Hepatitis A Management and Prevention

Immediate Transmission Prevention Measures

The Centers for Disease Control and Prevention recommends that patients with positive hepatitis A must implement strict hand hygiene, avoid food handling for at least 1 week after jaundice onset, and notify all close contacts for immune globulin prophylaxis within 2 weeks of exposure 1

The CDC recommends that all household members and sexual contacts must receive immune globulin (0.02 mL/kg) as soon as possible, ideally within 2 weeks of exposure 2, 1
The CDC advises that persons who shared illicit drugs with the infected patient require both IG and hepatitis A vaccine 2, 1
The CDC suggests that regular babysitters and others with ongoing close personal contact should receive IG 2
The CDC states that healthcare workers do not routinely need IG unless an epidemiologic investigation confirms transmission 2

Up to 20% of patients experience prolonged or relapsing symptoms lasting up to 6 months, according to the American College of Gastroenterology 1
Less than 1% develop acute liver failure, though case-fatality reaches 1.8% in adults over 50 years, as reported by the American College of Gastroenterology 1

The American College of Gastroenterology recommends that if the patient has chronic liver disease from any cause, they should receive hepatitis A vaccine if not already immune, as superinfection can cause fulminant hepatitis 1, 5

The CDC recommends that all children aged 12-23 months should receive routine hepatitis A vaccination 1
The CDC advises that high-risk adults requiring vaccination include: travelers to endemic areas, men who have sex with men, injection and non-injection drug users, persons with chronic liver disease, and those with clotting-factor disorders 1

The CDC recommends that if the infected patient is a food handler, all other food handlers at the same establishment should receive IG 2
The CDC states that patrons typically do not need IG unless the food handler directly handled uncooked foods while having diarrhea or poor hygiene, and patrons can be identified within 2 weeks 2

The CDC advises that IG administration to contacts should not be delayed while waiting for serologic confirmation—treat based on clinical suspicion, as the 2-week window is critical 2
The CDC recommends that contacts should not be screened for immunity before giving IG, as this causes harmful delays 2