Hepatitis A Clinical Information
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Hepatitis A Clinical
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Epidemiology of hepatitis A
Communicability of hepatitis A
Recommendations: suspect cases
Lab testing encouraged
Post-exposure prophylaxis recommendations
Immune globulin (IG) delivery can be arranged
Vaccination recommendations
Hepatitis A in Minnesota
Hepatitis A is endemic in Minnesota. The most frequently reported source of hepatitis A infection is contact with a person with hepatitis A.
Epidemiology of hepatitis A
The clinical course of hepatitis A varies greatly. Symptoms (listed below) typically have an abrupt onset. The likelihood of having symptoms with hepatitis A infection is related to a person’s age. In children less than 6 years of age, most (70%) hepatitis A infections are asymptomatic. Among older children and adults, infection is usually symptomatic, with jaundice occurring in more than 70% of cases.
Communicability of hepatitis A
Hepatitis A virus is transmitted primarily by the fecal-oral route. Persons with hepatitis A are infectious from approximately 2 weeks before symptom onset to up to 2 weeks after symptoms begin.Recommendations: Suspect cases
- Symptoms of hepatitis A include acute onset of any of the following: fatigue, anorexia, nausea with or without vomiting, abdominal pain, dark urine, fever, headache, diarrhea, or jaundice.
- Hepatitis A cannot be differentiated from other hepatitides on symptoms alone. Laboratory confirmation is needed when diagnosing hepatitis A.
- The incubation period for hepatitis A is usually 4 to 6 weeks (28 to 42 days) after exposure but can range from 2 to 7 weeks (15 to 50 days).
- Suspect cases of hepatitis A are reportable to the Minnesota Department of Health (MDH) at 651-201- 5414 or 1-877-676-5414 (toll-free).
Lab testing encouraged for symptomatic persons only
Hepatitis A infection is confirmed by the presence of hepatitis A-specific IgM antibody. Hepatitis A IgM antibody testing and liver function tests should be performed on suspect cases. Testing is not indicated for exposed persons who do not exhibit symptoms.
Post-exposure prophylaxis recommendations
- Persons exposed within the past 2 weeks should receive post-exposure treatment in accordance with new ACIP recommendations (published in the MMWR, October 19, 2007)
- For healthy persons 12 months - 40 years of age, hepatitis A vaccine at the age-appropriate dose is preferred. (Persons who receive a first dose of vaccine as post-exposure prophylaxis should receive a second dose at least 6 months later to confer ongoing protection.)
- For persons over 40 years of age, immune globulin (IG) is preferred; vaccine may be used if IG cannot be obtained.
- For children under 12 months of age, immunocompromised persons, persons with diagnosed chronic liver disease, and persons for whom vaccine is contraindicated, IG should be used.
- Persons exposed more than 2 weeks ago may develop symptoms within the next few weeks, regardless of whether they received treatment for a more recent exposure. The incubation period for hepatitis A is generally about one month, but may be 2 to 7 weeks.
Immune globulin (IG) delivery can be arranged
When the need arises, you can arrange for IG to be delivered. Overnight shipping may be available. Contact one of these distributors:
| Alternative Site Distributors | 1-800-837-5403 |
| Health Coalition | 1-800-456-7283 |
| Chapin Medical | 1-800-221-7180 |
| FFF Enterprises | 1-800-843-7477 |
| Nationwide | 1-800-997-8846 |
| NHS | 1-800-344-6087 |
Vaccination recommendations
Hepatitis A vaccine is available for persons 12 months of age and older. The vaccine series consists of 2 doses given 6 months apart. The vaccine is recommended for routine vaccination of all children 12 months of age and older, certain high-risk groups (e.g., international travelers), as well as anyone desiring protection against hepatitis A. The vaccine takes 2 to 4 weeks after the first dose to confer immunity.
