Hepatitis A

 

Am Fam Physician. 2021 Oct ;104(4):368-374.

  Patient information: A handout on this topic is available at https://familydoctor.org/condition/hepatitis-a.

Author disclosure: No relevant financial affiliations.

Hepatitis A is a common viral infection worldwide that is transmitted via the fecal-oral route. The incidence of infection in the United States decreased by more than 90% after an effective vaccine was introduced, but the number of cases has been increasing because of large community outbreaks in unimmunized individuals. Classic symptoms include fever, malaise, dark urine, and jaundice and are more common in older children and adults. People are most infectious 14 days before and seven days after the development of jaundice. Diagnosis of acute infection requires the use of serologic testing for immunoglobulin M anti–hepatitis A antibodies. The disease is usually self-limited, supportive care is often sufficient for treatment, and chronic infection or chronic liver disease does not occur. Routine hepatitis A immunization is recommended in children 12 to 23 months of age. Immunization is also recommended for individuals at high risk of contracting the infection, such as persons who use illegal drugs, those who travel to areas endemic for hepatitis A, incarcerated populations, and persons at high risk of complications from hepatitis A, such as those with chronic liver disease or HIV infection. The vaccine is usually recommended for pre- and postexposure prophylaxis, but immune globulin can be used in patients who are too young to be vaccinated or if the vaccine is contraindicated.

Hepatitis A is a common cause of acute hepatic inflammation and jaundice worldwide, and until 2004 it was the most commonly reported type of hepatitis in the United States.1 A combination of widespread vaccination, food safety practices, and improved sanitation decreased the incidence of hepatitis A in the United States from the 1970s until 2015. However, infection rates have recently increased because of large community outbreaks in susceptible individuals.2

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Serologic testing for immunoglobulin M anti–hepatitis A antibodies should be performed to confirm suspected hepatitis A.2,4

C

Consensus-based national guidelines from ACIP and the Centers for Disease Control and Prevention

Symptoms may be nonspecific

Hepatitis A vaccination should be offered to children 12 to 23 months of age and other populations at increased risk.2

C

Consensus guidelines from ACIP

Confers lifelong immunity

Pre-exposure prophylaxis is indicated for unimmunized patients planning to travel to an area with increased incidence of hepatitis A (everywhere outside of the United States except for Australia, Canada, Japan, New Zealand, and western Europe).2

C

Consensus guidelines from ACIP

Children younger than six months and persons with a contraindication to hepatitis A vaccine should receive immune globulin (Gamastan).

Persons older than 40 years and those with chronic liver disease should receive both hepatitis A vaccine and immune globulin.

All others should receive hepatitis A vaccine only.

Postexposure prophylaxis is recommended for all unvaccinated individuals who have had significant exposure to people with hepatitis A in the preceding two weeks.2

C

Consensus guidelines from ACIP

Children younger than 12 months and people with a contraindication to hepatitis A vaccine should receive immune globulin.

Persons older than 40 years and those with chronic liver disease should receive both hepatitis A vaccine and immune globulin.

All others should receive hepatitis A vaccine only.


ACIP = Advisory Committee on Immunization Practices.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Serologic testing for immunoglobulin M anti–hepatitis A antibodies should be performed to confirm suspected hepatitis A.2,4

C

Consensus-based national guidelines from ACIP and the Centers for Disease Control and Prevention

Symptoms may be nonspecific

Hepatitis A vaccination should be offered to children 12 to 23 months of age and other populations at increased risk.2

C

Consensus guidelines from ACIP

Confers lifelong immunity

Pre-exposure prophylaxis is indicated for unimmunized patients planning to travel to an area with increased incidence of hepatitis A (everywhere outside of the United States except for Australia, Canada, Japan, New Zealand, and western Europe).2

C

Consensus guidelines from ACIP

Children younger than six months and persons with a contraindication to hepatitis A vaccine should receive immune globulin (Gamastan).

Persons older than 40 years and those with chronic liver disease should receive both hepatitis A vaccine and immune globulin.

All others should receive hepatitis A vaccine only.

The Authors

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ROBERT C. LANGAN, MD, FAAFP, is program director at the St. Luke's Family Medicine Residency Program, Sacred Heart Campus, Allentown, Pa., and an adjunct professor in the Department of Family and Community Medicine at Temple University School of Medicine, Philadelphia, Pa....

ANDREW J. GOODBRED, MD, FAAFP, is associate program director at the St. Luke's Family Medicine Residency Program, Anderson Campus, Easton, Pa.

Address correspondence to Robert C. Langan, MD, FAAFP, 450 Chew St., Ste. 101, Allentown, PA 18102 (email: robert.langan@sluhn.org). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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20. American Medical Association; American Nurses Association–American Nurses Foundation; Centers for Disease Control and Prevention; Center for Food Safety and Applied Nutrition, Food and Drug Administration; Food Safety and Inspection Service, U.S. Department of Agriculture. Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals. MMWR Recomm Rep. 2004;53(RR-4):1–33.

21. Matheny SC, Kingery JE. Hepatitis A. Am Fam Physician. 2012;86(11):1027–1034. Accessed April 19, 2021. https://www.aafp.org/afp/2012/1201/p1027.html

22. GamaSTAN [package insert]. Grifol's Therapeutics, Inc.; 2018. Accessed May 13, 2021. https://www.fda.gov/media/86789/download

23. McKesson Pharmaceutical Supply. GamaSTAN S/D immune globulin gamma (IgG)(Human). Accessed February 2021. https://mms.mckesson.com/product/1110937/Grifols-Therapeutics-13533033512

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25. Brundage SC, Fitzpatrick AN. Hepatitis A. Am Fam Physician. 2006;73(12):2162–2168. Accessed May 7, 2021. https://www.aafp.org/afp/2006/0615/p2162.html

 

 

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