eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Hepatitis A: Treatment & Medication
Updated: Jun 2, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
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
Documented hypersensitivity
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)
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Treatment & Medication: Hepatitis A |
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References
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].
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].
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].
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].
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].
[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].
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].
AAP. Hepatitis A vaccine recommendations. Pediatrics. Jul 2007;120(1):189-99. [Medline].
AAP. Hepatitis A. In: Red Book: Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2006:326-35.
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].
Bell BP, Shapiro CN, Margolis HS. Hepatitis A virus. In: Textbook of Pediatric Infectious Diseases. 2004:2069-86.
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].
Bovier PA. Epaxal: a virosomal vaccine to prevent hepatitis A infection. Expert Rev Vaccines. Oct 2008;7(8):1141-50. [Medline].
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].
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].
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].
Frenck RW. Universal hepatitis A immunization recommendation made by ACIP. AAP News. 2005;26 (12):1. [Full Text].
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].
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].
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].
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].
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].
Snyder JD, Pickering LK. Hepatitis A through E. In: Nelson Textbook of Pediatrics. 17th ed. 2004:1324-7.
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].
Further Reading
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
Treatment & Medication: Hepatitis A