7 Hepatitis A

7.8 Public health measures

It is a legal requirement that all cases of hepatitis A be notified immediately on suspicion to the local medical officer of health.

7.8.1 Outbreak control

HAV vaccination is the preferred method for controlling outbreaks, or for post-exposure prophylaxis. HAV vaccine may be used for post-exposure prevention of infection if given within two weeks of exposure.11 The US Advisory Committee on Immunization Practices (ACIP) recommends HAV vaccine for post-exposure prophylaxis in healthy persons aged 12 months t0 40 years.12 Human IG may be given to infants aged under 12 months and adults aged 41 years and older, and to other vulnerable groups. IG is not usually offered if more than two weeks have elapsed since the onset of exposure to the index case.

See Table 7.3 below for immunoprophylaxis recommendations.

Newborn infants of infected mothers

Perinatal transmission is rare. If the mother develops symptoms two weeks before to one week after delivery, the infant may be given IG (0.02 mL/kg), although its efficacy in these circumstances has not been established. The mother may breastfeed. Specific advice should be sought from a paediatrician or infectious diseases physician.

Early childhood workers, children and household contacts

Prevention of spread in these circumstances requires educating people about the modes of spread. For example, HAV can survive on objects in the environment for up to several weeks.

Immunisation should be considered for unimmunised children aged 12 months and older and unimmunised adult workers aged 40 years and under in the same room as the index case. In addition, new workers appointed or children admitted up to six weeks after the outbreak should be vaccinated prior to entry. Infants aged under 12 months and workers aged 41 years and older may be offered IG. Household contacts of confirmed cases should also be protected. Minimal contact in schools is not considered a high-risk situation.

Community-wide outbreaks of hepatitis A infection

HAV vaccine is effective in controlling community-wide epidemics and common-source outbreaks of HAV infection.13 Before the vaccine is used for outbreak control, consideration should be given to the current epidemiology in the community, the population at risk should be defined, and the feasibility and cost of delivering a programme should be assessed.

Table 7.3: Recommendations for post-exposure immunoprophylaxis of Hepatitis A virus (HAV)

Time since exposure Age of patient Recommended prophylaxis
2 weeks or less Younger than 12 months IG, 0.02 mL/kga
12 months through 40 years HAV vaccineb
41 years or older IG, 0.02 mL/kga but HAV vaccineb can be used if IG is unavailablea
People of any age who are immune compromised or have chronic liver disease IG, 0.02 mL/kga
More than 2 weeks Younger than 12 months No prophylaxis
12 months or older No prophylaxis, but HAV vaccine may be indicated for ongoing exposureb
a IG (immunoglobulin) should be administered deep into a large muscle mass. Ordinarily no more than 5 mL should be administered in one site in an adult or large child; lesser amounts (maximum 3 mL in one site) should be given to small children and infants.
b See Table 7.2 for hepatitis A vaccine dosage and scheduling. Note that only one dose of HAV vaccine is funded for close contacts of hepatitis A cases.

Source: Adapted from: American Academy of Pediatrics. 2012. Hepatitis A. In: Pickering LK, Baker CJ, Kimberlin DW, et al (eds). Red Book: 2012 report of the Committee on Infectious Diseases (29th edition). Elk Grove Village IL: American Academy of Pediatrics, Table 3.13.

For more details on control measures, refer to the Communicable Disease Control Manual6 or the Control of Communicable Diseases Manual.14