Hepatitis A Prevention

8/10/01 (Franco)

RE: A 19 year old African-American male with nausea/vomiting, hematemesis, and black stool. 

Question: When a patient is diagnosed with Hepatitis A, what measures should be taken to prevent family members from getting the disease?

<1>

Unique Identifier: 20271265 / PubMed Identifier: 10813157

Authors: Aszkenasy OM.

Institution: Community Child Health Department, West Lane Hospital, Middlesbrough.

Abstract: An outbreak of hepatitis A occurred in a religious community in Indiana, USA. Sixty-nine cases were ascertained among the 4466 residents over a year, and the highest attack rate was in children. The management of the outbreak included the widespread use of prophylactic immune serum globulin (ISG). Despite this, further cases occurred. To guide further ISG administration, a survey was undertaken to ascertain what proportion remained susceptible to HAV infection. From a random sample of 600 people in the affected community 440 saliva specimens (73%) were obtained. Of these, 12.5% were found to be immune (95% confidence intervals from 9-16%). No changes were made to the ISG administration policy. There was no evidence to suggest that administration of ISG had any effect on the duration of the outbreak. There was a low rate of symptomatic infection among young children (less than 10 years); as ISG does not prevent the spread of the virus its use is not recommended in future outbreak situations.

<2>

Unique Identifier: 20239562 / PubMed Identifier: 10779260

Authors: Preboth M.

<3>

Unique Identifier: 20017197 / PubMed Identifier: 10549431

Authors: Winn WC Jr.

Institution: Clinical Microbiology Laboratory, Fletcher Allen Health Care, Burlington, Vermont, USA. washington.winn@vtmednet.org

Abstract: Enterically-transmitted hepatitis is caused by hepatitis A virus and hepatitis E virus. The most important agent is hepatitis A virus, which is distributed worldwide and infects all age groups. Most infections in children are minimally symptomatic and immunity is long-lasting, so severe disease tends to occur in nonimmune adults. Hepatitis E virus is found in the developing world and has a greater propensity for symptomatic infection of children. Both agents are transmitted via contaminated water, often through food vehicles. [References: 62]

<4>

[Link Directly to Fulltext Article in OVID]

Unique Identifier: 20009002 / PubMed Identifier: 10543657

Authors: Anonymous.

Abstract: Routine vaccination of children is the most effective way to reduce hepatitis A incidence nationwide over time. Since licensure of hepatitis A vaccine in 1995, this strategy has been implemented incrementally, starting with the recommendation of the Advisory Committee on Immunization Practices (ACIP) in 1996 to vaccinate children living in communities with the highest rates of infection and disease. These updated recommendations represent the next phase of this hepatitis A immunization strategy. Vaccination of children living in states and communities with consistently elevated rates of hepatitis A will provide protection from disease and is expected to reduce the overall incidence of hepatitis A. This report updates the ACIP's 1996 recommendations on the prevention of hepatitis A through immunization (MMWR 1996;45:[No. RR-151) and includes a) new data about the epidemiology of hepatitis A; b) recent findings about the effectiveness of community-based hepatitis A vaccination programs; and c) recommendations for the routine vaccination of children in states, counties, and communities with rates that are twice the 1987-1997 national average or greater (i.e., > or = 20 cases per 100,000 population) and consideration of routine vaccination of children in states, counties, and communities with rates exceeding the 1987-1997 national average (i.e., > or = 10 but <20 cases per 100,000 population). Unchanged in this report are previous recommendations regarding the vaccination of persons in groups at increased risk for hepatitis A or its adverse consequences and recommendations regarding the use of immune globulin for protection against hepatitis A.

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[Link Directly to Fulltext Article in OVID]

Unique Identifier: 99224683 / PubMed Identifier: 10209977

Authors: Sagliocca L. Amoroso P. Stroffolini T. Adamo B. Tosti ME. Lettieri G. Esposito C. Buonocore S. Pierri P. Mele A.

Institution: Azienda Ospedaliera Santobono Pausilipon, Naples, Italy.

Abstract: BACKGROUND: Hepatitis A vaccination stops outbreaks of hepatitis A infection, but its efficacy against infection after exposure has not been proven. We investigated the use of hepatitis A vaccine to prevent secondary infections with hepatitis A virus (HAV). METHODS: We did a randomised controlled trial of hepatitis A vaccine in household contacts of people with sporadic HAV infection (index cases). Households (index cases and contacts) were randomly assigned to the vaccine group or unvaccinated group, according to the study week in which they were enrolled. All household contacts in the vaccine group received vaccination at the time of entry to the study. FINDINGS: During 45 days of follow-up, secondary infection had occurred in ten (13.3%) of 75 households (two families had two cases each) in the untreated group and in two (2.8%) of 71 households in the vaccine group. The protective efficacy of the vaccine was 79% (95% CI 7-95). The number of secondary infections among household contacts was 12 (5.8%) of 207 in the unvaccinated group and two (1.0%) of 197 in the vaccinated group. Therefore, 18 individuals needed to be vaccinated to prevent one secondary infection. INTERPRETATION: Hepatitis A vaccine is effective in the prevention of secondary infection of HAV and should be recommended for household contacts of primary cases of HAV infection.

<6>

Unique Identifier: 99047326 / PubMed Identifier: 9831431

Authors: Gardner P.

<7>

[Link Directly to Fulltext Article in OVID]

Unique Identifier: 99047321 / PubMed Identifier: 9831426

Authors: Levy MJ. Herrera JL. DiPalma JA.

Institution: Division of Gastroenterology, University of South Alabama College of Medicine, Mobile 36617, USA.

Abstract: The hepatitis A virus is usually transmitted person-to-person due to fecal-oral exchange of virus. Approximately 30,000 infections are reported each year in the United States, with the actual incidence being much greater. Prophylaxis with immune globulin has had a minimal impact on the overall incidence of hepatitis A. The recent availability and proven efficacy of a hepatitis A vaccine offers the hope that the incidence of infection may be substantially reduced. Pre- and postexposure prophylaxis should be targeted to individuals at increased risk of either acquiring infection, transmitting infection, or developing fulminant hepatitis, or to help control epidemics. This article reviews the current literature and discusses recommendations for pre- and postexposure prophylaxis against hepatitis A virus. [References: 97]

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Unique Identifier: 97408405 / PubMed Identifier: 9262924

Authors: Levinson MJ.

Institution: University of Tennessee, Memphis, USA.

<9>

[Link Directly to Fulltext Article in OVID]

Unique Identifier: 97154733 / PubMed Identifier: 9005304

Authors: Anonymous.

Abstract: This report provides recommendations for use of the newly licensed hepatitis A vaccines (HAVRIX, manufactured by SmithKline Beecham Biologicals, and VAQTA, manufactured by Merck & Company, Inc.) in persons > or = 2 years of age and updates previous recommendations for use of immune globulin (IG) for protection against hepatitis A (superseding MMWR 1990;39[No. RR-2]:1-5). For preexposure protection, hepatitis A vaccine can now be used instead of IG in many circumstances; for postexposure prophylaxis, the recommendations for IG use are unchanged.

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Unique Identifier: 96375583 / PubMed Identifier: 8781894

Authors: Feinstone SM.

Institution: Division of Viral Products, Center for Biologics Evaluation and Research, Bethesda, MD 20892, USA.

Abstract: Hepatitis A is a disease with worldwide distribution. Conditions of sanitation and hygiene determine the overall epidemiological situation in any area, but risk behaviour determines an individual's chance of exposure. The recent licensing of formalin-inactivated vaccines for the prevention of hepatitis A requires an understanding of the epidemiology in order to devise how best to use this the vaccine in individuals or populations. Although higher-risk groups can be identified in developed countries, and vaccine will be useful to those groups, it is not likely that the vaccine will have a large effect on the prevalence of hepatitis A until it becomes a part of the routine childhood immunization schedule. [References: 67]

<11>

Unique Identifier: 96384244 / PubMed Identifier: 8792141

Authors: Levinthal G. Ray M.

Institution: Friedman Center for Digestive and Liver Disorders, Mt Sinai Medical Center, Cleveland, OH 44106, USA.

Abstract: Hepatitis A probably causes an identifiable illness in less than 5% of individuals who are infected with the virus. Nonetheless, it has been an important cause of morbidity throughout history. Hepatitis A remains endemic in some developing nations, and cyclical epidemics still occur in developed nations, including the United States. Because infections are less common in children in developed nations, the pattern of infection has shifted toward older age groups. This shift is a concern because the disease tends to be far more symptomatic in older patients, and more than 70% of reported deaths are among persons older than 49 years of age. Hepatitis A does not cause chronic disease, but atypical presentations associated with a relapse may persist for several months. Although the risk of infection can be significantly reduced by adhering to good sanitary precautions, these precautions are not always practiced in certain environments, and there is a need for a universal immunization strategy. Passive immunization with pooled immune serum globulin is effective when administered within 2 to 3 weeks of exposure. Unfortunately, the window of opportunity is often missed because the majority of cases of hepatitis A have no history of exposure. The effectiveness of immune serum globulin is also short-lived. An effective breakthrough in prevention occurred with the development of a killed vaccine, which has proven to be effective for active immunization. It was licensed in the United States in 1995. [References: 81]