Treatment of Hepatitis A
Hepatitis A requires only supportive care, as no specific antiviral therapy exists or is necessary for this self-limited infection. 1, 2
Acute Phase Management
The cornerstone of treatment is symptomatic support with strict avoidance of hepatotoxic medications. 2 This includes:
- Rest, adequate hydration, and symptomatic relief as needed 1
- High-calorie diet to support recovery 3
- Strict avoidance of all hepatotoxic medications and drugs metabolized by the liver during acute illness 2
- Complete abstinence from alcohol 3
- Avoid excessive acetaminophen (>2 g/day) and hepatotoxic herbal supplements 1
Hospitalization Criteria
Hospitalize patients who develop dehydration from nausea and vomiting or show any signs suggesting acute liver failure. 1, 2 Intravenous rehydration becomes necessary when patients cannot maintain adequate oral intake. 3
Disease Course and Monitoring
The clinical course varies significantly:
- Most patients recover uneventfully within 2 months 4
- 10-15% experience prolonged or relapsing disease lasting up to 6 months, with approximately 20% of relapsing cases having multiple recurrences 2
- Fulminant hepatitis is rare (0.015-0.5% incidence) but carries significant mortality risk 5
- Adults over age 50 have a mortality rate of 1.8% compared to 0.3-0.6% overall 2
High-Risk Populations Requiring Enhanced Surveillance
Patients with underlying chronic liver disease (including hepatitis B or C coinfection) and immunocompromised individuals require careful monitoring. 2 These populations face higher risk of severe complications and should be followed more closely throughout the illness.
Post-Exposure Prophylaxis for Contacts
Administer post-exposure prophylaxis within 2 weeks of exposure for maximum effectiveness—efficacy drops significantly after this window. 2
Who Receives Prophylaxis
Provide prophylaxis to all household and sexual contacts of confirmed hepatitis A cases. 2
Choice of Prophylactic Agent
For healthy individuals aged ≥12 months, hepatitis A vaccine alone is now preferred over immune globulin. 2 The vaccine provides >85% protection when given before or within 2 weeks after exposure. 1
Use immune globulin specifically for: 2
- Infants under 12 months of age
- Immunocompromised persons
- Patients with chronic liver disease
- Those with contraindications to vaccination
Prevention in High-Risk Groups
Vaccinate all men who have sex with men, as this population experiences frequent outbreaks. 2 Additional vaccination targets include:
- All persons who use injection or non-injection drugs 2
- All patients with chronic liver disease, including those with hepatitis B and/or C coinfection 2
- International travelers to endemic areas 1
Check hepatitis A total or IgG antibody 1-2 months after the second vaccine dose to confirm immunogenicity. 2
Critical Pitfalls to Avoid
Never delay post-exposure prophylaxis beyond 2 weeks, as efficacy drops precipitously after this timeframe. 2 This represents the single most important time-sensitive intervention.
Do not prescribe any medications metabolized by the liver during acute illness, as hepatic function is compromised. 2 This includes many commonly used drugs that could worsen liver injury.
Do not assume contacts are immune—verify immunity status and provide prophylaxis as indicated. 2 Even in vaccinated populations, breakthrough infections can occur, making contact tracing and prophylaxis essential.
Recognize that standard measures like condom use do not prevent hepatitis A transmission, as the fecal-oral route is the primary mode of spread. 1 Vaccination remains the only effective prevention strategy for at-risk populations.