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Hepatitis A (HAV)

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SOURCE

Source: Deming P. Viral hepatitis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=132516044. Accessed April 10, 2017.

DEFINITION

  • Acute, self-limiting viral infection of liver.

  • Confers lifelong immunity.

ETIOLOGY

  • RNA virus.

    • Genus Hepatovirus of Picornaviridae family.

    • Humans only reservoir.

PATHOPHYSIOLOGY

  • Absorbed through stomach or small intestine and taken up by liver.

  • Viral replication within hepatocytes and gastrointestinal (GI) epithelial cells.

  • Secreted into bile.

    • Cycle continues with reabsorption or excretion into stool.

    • Enterohepatic cycle continues until interrupted by antibody neutralization.

EPIDEMIOLOGY

  • Infection primarily occurs through:

    • Fecal-oral route.

    • Person-to-person contact.

    • Ingestion of contaminated food or water.

PREVENTION AND SCREENING

  • Routine.

    • Regular handwashing.

      • After using bathroom.

      • After changing diaper.

      • Before food preparation.

    • Traveling in high endemic areas, avoid.

      • Ice and unbottled water.

      • Fresh produce.

      • Uncooked foods.

  • Vaccination (Tables 1 and 2)

  • Immunoglobulin (Ig)

    • Used when pre- or postexposure prophylaxis against HAV infection needed in persons for whom vaccination not an option.

      • Preferred for persons >40 years old, children <12 months, immunocompromised persons, and persons with chronic liver disease3

    • Most effective within 2 weeks after exposure1

    • Dosing:

      • 0.02 mL/kg IM for postexposure prophylaxis or short-term (<3 months) preexposure prophylaxis6

      • 0.06 mL/kg IM for long-term preexposure prophylaxis (≤5 months)

    • May be given with HAV vaccine, but at different sites1

TABLE 1.aRecommendations for Hepatitis A Vaccination
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TABLE 1. Recommendations for Hepatitis A Vaccination
All children at 1 year of age
Children and adolescents ages 2–18 years who live in states or communities where routine hepatitis A vaccination has been implemented because of high disease incidence
Persons traveling to or working in countries that have high or intermediate endemicity of infectiona
Men who have sex with men
Illegal-drug users
Persons who have occupational risk for infection (eg, persons who work with HAV-infected primates or HAV in a research laboratory setting)
Persons who have clotting factor disorders
Persons who have chronic liver disease (eg, persons with chronic liver disease caused by hepatitis B or C and persons awaiting liver transplants)

HAV, hepatitis A virus.

a

Travelers to Canada, Western Europe, and Scandinavia3, Japan, Australia, or New Zealand are at no greater risk for HAV infection than they are while in United States. All other travelers should be assessed for hepatitis A risk.

Source: Centers for Disease Control and Prevention. www.cdc.gov.

TABLE 2.aRecommended Dosing of Havrix and Vaqtaa 4,5
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TABLE 2. Recommended Dosing of Havrix and Vaqtaa 4...

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