Chester County Medicine Winter 2019 - 9

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majority (85%) recover completely in 2-3 months, with resolution
in nearly all the rest by 6 months. Only a small number of people
(less than 1%) develop fulminant liver failure, usually in those
age 50 years or older or with underlying liver disease. Both here
and around the world, as fewer children are getting hepatitis A
infections, cases are becoming more severe. Up to 10 per cent of
people may have relapse (or relapses) within 6-12 months, but
once again, the vast majority have a complete recovery and no one
develops a chronic infection. HAV infection can be diagnosed
with serum IgM anti-HAV antibodies. Treatment is supportive, as
infection is usually self-limited.

Prevention
Basic sanitation prevents HAV transmission in the US,
and avoidance of tap water and raw foods where sanitation is
inadequate helps prevent HAV while traveling. Handwashing,
particularly after toileting/changing diapers and before food
handling, is also effective. Certain disinfecting solutions (for hands
or surfaces) may kill HAV but not all; check product information
for specifics. The best prevention is vaccination. A 2-dose series is
now recommended for all children starting at age 12 months, with
the second dose 6 months after the first. Catch-up vaccination is
recommended for anyone who has not completed a 2-dose series.
Priority populations with a recommendation for vaccination are:
* people experiencing homelessness,
* people who use drugs (injection OR non-injection),
* men who have sex with men, and
* close contacts of those with hepatitis A.
In addition, all individuals at risk for hepatitis A are
recommended to get vaccinated including:
* Persons traveling to, or working in, countries with high or

intermediate rates of hepatitis A. The CDC Travelers' Health
website provides specific guidance on these areas,
* Persons who have occupational risk for infection,
* Persons who have chronic liver disease,
* Persons who have clotting-factor disorders,
* Household members and other close personal contacts of
adopted children newly arriving from countries with high
or intermediate rates of hepatitis A, and
* Persons with direct contact with persons who have
hepatitis A.
Although the 2-dose series provides optimal protection, studies
have shown high proportions of people become seropositive at
only 2 weeks following the initial dose, and protection may last as
long as 10 years. Therefore, providing one dose of the vaccine is
worthwhile, even in individuals who may not return for a second
dose. Post-exposure prophylaxis (PEP) is effective because of the
long incubation period of hepatitis A. Eligible individuals who
have not completed the 2-dose vaccination series should receive
PEP within 2 weeks of exposure to hepatitis A. These include
household and sexual contacts of someone with laboratoryconfirmed hepatitis A; those who have shared injection drugs;
and caretakers not using personal protective equipment. PEP
depends on age and health status. For healthy individuals ages 1
year to 40 years, a dose of hepatitis A vaccine should be given as
soon as possible, within 2 weeks of exposure. For those over age
40 years, vaccine should be given and immune globulin should
be considered, since they are at higher risk for serious disease.
Similarly, those age 1 year and older with immunosuppression and
those with chronic liver disease should receive both the vaccine
and the immune globulin. Finally, infants under 12 months and
those who cannot receive vaccine should receive immune globulin
alone. Anyone receiving a single dose of vaccine as part of PEP
should receive a second dose 6 months after the first for long term
protection, but 2 doses is not essential to PEP.
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WINTER 2019 | CHESTER COUNT Y Medicine 9

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Chester County Medicine Winter 2019

Table of Contents for the Digital Edition of Chester County Medicine Winter 2019