Hepatitis A

The major mechanism of spread is through oral inoculation of fecally excreted virus, which makes this infection preventable through simple public health measures.[1]​Centers for Disease Control and Prevention. Hepatitis A. [internet publication]. https://www.cdc.gov/hepatitis-a/index.html The virus may survive for up to 4 hours on the fingertips; adherence to strict handwashing after handling fecal material is of utmost importance.[31]Mbithi JN, Springthorpe VS, Boulet JR, et al. Survival of hepatitis A virus on human hands and its transfer on contact with animate and inanimate surfaces. J Clin Microbiol. 1992 Apr;30(4):757-63. http://www.ncbi.nlm.nih.gov/pubmed/1315331?tool=bestpractice.com

In the US, routine hepatitis A vaccination is recommended for:[1]​Centers for Disease Control and Prevention. Hepatitis A. [internet publication]. https://www.cdc.gov/hepatitis-a/index.html [25]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com [32]Centers for Disease Control and Prevention. Immunization schedules: child and adolescent immunization schedule by age: recommendations for ages 18 years or younger, United States, 2025. 2024 [internet publication]. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html [33]Centers for Disease Control and Prevention. Immunization schedules: ​adult immunization schedule by age: recommendations for ages 19 years or older, United States, 2025. Nov 2024 [internet publication]. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html ​​[34]American College of Obstetricians and Gynecologists. Practice Guideline No. 6: viral hepatitis in pregnancy. Sep 2023 [internet publication]. https://journals.lww.com/greenjournal/abstract/2023/09000/viral_hepatitis_in_pregnancy__acog_clinical.33.aspx http://www.ncbi.nlm.nih.gov/pubmed/37590986?tool=bestpractice.com

Children and adolescents:

• All children ages 12-23 months

• Children and adolescents ages 2-18 years who have not previously received the hepatitis A vaccination (i.e., children and adolescents are recommended for catch up vaccination).

People (including pregnant women) at increased risk of hepatitis A virus (HAV) infection:[1]​Centers for Disease Control and Prevention. Hepatitis A. [internet publication]. https://www.cdc.gov/hepatitis-a/index.html

• International travelers

• Men who have sex with men

• People who use injection or noninjection drugs (i.e., those who use illegal drugs)

• People with occupational risk of exposure

• People who anticipate close personal contact with an international adoptee

• People experiencing homelessness

• People with HIV infection ages ≥1 year.

People (including pregnant women) at risk of developing serious complications from HAV infection:

• People with chronic liver disease

• People with HIV infection.

The Advisory Committee on Immunization Practices (ACIP) also recommends hepatitis A vaccination for:[25]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com

• Unvaccinated people in outbreak settings who are at risk for HAV infection or at risk for severe disease from HAV

• People in settings that provide services to adults in which a high proportion of those persons have risk factors for HAV infection

• Any people who request vaccination.

Refer to ACIP vaccine recommendations and guidelines for further details. CDC: ACIP vaccine recommendations and guidelines Opens in new window

Hepatitis A vaccine recommendations may differ in other countries.[35]World Health Organization. WHO position paper on hepatitis A vaccines – October 2022. Oct 2022 [internet publication]. https://www.who.int/publications/i/item/who-wer9740-493-512 [36]UK Health Security Agency. Hepatitis A: guidance, data and analysis. Jun 2021 [internet publication]. https://www.gov.uk/government/collections/hepatitis-a-guidance-data-and-analysis

Active or passive immunization is available for protection following exposure to hepatitis A virus (HAV) infection. Recommendations concerning postexposure prophylaxis may differ geographically, so specific national guidelines should be consulted.[25]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com ​​[35]World Health Organization. WHO position paper on hepatitis A vaccines – October 2022. Oct 2022 [internet publication]. https://www.who.int/publications/i/item/who-wer9740-493-512 [36]UK Health Security Agency. Hepatitis A: guidance, data and analysis. Jun 2021 [internet publication]. https://www.gov.uk/government/collections/hepatitis-a-guidance-data-and-analysis [47]Centers for Disease Control and Prevention. Morbidity and mortality weekly report: update: recommendations of the Advisory Committee on Immunization Practices for use of hepatitis A vaccine for postexposure prophylaxis and for preexposure prophylaxis for international travel. Mar 2019 [internet publication]. https://www.cdc.gov/mmwr/volumes/67/wr/mm6743a5.htm ​​​​​[48]UK Health Security Agency. Public health control and management of hepatitis A. Feb 2024 [internet publication]. https://assets.publishing.service.gov.uk/media/65ccdbbd1d93950012946677/Hepatitis-A-guidance-13-february-2024.pdf

Immunocompetent people (ages ≥12 months)

For healthy people with recent HAV exposure (<2 weeks) who have not completed the two-dose hepatitis A vaccine series, the Centers for Disease Control and Prevention (CDC) recommends:[25]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com

• A single dose of the hepatitis A vaccine as soon as possible

• Discretionary co-administration of immune globulin for people ages >40 years (depending on provider assessment of individual risk factors for HAV infection and/or HAV-related complications).

Immunocompromised people or chronic liver disease (ages ≥12 months)

For immunocompromised people or those with chronic liver disease who have not completed the two-dose hepatitis A vaccine series, the CDC recommends:[25]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com

• Immune globulin and a single dose of hepatitis A vaccine simultaneously at anatomically discrete sites, as soon as possible (<2 weeks).

Infants ages <12 months/vaccine contraindicated

Children younger than 12 months and those with a history of a life-threatening allergy following administration of hepatitis A vaccine (or severe allergy to any component of the vaccine) should receive:[25]Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm http://www.ncbi.nlm.nih.gov/pubmed/32614811?tool=bestpractice.com CDC: hepatitis A Opens in new window

• Immune globulin as soon as possible (<2 weeks since exposure).

Patients who require postexposure prophylaxis

The CDC recommends postexposure prophylaxis for the following patient populations: CDC: hepatitis A Opens in new window

• All previously unvaccinated people exposed to (or at risk of exposure to) people with serologically confirmed hepatitis A, including:

  • Household members

  • Sexual contacts

  • People who have shared injection drugs with someone with hepatitis A

  • Caregivers not using personal protective equipment

• All previously unvaccinated members of staff and attendees at childcare centers where:

  • One or more cases of hepatitis A infection is recognized in children or employees

  • Caregivers are recognized in two or more households of center attendees

• Food handlers in the same establishment of another food handler who receives a diagnosis of hepatitis A

• People who have close contact with infected patients, if an epidemiologic investigation indicates hepatitis A transmission has occurred:

  • In a school

  • Among hospital patients

  • Between patients and hospital staff.

Further specific considerations are provided online by the CDC. CDC: hepatitis A Opens in new window