Hepatitis A primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]
Overview
- Hepatitis A can be prevented by good hygiene and sanitation. Vaccination is also available, and is reconmended in areas where the prevalence of hepatitis A is high. To prevent it, use your own towels and toothbrushes, eating utensils, and other personal products. Always wash your hands after and before eating and more importantly after using the toilet.
- Two products are used to prevent hepatitis A virus infection: immune globulin and hepatitis A vaccine.
- Immune globulin is a preparation of antibodies that can be given before exposure for short-term protection against hepatitis A and for persons who have already been exposed to hepatitis A virus. Immune globulin must be given within 2 weeks after exposure to hepatitis A virus for maximum protection.
- Hepatitis A vaccine has been licensed in the United States for use in persons 12 months of age and older. The vaccine is recommended (before exposure to hepatitis A virus) for persons who are more likely to get hepatitis A virus infection or are more likely to get seriously ill if they do get hepatitis A. The vaccines currently licensed in the United States are HAVRIX® (manufactured by GlaxoSmithKline) and VAQTA® (manufactured by Merck & Co., Inc).
Hepatitis A Vaccine
Inactivated and attenuated hepatitis A vaccines have been developed and evaluated in human clinical trials and in nonhuman primate models of HAV infection; however, only vaccines made from inactivated HAV have been evaluated for efficacy in controlled clinical trials. The vaccines containing HAV antigen that are currently licensed in the United States are the single-antigen vaccines HAVRIX® (manufactured by GlaxoSmithKline, Rixensart, Belgium) and VAQTA® (manufactured by Merck & Co., Inc., Whitehouse Station, New Jersey) and the combination vaccine TWINRIX® (containing both HAV and HBV antigens; manufactured by GlaxoSmithKline). All are inactivated vaccines.
The Hepatitis A vaccine, Avaxim, protects against the virus in more than 95% of cases and provides protection from the virus for ten years. The vaccine contains inactivated Hepatitis A virus providing active immunity against a future infection.[1]
Pre-exposure Vaccination
Persons in the following groups who are likely to be treated in STD clinic settings should be offered hepatitis A vaccine:
- all MSM;
- illegal drug users (of both injection and noninjection drugs); and
- persons with chronic liver disease (CLD), including persons with chronic HBV and HCV infection who have evidence of CLD.
Serologic Testing
Pre-exposure
- Approximately one third of the U.S. population has serologic evidence of previous HAV infection, which increases with age and reaches 75% among persons aged more than 70 years.
- Screening for HAV infection might be cost-effective in populations where the prevalence of infection is likely to be high (e.g., persons aged more than 40 years and persons born in areas of high HAV endemicity).
- The potential cost-savings of testing should be weighed against the cost and the likelihood that testing will interfere with initiating vaccination.
- Vaccination of a person who is already immune is not harmful.