Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

INITIAL

unvaccinated people with recent exposure to hepatitis A (<2 weeks)

1st line – hepatitis A vaccine and/or immunoglobulin

Back
INITIAL
|
unvaccinated people with recent exposure to hepatitis A (<2 weeks)
1st line – 

hepatitis A vaccine and/or immunoglobulin

Active or passive immunisation is available for protection following exposure to hepatitis A virus (HAV) infection.

The Centers for Disease Control and Prevention (CDC) recommends a single dose of hepatitis A vaccine as soon as possible post-exposure (<2 weeks) for immunocompetent people (aged ≥12 months) who have not completed the two-dose hepatitis A vaccine series:[21] CDC: hepatitis A FAQs for health professionals Opens in new window Co-administration of immunolobulin (at a discrete anatomical site) may be considered for people aged >40 years with risk factors for HAV infection or its complications.

For immunocompromised people, or those with chronic liver disease, who have not completed the two-dose hepatitis A vaccine series, the CDC recommends immunoglobulin and a single dose of hepatitis A vaccine simultaneously (at a discrete anatomical site), as soon as possible (<2 weeks since exposure).

Infants aged <12 months and those with a history of life-threatening allergy following administration of hepatitis A vaccine (or severe allergy to any component of the vaccine) should receive immunoglobulin as soon as possible (<2 weeks since exposure).[21] CDC: hepatitis A FAQs for health professionals Opens in new window

Recommendations concerning post-exposure prophylaxis may differ geographically, so specific national guidelines should be consulted.[21][31][32][43]​​​[44]

Intramuscular immunoglobulin may need to be obtained from a specialist centre; it is not widely commercially available.

Primary options

hepatitis A vaccine: administer according to current recommended schedule

and/or

normal immunoglobulin human: consult specialist for guidance on intramuscular dose

ACUTE

confirmed hepatitis A

1st line – supportive care

Back
ACUTE
|
confirmed hepatitis A
1st line – 

supportive care

Treatment for infection is primarily supportive, including appropriate rest when necessary.[19] No specific antiviral therapy is available.

Excess paracetamol and alcohol should be avoided.[2][18]

Rarely, hospitalisation may become necessary for volume depletion, coagulopathy, encephalopathy, or severe prostration.[18] This is particularly important in patients with co-infection with hepatitis B virus, hepatitis C virus, or cirrhosis of any cause, as acute hepatitis A virus (HAV) infection in these conditions has a higher risk for severe disease.

Plus – liver transplant

Back
ACUTE
|
confirmed hepatitis A
|
with acute liver failure
Plus – 

liver transplant

Treatment recommended for ALL patients in selected patient group

In <1% of patients, acute liver failure occurs characterised by worsening jaundice, coagulopathy, and encephalopathy.[35][36]​ Prompt referral to centres experienced in liver transplantation is warranted in such cases. This is of particular significance in patients with coexisting hepatitis C or hepatitis B virus infections, or cirrhosis of any cause. Hepatitis A virus (HAV) infection in these conditions has a higher risk for acute liver failure.

A prognostic index consisting of four clinical and laboratory features (serum alanine aminotransferase [ALT] <2600 units/L, creatinine >177 micromoles/L [>2 mg/dL], intubation, pressors) predicts the likelihood of transplantation/death significantly better than other published models.[35] The lower ALT levels that were found to be one of the indicators of poor prognosis were thought to be due to extensive necrosis at presentation.[35]

back arrow

Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

Use of this content is subject to our disclaimer