Approach

Management strategies are individualized and should involve specialists when appropriate, depending on specific patient characteristics.

Postexposure prophylaxis

Active or passive immunization is available for protection following exposure to hepatitis A virus (HAV) infection. Recommendations concerning postexposure prophylaxis may differ geographically, so specific national guidelines should be consulted.[21][31][32][43]​​​[44]

Immunocompetent people (ages ≥12 months)

For healthy people with recent HAV exposure (<2 weeks) who have not completed the two-dose hepatitis A vaccine series, the the Centers for Disease Control and Prevention (CDC) recommends:[21]

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

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

Immunocompromised people or those with chronic liver disease (ages ≥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]

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

Infants ages <12 months/vaccine contraindicated

Children younger than 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:[21] CDC: hepatitis A FAQs for health professionals Opens in new window

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

Patients who require postexposure prophylaxis

The CDC recommends postexposure 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

    • Caregivers not using personal protective equipment

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

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

    • Caregivers are recognized in two or more households of center 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 epidemiologic 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

Confirmed infection: supportive care

Treatment for HAV infection is primarily supportive, including appropriate rest when necessary.[19] Excessive acetaminophen and alcohol should be avoided.[2][18] There are no specific antiviral therapies available.

Once acute infection occurs, management is largely outpatient-based. Rarely, hospitalization may become necessary for volume depletion, coagulopathy, or encephalopathy.[18]

Contact precautions are taken during the infectious period, particularly in the incontinent patient group or patients requiring diapers. The infectious period lasts for about 2 weeks after the onset of illness in healthy individuals. Certain patient groups remain infectious for up to 6 months. This includes children and immunocompromised patients.[2]

Confirmed infection: referral for liver transplant

In <1% of patients, acute liver failure occurs, characterized by worsening jaundice, coagulopathy, and encephalopathy.[35][36]​ Prompt referral to centers 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. 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 >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]

Use of this content is subject to our disclaimer