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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. Accessed April 10, 2017.


  • Acute, self-limiting viral infection of liver.

  • Confers lifelong immunity.


  • RNA virus.

    • Genus Hepatovirus of Picornaviridae family.

    • Humans only reservoir.


  • 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.


  • Infection primarily occurs through:

    • Fecal-oral route.

    • Person-to-person contact.

    • Ingestion of contaminated food or water.


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

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