Usually self-limiting infection.
Post-exposure prophylaxis: should be administered within 2 wks of exposure.
Indication/Age group | Risk category/Health status | ||
< 12 mos | Healthy | No | 0.1 mL/kg |
12 mos-40 yrs | Healthy | 1 dose∇ | None |
> 40 yrs | Healthy | 1 dose∇ | 0.1 mL/kg§ |
≥ 12 mos | Immunocompromised or chronic liver disease | 1 dose∇ | 0.1 mL/kg¶ |
≥ 12 mos | Vaccine contraindicated (life-threatening allergy) | No | 0.1 ml/kg |
∇The second dose not required for PEP; however, for long-term immunity administer the second dose > 6 months.
§Based on provider risk assessment, if both vaccine and Ig warranted, administer simultaneously but at different anatomical sites.
¶Administer vaccine and Ig simultaneously but at different anatomical sites.
Indication/Age group | Risk category/Health status | ||
< 12 mos | Healthy | No | 0.1 mL/kg |
12 mos-40 yrs | Healthy | 1 dose∇ | None |
> 40 yrs | Healthy | 1 dose∇ | 0.1 mL/kg§ |
≥ 12 mos | Immunocompromised or chronic liver disease | 1 dose∇ | 0.1 mL/kg¶ |
≥ 12 mos | Vaccine contraindicated (life-threatening allergy) | No | 0.1 ml/kg |
∇Second dose not required for PEP; however, for long-term immunity administer second dose > 6 months.
§Based on provider risk assessment, if both vaccine and Ig warranted, administer simultaneously but at different anatomical sites.
¶Administer vaccine and Ig simultaneously but at different anatomical sites.
Comment: Concise but comprehensive review including diagnosis and management.
Comment: This document incorporates all recent updates and recommendations regarding HAV prevention. New or updated recommendations include a) immunize all children 2-18 yrs if not previously receiving, b) all HIV infected children > 1 yr, c) immunize all with chronic liver disease or if > 2x ULN transaminases, d) pregnant women at risk, e) all involved in Hep A outbreaks if at risk, f) those who provide services to people with risk factors, g) no longer recommended: people who routinely receive blood products.
Comment: CDC report speaks to the significant increases in Hepatitis A infections that now reflect some person to person spread through MSM, intravenous drug use, homelessness and larger than previous foodborne outbreaks. Targeting high-risk groups for HAV immunization will help but people who are involved are often difficult to engage in organized medical care.
Comment: Report of cases among people who were using drugs or homeless in these states, with outbreaks implicating person-person spread which is different than prior large outbreaks due to contaminated foods. HAV immunization is important for this population, but a group hard to find or to convince.
Comment: Rates of HAV antibodies post-immunization have ranged from 96.2-100.0% with the durability of at least 15 years. The use of either Twinrix™ or monovalent vaccines had similar safety performance.
Comment: A review of 11 studies suggested that HAV immunization is sufficient for pre-exposure prophylaxis. Nine randomized trials (including both inactivated and live vaccines), clinically apparent hepatitis A occurred in 31/375,726 (0.01%) versus 505/356,654 (0.18%) participants in the HAV vaccine and control groups respectively (RR 0.09, 95% CI 0.05 to 0.17).
Comment: A study from New York with implications for public health found that 61% of hepatitis A infections were related to travel. The highest risk group was Hispanics.
Comment: Since the introduction of the hepatitis A vaccine in the U.S., mortality rates of declined 32% (high of 142/yr 1995 to 54 in 2003). The study used death certificate data.
Comment: Follow-up study found demonstrable specific anti-HAV antibodies in both children (100%) and adults (96%) who received vaccine. No current information suggests the need for boosting.
Comment: The study examined post-exposure prophylaxis for HAV comparing immunization to immune globulin: rates of HAV were 4.4% for vaccine group and 3.3% for immunization group. Overall, the authors conclude that these low rates mean that the vaccine may be a good alternative and have the secondary benefit of long-term protection, although there was a slightly higher rate in the vaccine recipients.
Rating: Important
Comment: Covers history of the virus and clinical essentials.
Comment: Report builds on earlier case descriptions of likely false positive HAV IgM tests. Recommendation not to use as screen in asymptomatic adults, since positives are likely to be false. Testing should be limited to those with clinical suspicion of HAV. The concern is the false-positives trigger investigations by public health departments and perhaps unnecessary courses of passive and active immunizations.
Rating: Important
Source CDC
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