, 3
- Fulminant disease is characterized by worsening jaundice, deteriorating liver function, coagulopathy, and encephalopathy 1
- Liver transplantation may be required for fulminant hepatitis A, though spontaneous recovery occurs in 30-60% of cases 1, 4
Clinical Course Expectations
- Peak infectivity occurs 2 weeks before jaundice onset, so patients are often past peak infectiousness when diagnosed 1, 3
- Discoloration of stool typically resolves within 2-3 weeks, indicating disease resolution 1
- Children can shed virus for up to 10 weeks after illness onset 3
Key Clinical Pitfall
The most important pitfall is failing to identify patients with chronic liver disease at presentation, as these patients require closer monitoring for fulminant hepatitis A development. 1, 3 Always obtain a thorough history of pre-existing liver conditions, including hepatitis B, hepatitis C, cirrhosis, or alcohol-related liver disease.
Post-Exposure Prophylaxis for Contacts
While not treatment for the infected patient, contacts exposed to the foodborne source should receive post-exposure prophylaxis:
- Hepatitis A vaccine or immune globulin (IG) should be administered within 2 weeks of exposure 1
- For healthy persons, hepatitis A vaccine alone is now preferred 1
- IG should be used for children <12 months, immunocompromised persons, those with chronic liver disease, and those for whom vaccine is contraindicated 1