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Source: Deming, P. Viral Hepatitis. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. Accessed May 29, 2012.

  • 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 (Table 1 and Table 2)
  • Immunoglobulin (Ig)
    • Used when pre- or postexposure prophylaxis against HAV infection needed in persons for whom vaccination not an option.
    • Most effective if given in incubation period of infection.
    • Dosing:
      • 0.02 mL/kg IM for postexposure prophylaxis or short-term (<3 months) preexposure prophylaxis
      • 0.06 mL/kg IM for long-term preexposure prophylaxis (≤5 months)
    • May be given with HAV vaccine.

Table 1. Recommendations for Hepatitis A Vaccination
Table 2. Recommended Dosing of Havrix and Vaqta

  • International travel to HAV endemic areas
    • Children under 15 years especially at risk
  • Sexual and household contact with HAV infected persons
    • Men who have sex with men
  • Injection drug users
  • ...

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