Treatment for Hepatitis A
Hepatitis A requires only supportive care, as it is a self-limited infection that does not cause chronic liver disease or require antiviral therapy. 1, 2
Primary Management Strategy
Treatment is entirely supportive for all patients with hepatitis A, regardless of how the infection was acquired. 2 The infection resolves spontaneously in the vast majority of cases without specific medications. 2
Outpatient Supportive Care
- No specific medications are required for uncomplicated hepatitis A infection. 1, 2
- Avoid all medications that might cause liver damage or are metabolized by the liver during the acute illness. 1, 2, 3
- No dietary restrictions are necessary - patients can eat as tolerated. 1, 2
- No activity restrictions are required - bedrest is only needed if the patient is very symptomatic. 1, 4
- Most patients recover completely within 3-4 weeks with full resolution of elevated liver enzymes. 2
When to Hospitalize
Hospitalization is necessary only for two specific situations: 1, 2, 3
- Patients who develop dehydration from severe nausea and vomiting that prevents adequate oral intake - these patients require intravenous rehydration. 1, 2, 4
- Patients who develop fulminant hepatitis A with signs of acute liver failure (worsening jaundice, deteriorating liver function, coagulopathy, encephalopathy). 1, 2, 3
Monitoring for Complications
Relapsing Disease
- 10-15% of patients experience relapsing disease lasting up to 6 months, with approximately 20% having multiple relapses. 2
- Even with relapses, overall outcomes remain very good. 2
- For cholestatic hepatitis with prolonged jaundice, a short course of rapidly tapered corticosteroids can reduce symptoms. 2
High-Risk Populations
- Patients >50 years old have a case fatality rate of 1.8% (compared to 0.3% overall). 2
- Patients with chronic liver disease are at significantly increased risk for fulminant hepatitis A and require closer monitoring. 2, 3
Fulminant Hepatic Failure
- Occurs in <1% of cases but requires immediate recognition. 5
- Monitor for worsening jaundice, prolonged INR, and hepatic encephalopathy. 3
- Liver transplantation may be required, though spontaneous recovery occurs in 30-60% of fulminant cases. 2
- Coagulation factor assays (prothrombin time and factor V levels) are the best monitoring tools. 6
Clinical Course Expectations
- Peak infectivity occurs 2 weeks before jaundice onset, so patients are often past peak infectiousness when diagnosed. 2
- People are most infectious 14 days before and 7 days after the development of jaundice. 7
- Children can shed virus for up to 10 weeks after illness onset. 2
- Discoloration of stool typically resolves within 2-3 weeks, indicating disease resolution. 2
Post-Exposure Prophylaxis for Contacts
Contacts exposed to the same source should receive post-exposure prophylaxis within 2 weeks of exposure. 2, 3
- For healthy persons, hepatitis A vaccine alone is now preferred. 2
- Immune globulin (IG) at 0.02 mL/kg IM should be used for: 1, 2
- Children <12 months old
- Immunocompromised persons
- Those with chronic liver disease
- Those for whom vaccine is contraindicated
- Hepatitis A vaccine can be administered simultaneously with IG at different injection sites. 3