Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

INITIAL

unvaccinated people with recent exposure to hepatitis A (<2 weeks)

1st line – hepatitis A vaccine and/or immune globulin

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INITIAL
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unvaccinated people with recent exposure to hepatitis A (<2 weeks)
1st line – 

hepatitis A vaccine and/or immune globulin

Active or passive immunization is available for protection following exposure to hepatitis A virus (HAV) infection.

The Centers for Disease Control and Prevention (CDC) recommends a single dose of hepatitis A vaccine as soon as possible postexposure (<2 weeks) for immunocompetent people (≥12 months of age) who have not completed the two-dose hepatitis A vaccine series:[25] CDC: hepatitis A Opens in new window Co-administration of immune globulin (at a discrete anatomic site) may be considered for people ages >40 years with risk factors for HAV infection or its complications. 

For immunocompromised people, or those with chronic liver disease, who have not completed the two-dose hepatitis A vaccine series, the CDC recommends immune globulin and a single dose of hepatitis A vaccine simultaneously (at a discrete anatomic site), as soon as possible (<2 weeks since exposure).

Infants ages <12 months and those with a history of life-threatening allergy following administration of hepatitis A vaccine (or severe allergy to any component of the vaccine) should receive immune globulin as soon as possible (<2 weeks since exposure).[25] CDC: hepatitis A Opens in new window

Recommendations concerning postexposure prophylaxis may differ geographically, so specific national guidelines should be consulted.[25][35][36][47]​​​[48]

Intramuscular immune globulin may need to be obtained from a specialist center; it is not widely commercially available.

Primary options

hepatitis A vaccine, inactivated (HepA): administer according to current recommended schedule

and/or

immune globulin (human): consult specialist for guidance on intramuscular dose

ACUTE

confirmed hepatitis A

1st line – supportive care

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ACUTE
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confirmed hepatitis A
1st line – 

supportive care

Treatment for infection is primarily supportive and should include a balanced diet with healthy food, plenty of fluids, and appropriate rest.[1][23]​​ No specific antiviral therapy is available.

Excess acetaminophen and alcohol should be avoided.[2]​​[22]

Rarely, hospitalization may become necessary for volume depletion, coagulopathy, encephalopathy, or severe prostration.[22] This is particularly important in patients with co-infection with hepatitis B virus, hepatitis C virus, or cirrhosis of any cause, as acute hepatitis A virus (HAV) infection in these conditions has a higher risk for severe disease.

Plus – liver transplant

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ACUTE
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confirmed hepatitis A
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with acute liver failure
Plus – 

liver transplant

Treatment recommended for ALL patients in selected patient group

In <1% of patients, acute liver failure occurs characterized by worsening jaundice, coagulopathy, and encephalopathy.[38][39]​ Prompt referral to centers experienced in liver transplantation is warranted in such cases. This is of particular significance in patients with coexisting hepatitis C or hepatitis B virus infections, or cirrhosis of any cause. Hepatitis A virus (HAV) infection in these conditions has a higher risk for acute liver failure.

A prognostic index consisting of four clinical and laboratory features (serum alanine aminotransferase (ALT) <2600 units/L, creatinine >2 mg/dL, intubation, pressors) predicts the likelihood of transplantation/death significantly better than other published models.[38] The lower ALT levels that were found to be one of the indicators of poor prognosis were thought to be due to extensive necrosis at presentation.[38]

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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