What is the management for Hepatitis A (Hep A)?

Management of Hepatitis A

Hepatitis A management is entirely supportive care, as no specific antiviral therapy exists or is necessary for this self-limited infection. 1, 2

Acute Phase Management

Supportive Care Measures

• Provide symptomatic treatment only - no medications are required for uncomplicated hepatitis A infection 1, 2
• Ensure adequate hydration and nutrition with a high-calorie diet 2
• Recommend bed rest if the patient is significantly symptomatic 2
• Strictly avoid hepatotoxic medications and drugs metabolized by the liver during the acute illness 1, 2
• Mandate complete alcohol abstinence throughout the illness course 2

Hospitalization Criteria

• Hospitalize patients who cannot maintain oral intake due to severe nausea and vomiting requiring intravenous rehydration 2, 3
• Immediately hospitalize any patient with altered mental status suggesting evolving fulminant hepatic failure 2
• Consider hospitalization for patients with significant dehydration 4

Monitoring and Follow-Up

Disease Course Expectations

• Most patients recover uneventfully with complete resolution 2
• 10-15% of symptomatic patients experience prolonged or relapsing disease lasting up to 6 months 1
• Approximately 20% of those with relapsing disease have multiple recurrences 1
• Fulminant hepatic failure occurs in <1% of cases but carries significant mortality risk 3, 5

High-Risk Populations Requiring Closer Monitoring

• Adults over age 50 years have a mortality rate of 1.8% compared to 0.3-0.6% overall 1
• Patients with underlying chronic liver disease (including hepatitis B or C coinfection) require careful monitoring 4
• Pregnant women may experience more severe disease 3
• Immunocompromised individuals need enhanced surveillance 1

Post-Exposure Management of Contacts

Timing of Prophylaxis

• Administer post-exposure prophylaxis within 2 weeks of exposure for maximum effectiveness 1, 4
• Prophylaxis is indicated for household and sexual contacts of confirmed hepatitis A cases 4

Choice of Prophylaxis Agent

• For healthy individuals aged ≥12 months: hepatitis A vaccine alone is now preferred over immune globulin 1
• Use immune globulin (0.02 mL/kg IM) for:
  • Infants under 12 months of age 1
  • Immunocompromised persons 1
  • Patients with chronic liver disease 1
  • Those with contraindications to vaccination 1

Prevention Strategies

Vaccination Recommendations

• Vaccinate all men who have sex with men - this is a strong recommendation based on outbreak data 4
• Vaccinate persons who use injection or non-injection drugs 4
• Vaccinate all patients with chronic liver disease, including those with hepatitis B and/or C coinfection 4
• Vaccinate travelers to countries with high hepatitis A endemicity 4
• Consider vaccination for all other non-immune patients 4

Vaccine Response Assessment

• Check hepatitis A total or IgG antibody 1-2 months after the second vaccine dose to confirm immunogenicity 4
• Administer a repeat vaccine series if the patient remains seronegative 4

Critical Pitfalls to Avoid

• Never delay post-exposure prophylaxis - efficacy drops significantly after 2 weeks from exposure 4, 1
• Do not prescribe medications metabolized by the liver during acute illness, as hepatic function is compromised 1, 2
• Do not miss signs of fulminant hepatic failure - any mental status changes require immediate evaluation for potential liver transplantation 2
• Do not assume all contacts are immune - verify immunity status and provide prophylaxis as indicated 4