Hepatitis A

The major mechanism of spread is through oral inoculation of faecally excreted virus, which makes this infection preventable through simple public health measures. The virus may survive for up to 4 hours on the fingertips; adherence to strict handwashing after handling faecal material is of utmost importance.[27]Mbithi JN, Springthorpe VS, Boulet JR, et al. Survival of hepatitis A virus on human hands and its transfer on contact with animate and inanimate surfaces. J Clin Microbiol. 1992 Apr;30(4):757-63. http://www.ncbi.nlm.nih.gov/pubmed/1315331?tool=bestpractice.com

In the US, routine hepatitis A vaccination is recommended for:[21]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com [28]Centers for Disease Control and Prevention. Immunization schedules: child and adolescent immunization schedule by age: recommendations for ages 18 years or younger, United States, 2024. Nov 2023 [internet publication]. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html [29]Centers for Disease Control and Prevention. Immunization schedules: ​adult immunization schedule by age: recommendations for ages 19 years or older, United States, 2024. Nov 2023 [internet publication]. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html [30]American College of Obstetricians and Gynecologists. Practice Guideline No. 6: viral hepatitis in pregnancy. Sep 2023 [internet publication]. https://journals.lww.com/greenjournal/abstract/2023/09000/viral_hepatitis_in_pregnancy__acog_clinical.33.aspx http://www.ncbi.nlm.nih.gov/pubmed/37590986?tool=bestpractice.com ​​

Children and adolescents:

• All children aged 12-23 months

• Children and adolescents aged 2-18 years who have not previously received the hepatitis A vaccination (i.e., children and adolescents are recommended for catch up vaccination).

People (including pregnant women) at increased risk of hepatitis A virus (HAV) infection:

• International travellers

• Men who have sex with men

• People who use injection or noninjection drugs (i.e., those who use illegal drugs)

• People with occupational risk of exposure

• People who anticipate close personal contact with an international adoptee

• People experiencing homelessness

• People with HIV infection aged ≥1 year.

People (including pregnant women) at risk of developing serious complications from HAV infection:

• People with chronic liver disease

• People with HIV infection.

The Advisory Committee on Immunization Practices (ACIP) also recommends hepatitis A vaccination for:[21]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com

• Unvaccinated people in outbreak settings who are at risk for HAV infection or at risk for severe disease from HAV

• People in settings that provide services to adults in which a high proportion of those persons have risk factors for HAV infection

• Any people who request vaccination.

Refer to ACIP vaccine recommendations and guidelines for further details. CDC: ACIP vaccine recommendations and guidelines Opens in new window

Hepatitis A vaccine recommendations may differ in other countries.[31]World Health Organization. WHO position paper on hepatitis A vaccines – October 2022. Oct 2022 [internet publication]. https://www.who.int/publications/i/item/who-wer9740-493-512 [32]UK Health Security Agency. Hepatitis A: guidance, data and analysis. Jun 2021 [internet publication]. https://www.gov.uk/government/collections/hepatitis-a-guidance-data-and-analysis

Active or passive immunisation is available for protection following exposure to hepatitis A virus (HAV) infection. Recommendations concerning post-exposure prophylaxis may differ geographically, so specific national guidelines should be consulted.[21]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com ​​[31]World Health Organization. WHO position paper on hepatitis A vaccines – October 2022. Oct 2022 [internet publication]. https://www.who.int/publications/i/item/who-wer9740-493-512 [32]UK Health Security Agency. Hepatitis A: guidance, data and analysis. Jun 2021 [internet publication]. https://www.gov.uk/government/collections/hepatitis-a-guidance-data-and-analysis [43]Centers for Disease Control and Prevention. Morbidity and mortality weekly report: update: recommendations of the Advisory Committee on Immunization Practices for use of hepatitis A vaccine for postexposure prophylaxis and for preexposure prophylaxis for international travel. Mar 2019 [internet publication]​. https://www.cdc.gov/mmwr/volumes/67/wr/mm6743a5.htm ​​[44]Public Health England. Public health control and management of hepatitis A. Jun 2017 [internet publication]. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/623036/Public_health_control_and_management_of_hepatitis_A_2017.pdf ​​​​

Immunocompetent people (aged ≥12 months)

For healthy people with recent HAV exposure (<2 weeks) who have not completed the two-dose hepatitis A vaccine series, the US Centers for Disease Control and Prevention (CDC) recommends:[21]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com

• A single dose of the hepatitis A vaccine as soon as possible

• Discretionary co-administration of immunoglobulin for people aged >40 years (depending on provider assessment of individual risk factors for HAV infection and/or HAV-related complications).

Immunocompromised people or chronic liver disease (aged ≥12 months)

For immunocompromised people or those with chronic liver disease who have not completed the two-dose hepatitis A vaccine series, the CDC recommends:[21]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com

• Immunoglobulin and a single dose of hepatitis A vaccine simultaneously at anatomically discrete sites, as soon as possible (<2 weeks).

Infants aged <12 months/vaccine contraindicated

Children younger than 12 months and those with a history of a life-threatening allergy following administration of hepatitis A vaccine (or severe allergy to any component of the vaccine) should receive:[21]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com CDC: hepatitis A FAQs for health professionals Opens in new window

• Immunoglobulin as soon as possible (<2 weeks since exposure).

Patients who require post-exposure prophylaxis

The CDC recommends post-exposure prophylaxis for the following patient populations: CDC: hepatitis A FAQs for health professionals Opens in new window

• All previously unvaccinated people exposed to (or at risk of exposure to) people with serologically confirmed hepatitis A including:

  • Household members

  • Sexual contacts

  • People who have shared injection drugs with someone with hepatitis A

  • Carers not using personal protective equipment

• All previously unvaccinated members of staff and attendees at childcare centres where:

  • One or more cases of hepatitis A infection is recognised in children or employees

  • Cases are recognised in two or more households of centre attendees

• Food handlers in the same establishment of another food handler who receives a diagnosis of hepatitis A

• People who have close contact with infected patients, if an epidemiological investigation indicates hepatitis A transmission has occurred:

  • In a school

  • Among hospital patients

  • Between patients and hospital staff.

Further specific considerations are provided online by the CDC. CDC: hepatitis A FAQs for health professionals Opens in new window