Hepatitis A and E: Prevention and Treatment
Hepatitis A Virus (HAV)
Prevention Through Vaccination
All children should receive hepatitis A vaccine at age 12-23 months, with catch-up vaccination for unvaccinated children aged 2-18 years, as this is the cornerstone of HAV elimination strategy. 1, 2
Routine Childhood Vaccination
- Universal vaccination of children aged 12-23 months is recommended, integrated into the routine childhood vaccination schedule 1, 2
- Vaccination should be completed according to licensed schedules for long-term protection 2
- Children not vaccinated by age 2 years can receive catch-up vaccination at subsequent visits 1
High-Risk Adult Populations Requiring Vaccination
The following groups should receive hepatitis A vaccination 1, 2, 3:
- Travelers to countries with high or intermediate HAV endemicity (vaccination should begin as soon as travel is considered) 1, 2
- Men who have sex with men 2, 4
- Users of injection and non-injection illicit drugs 2, 4
- Persons with chronic liver disease (including hepatitis B, hepatitis C, cirrhosis, or those awaiting/received liver transplants) 2, 5
- Persons with clotting-factor disorders 2
- Persons experiencing homelessness 4
Pre-Travel Vaccination Strategy
For travelers to endemic areas, optimal protection requires starting vaccination as soon as travel is considered, with protection assumed within 4 weeks after the first dose. 1, 2
- For travelers departing in <4 weeks: Consider adding immune globulin (IG) 0.02 mL/kg at a different anatomic injection site for optimal protection 1, 2
- Travelers departing in <4 weeks who cannot receive IG should still receive vaccine, though protection may not be complete 1
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, ideally within 2 weeks of exposure. 1, 2
Specific Postexposure Scenarios
Household and Close Personal Contacts:
- IG should be administered to all previously unvaccinated household and sexual contacts of serologically confirmed hepatitis A cases 1
- Persons who shared illicit drugs with an infected person should receive both IG and hepatitis A vaccine 1
- Consider IG for persons with ongoing close personal contact (e.g., regular babysitting) 1
Child Care Centers:
- IG should be administered to all previously unvaccinated staff and attendees if one or more cases are recognized in children or employees, or if cases occur in two or more households of attendees 1
- Hepatitis A vaccine may be administered simultaneously with IG at a separate injection site 1
Food Handler Exposure:
- IG should be administered to other food handlers at the same establishment 1
- IG for patrons is typically not indicated unless the food handler directly handled uncooked/post-cooked foods while having diarrhea or poor hygiene, and patrons can be treated within 2 weeks 1
Treatment
There is no specific antiviral treatment for hepatitis A; management is supportive as the infection is self-limited. 6
- Most infections resolve spontaneously without chronic sequelae 6
- Up to 20% of patients may experience prolonged or relapsed course lasting up to 6 months 1
- Less than 1% experience acute liver failure, with case-fatality ratio of 0.3-0.6% overall, but reaching 1.8% in adults >50 years 1, 6
Outbreak Control
During community outbreaks, accelerated vaccination programs should be implemented as an additional control measure, with focused efforts on high-risk adult populations. 1, 2
- Routine childhood vaccination programs have dramatically reduced large community outbreaks 2
- Limited outbreaks among high-risk adults require targeted vaccination efforts 2
Hepatitis E Virus (HEV)
Critical Evidence Gap
No guideline or research evidence regarding hepatitis E prevention or treatment was provided in the available literature. The evidence base supplied focuses exclusively on hepatitis A virus.
General Medical Knowledge Application
Based on standard medical practice (not from provided evidence):
- HEV is primarily transmitted through fecal-oral route via contaminated water
- No vaccine is currently licensed in the United States or Europe (though vaccines exist in some countries)
- Prevention relies on safe water, sanitation, and hygiene practices
- Treatment is generally supportive; ribavirin may be considered in severe cases or immunocompromised patients
- Most infections are self-limited in immunocompetent individuals
Key Clinical Pitfall
Do not confuse hepatitis A and hepatitis E management strategies—while both are fecal-orally transmitted, HAV has effective vaccination and postexposure prophylaxis options, whereas HEV prevention relies primarily on sanitation measures in most countries. 6