eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Hepatitis A: Treatment & Medication

Author: Nicholas John Bennett, MB, BCh, PhD, Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University
Coauthor(s): Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University; Lisa C Turner, MD, Clinical Instructor, Departments of Pediatrics and Communicable Diseases, University of Michigan Medical Center
Contributor Information and Disclosures

Updated: Jun 2, 2009

Treatment

Medical Care

  • Treatment is supportive because no specific therapy is available. The investigational antienteroviral drug pleconaril (Disoxaril; ViroPharma) has no activity against hepatitis A virus (HAV).
  • Hospitalization is indicated for patients with significant dehydration due to vomiting or those with fulminant hepatitis.
  • Medications that have known liver toxicity should be avoided.

Consultations

  • Consultation with a subspecialist is generally not required.
  • Fulminant hepatitis warrants care by a pediatric gastroenterologist and, possibly, an intensive care specialist.

Diet

  • No specific dietary changes are needed.
  • In euvolemic patients with vomiting (but without dehydration that requires intravenous fluid therapy), appropriate intake of oral fluid is recommended, as with other viral illnesses.

Activity

  • Patients should not return to school or work for one week after the onset of illness.
  • Hospitalized patients who use diapers or those who are incontinent should have contact isolation for one week after the onset of illness.
  • Activity can otherwise be resumed, as tolerated.

Medication

Vaccines

Indicated for primary immunization to prevent hepatitis A. Publications are also emerging regarding postexposure use alone or in conjunction with immune globulin.4,5


Hepatitis A vaccine inactivated (Havrix, Vaqta)

For active immunization against disease caused by hepatitis A virus (HAV). Complete primary immunization at least 2 wk prior to expected exposure to HAV. Primary immunization series consists of 2 doses.

Adult

Primary immunization:
Havrix: 1440 U (1 mL) IM, repeat with 1 booster dose 6-12 mo later
Vaqta: 50 U (1 mL) IM, repeat with 1 booster dose 6-18 mo later
Postexposure prophylaxis in unvaccinated persons: Single age-appropriate vaccine dose as soon as possible after hepatitis A exposure with IG, and then complete immunization series with booster dose

Pediatric

Primary immunization:
<1 year: Not established
>1-18 years:
Havrix: 720 U (0.5 mL) IM, repeat with 1 booster dose 6-12 mo later
Vaqta: 25 U (0.5 mL) IM, repeat with 1 booster dose 6-18 mo later
Postexposure prophylaxis in unvaccinated persons: Single age-appropriate vaccine dose as soon as possible after hepatitis A exposure with IG, and then complete immunization series with booster dose

Immunosuppressants may reduce effectiveness; when concomitant administration of other vaccines or IG required, give different syringes and different injection sites

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in individuals on anticoagulant therapy; may not prevent hepatitis A infection in individuals with unrecognized hepatitis A infection at the time of vaccination; caution when administering to nursing women and people with thrombocytopenia or a bleeding disorder as bleeding may occur following IM use; immunosuppressed people or those receiving immunosuppressive therapy may not obtain expected immune response (may require additional doses)

More on Hepatitis A

Overview: Hepatitis A
Differential Diagnoses & Workup: Hepatitis A
Treatment & Medication: Hepatitis A
Follow-up: Hepatitis A
Multimedia: Hepatitis A
References
[ CLOSE WINDOW ]

References

  1. Feinstone SM, Kapikian AZ, Purceli RH. Hepatitis A: detection by immune electron microscopy of a viruslike antigen associated with acute illness. Science. Dec 7 1973;182(116):1026-8. [Medline].

  2. Wasley A, Grytdal S, Gallagher K. Surveillance for acute viral hepatitis--United States, 2006. MMWR Surveill Summ. Mar 21 2008;57(2):1-24. [Medline]. [Full Text].

  3. Wasley A, Samandari T, Bell BP. Incidence of hepatitis A in the United States in the era of vaccination. JAMA. Jul 13 2005;294(2):194-201. [Medline].

  4. Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. May 19 2006;55:1-23. [Medline]. [Full Text].

  5. Victor JC, Monto AS, Surdina TY, Suleimenova SZ, Vaughan G, Nainan OV, et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. Oct 25 2007;357(17):1685-94. [Medline]. [Full Text].

  6. [Guideline] Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. Oct 19 2007;56(41):1080-4. [Medline].

  7. Ahmed M, Munshi SU, Nessa A, Ullah MS, Tabassum S, Islam MN. High prevalence of hepatitis A virus antibody among Bangladeshi children and young adults warrants pre-immunization screening of antibody in HAV vaccination strategy. Indian J Med Microbiol. Jan-Mar 2009;27(1):48-50. [Medline].

  8. AAP. Hepatitis A vaccine recommendations. Pediatrics. Jul 2007;120(1):189-99. [Medline].

  9. AAP. Hepatitis A. In: Red Book: Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2006:326-35.

  10. Barkai G, Belmaker I, Givon-Lavi N, Dagan R. The Effect of Universal Toddlers-Only Hepatitis A Virus Vaccination Program on Seropositivity Rate in Unvaccinated Toddlers: Evidence for Reduced Virus Circulation in the Community. Pediatr Infect Dis J. Mar 18 2009;[Medline].

  11. Bell BP, Shapiro CN, Margolis HS. Hepatitis A virus. In: Textbook of Pediatric Infectious Diseases. 2004:2069-86.

  12. Black S, Shinefield H, Hansen J, et al. A post-licensure evaluation of the safety of inactivated hepatitis A vaccine (VAQTA, Merck) in children and adults. Vaccine. Jan 26 2004;22(5-6):766-72. [Medline].

  13. Bovier PA. Epaxal: a virosomal vaccine to prevent hepatitis A infection. Expert Rev Vaccines. Oct 2008;7(8):1141-50. [Medline].

  14. CDC. Notice to readers: FDA approval of Havrix (hepatitis A vaccine, inactivated) for persons aged 1-18 years. MMWR. December 9, 2005;54(48):1235-1236. [Full Text].

  15. CDC. Notice to readers: FDA approval of VAQTA (hepatitis A vaccine, inactivated) for children aged >1 year. MMWR. October 14, 2005;54(40):1026. [Full Text].

  16. Dmochowski L. Viral type A and type B hepatitis: morphology, biology, immunology and epidemiology--a review. Am J Clin Pathol. May 1976;65(5 Suppl):741-86. [Medline].

  17. Frenck RW. Universal hepatitis A immunization recommendation made by ACIP. AAP News. 2005;26 (12):1. [Full Text].

  18. Hadler SC, Webster HM, Erben JJ, et al. Hepatitis A in day-care centers. A community-wide assessment. N Engl J Med. May 29 1980;302(22):1222-7. [Medline].

  19. Hammitt LL, Bulkow L, Hennessy TW, Zanis C, Snowball M, Williams JL, et al. Persistence of antibody to hepatitis A virus 10 years after vaccination among children and adults. J Infect Dis. Dec 15 2008;198(12):1776-82. [Medline].

  20. Hoang PL, Trong KH, Tran TT, Huy TT, Abe K. Detection of hepatitis A virus RNA from children patients with acute and fulminant hepatitis of unknown etiology in Vietnam: Genomic characterization of Vietnamese HAV strain. Pediatr Int. Oct 2008;50(5):624-7. [Medline].

  21. Jacobs RJ, Greenberg DP, Koff RS, et al. Regional variation in the cost effectiveness of childhood hepatitis A immunization. Pediatr Infect Dis J. Oct 2003;22(10):904-14. [Medline].

  22. Lolekha S, Pratuangtham S, Punpanich W, et al. Immunogenicity and safety of two doses of a paediatric hepatitis A vaccine in thai children: comparison of three vaccination schedules. J Trop Pediatr. Dec 2003;49(6):333-9. [Medline].

  23. Snyder JD, Pickering LK. Hepatitis A through E. In: Nelson Textbook of Pediatrics. 17th ed. 2004:1324-7.

  24. Todd EC, Greig JD, Bartleson CA, Michaels BS. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 4. Infective doses and pathogen carriage. J Food Prot. Nov 2008;71(11):2339-73. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

hepatitis A, hepatitis A virus, HAV, viral hepatitis, catarrhal jaundice, epidemic jaundice, infectious hepatitis, viral hepatitis type A, virus A hepatitis, Picornaviridae, picornavirus, cholestasis, fulminant hepatitis, splenomegaly, fulminant hepatitis, abdominal pain, diarrhea, treatment, diagnosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Nicholas John Bennett, MB, BCh, PhD, Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University
Nicholas John Bennett, MB, BCh, PhD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Lisa C Turner, MD, Clinical Instructor, Departments of Pediatrics and Communicable Diseases, University of Michigan Medical Center
Lisa C Turner, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Rosemary Johann-Liang, MD, Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration
Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.