Hep A Flashcards
Transmission is via…
Faecal-oral, either from person to person or through contaminated food or drink
Infection with hep A causes an _______ hepatitis
Acute
Notifiable infection?
Yes
Risk factors
Travel to high prevalence countries
oral-anal sexual contact (rimming)
IV drug use
Is testing for hep A part of routine sexual health screen in NZ?
No
Do you need to screen someone for hep A before vaccination?
No - no harm in vaccinating an already immune person, however some groups with a higher probability of prior infection may wish to avoid the expense of vaccination
Unfunded indications for screening before vaccination
MSM and others engaging in oral-anal sexual contact
People who inject drugs
People who have hepatitis B or C (superinfection with HAV leads to increased morbidity and mortality)
People travelling to high-risk countries
HAV testing is not funded in NZ, unless ___________
Acute infection is suspected
Routine testing for HAV immune status =
Total HAV antibody (Ab)
Differential testing for HAV IgG and IgM is limited to patients suspected of __________
Having acute HAV (jaundice and deranged liver function tests)
Interpretation of results - Total HAV Ab < 20 IU/mL
Susceptible
Offer vaccination if risk, and patient willing to pay
Interpretation of results - Total HAV Ab > 20 IU/mL and no suspicion of acute hepatitis
Previous infection or vaccination
Reassure the patient
No further action required
Suspicion of acute hepatitis and total HAV Ab > 20 IU/mL or positive HAV IgM +/- positive HAV IgG
Possible acute infection
Request liver function tests and HAV IgM if not already done
HAV IgM remains positive for __________ after acute infection
6 months or more
Management of acute hep A acute infection
Supportive care and monitoring
Advise avoiding food-handling and sexual contact (including oral-genital and oral-anal) until non-infectious
Notify public health
Acute hep A infection - when is the patient infectious?
From 2 weeks before until 1 week after onset of jaundice
Consider unfunded vaccination for the following target groups in the context of a sexual health check…
MSM and others engaging in oral-anal sexual contact
People who inject drugs
People who have hepatitis B or C (superinfection with HAV leads to increased morbidity and mortality)
Is HAV infection associated with worse clinical outcomes in people living with HIV?
No
Is HAV vaccine recommended for people living with HIV?
HAV vaccine is recommended (unfunded) for people living with HIV, who have additional risk factors (see target populations above)
