What is the treatment and prevention for Hepatitis A (infectious liver disease)?

Hepatitis A: Treatment and Prevention

Treatment

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

Supportive Management

• Provide hydration, rest, and symptomatic relief as the mainstay of treatment 2, 3
• Hospitalize patients who develop dehydration from nausea and vomiting 1, 3
• Avoid all hepatotoxic medications and drugs metabolized by the liver during acute illness 1, 2
• Monitor liver function tests (ALT, AST, bilirubin, INR) in patients with severe jaundice 3
• Watch closely for signs of fulminant hepatitis including prolonged INR and hepatic encephalopathy, which occurs in <1% of cases but carries significant mortality 3, 4

Clinical Course Expectations

• Most patients recover completely within 2 months without chronic sequelae 1, 5
• 10-20% experience prolonged or relapsing illness lasting up to 6 months, with approximately 20% of these having multiple relapses 2, 5, 4
• Overall mortality is 0.3%, but increases to 1.8% in adults over 50 years 1, 2
• Patients with chronic liver disease face higher risk of fulminant hepatitis A and death 1, 2

Prevention

Pre-Exposure Vaccination (Primary Prevention)

Hepatitis A vaccination is the most effective prevention strategy and should be prioritized for all eligible individuals. 1

Routine Vaccination Recommendations

• All children aged 12-23 months should receive routine hepatitis A vaccination 1, 2, 6
• All children aged 2-19 years in states/communities with historically high disease rates 1

High-Risk Groups Requiring Vaccination

• Men who have sex with men (both adolescents and adults) 1
• Users of injection and non-injection illegal drugs 1
• Travelers to countries with intermediate or high hepatitis A endemicity 1, 6
• Persons with chronic liver disease (including hepatitis B, hepatitis C, cirrhosis) 1, 6
• Persons with clotting factor disorders 1
• Persons working with nonhuman primates 1
• Incarcerated populations 6
• Persons with HIV infection 6

Vaccine Efficacy

• 99-100% of persons develop protective antibodies after one dose, with the second dose providing long-term protection 1
• Vaccine efficacy is 94-100% in preventing HAV infection 1

Post-Exposure Prophylaxis

For healthy unvaccinated individuals exposed to hepatitis A, hepatitis A vaccine alone is now preferred over immune globulin. 2, 3

Timing and Administration

• Administer prophylaxis within 2 weeks of exposure for maximum effectiveness 1, 2
• Vaccine and immune globulin can be given simultaneously at different injection sites if both are indicated 1, 3

Immune Globulin Indications

Use immune globulin (IG) instead of or in addition to vaccine for:

• Infants <12 months of age 2
• Immunocompromised persons 2
• Persons with chronic liver disease 2
• Persons with vaccine contraindications 2
• Persons for whom vaccine efficacy may be reduced 1

Specific Exposure Scenarios Requiring Prophylaxis

Close Personal Contact:

• All household and sexual contacts of confirmed cases 1
• Persons who shared illicit drugs with a confirmed case (give both IG and vaccine) 1
• Regular babysitters and others with ongoing close contact 1

Child Care Centers:

• All unvaccinated staff and attendees if ≥1 case occurs in children or employees 1
• All unvaccinated staff and attendees if cases occur in ≥2 households of attendees 1
• Consider for household members of children in diapers during outbreaks (≥3 families affected) 1

Food Handler Exposure:

• Administer IG to other food handlers at the same establishment when a food handler is diagnosed 1
• Consider IG for patrons only if: the infected food handler directly handled uncooked/post-cooked foods AND had diarrhea or poor hygiene AND patrons can be identified and treated within 2 weeks 1
• Do not give IG after cases begin in common-source outbreaks (the 2-week window has passed) 1

Schools, Hospitals, Workplaces:

• IG is NOT routinely indicated for single cases when the source is outside the setting 1
• Give IG only if epidemiologic investigation confirms HAV transmission occurred within the setting 1

Infection Control Measures

Implement strict hygiene practices to prevent transmission:

• Ensure thorough handwashing facilities and frequent handwashing by all individuals 3, 7
• Maintain proper sanitation and safe drinking water supply 3
• Emphasize careful food handling practices 1
• Isolate infected individuals during peak infectivity (2 weeks before to 1 week after jaundice onset) 6

Critical Pitfall to Avoid

Do not delay post-exposure prophylaxis while awaiting serologic testing - the 2-week window is critical, and testing is not cost-effective for prophylaxis decisions 1. The virus reaches maximum concentration in stool during the 2 weeks before jaundice appears, making early intervention essential 2.