Hepatitis A

Question 1

What is the risk of perinatal transmission of HAV?

Answer 1

0% - There is no perinatal transmission of HAV.

Question 2

Can pregnant women be vaccinated against HAV?

Answer 2

The inactivated HAV vaccine can be safely used for prevention, including during pregnancy if a patient is at risk for HAV exposure. Two doses IM (Havrix 1 mL [50 U] or Vaqta 1 g [1440 U]), given 6 to 12 months apart, are needed to confer immunity. HA vaccine is also available in combination with HB vaccine. Immunity after vaccination lasts >10 years.

Question 3

How should pregnant woman with an exposure to HAV be treated?

Answer 3

Exposed pregnant women can receive immune globulin injections, which are >85% effective in preventing HAV infection if given within two weeks of exposure. The standard intramuscular dose of immune globulin IS 0.02 mg/kg. The HAV vaccine series should also be initiated.

Question 4

What is the therapy for acute HAV infection?

Answer 4

The vast majority of hepatitis A virus (HAV) infections are self-limited. Therapy is supportive.

Question 5

Symptoms of HAV infection

Answer 5

Fever, malaise, decreased appetite, nausea, abdominal discom- fort, dark urine, jaundice.

Question 6

How is HAV transmitted?

Answer 6

Fecal/oral contact with infected person or contaminated food/ water; rarely from blood transmission. Most U.S. cases are from person-to-person or sexual contacts or transmission during outbreaks.

Question 7

Average HAV incubation period?

Answer 7

28 (15-49 days)

Question 8

What are the complications/chronic sequelae of HAV?

Answer 8

Mortality is <0.3%. Chronic carrier state does not exist.

Question 9

Diagnosis of HAV

Answer 9

HAV IgM and IgG. HAV IgM is detectable 5 to 10 days before the onset of symptoms and usually decreases to undetectable concentrations within six months after recovery. Consider rest of hepatitis workup. Check AST/ ALT, bilirubin.

Question 10

Where are the HAV endemic areas?

Answer 10

High: Mexico, South America, Africa, Middle East
Intermediate: Asia

Question 11

Is breast-feeding permitted in women with HAV?

Answer 11

Not contraindicated

Question 12

Who should receive the HAV vaccine?

Answer 12

International travelers
Children in endemic areas
Intravenous drug users
Individuals who have occupational exposure (e.g., workers in a primate laboratory)
Residents and staff of chronic care institutions
Individuals with liver disease
Homosexual men
Individuals with clotting factor disorders