Hepatitis A Information for Ob-gyns
Symptomatic Hepatitis A Virus (HAV) infection is characterized by the abrupt onset of fever, malaise, anorexia, nausea, abdominal pain, dark urine, and jaundice.
Symptoms of HAV infection last approximately 2 months, but the disease may be either prolonged or relapsing for up to 6 months. Hepatitis A is most infectious 2 weeks prior to jaundice, when the liver function test results are highest and there is the greatest concentration of virus in the stool. The incubation period is approximately 28 days, with a range of 15–50 days. Viremia occurs soon after transmission, evidenced by elevated liver function tests. An individual’s infectivity usually wanes one week after the appearance of jaundice. HAV infection confers lifelong immunity and does not lead to chronic infection.
The hepatitis A vaccine is recommended for persons who are at increased risk for infection. The specific dosage varies according to the age of the patient. Individuals considered at increased risk for HAV infection include persons traveling to or working in countries with high or intermediate disease endemicity, men who have sex with men, users of injecting and noninjecting illicit drugs, susceptible persons who receive clotting-factor concentrates, and individuals who work with primates artificially infected with HAV. Hepatitis A vaccine is recommended for individuals with chronic liver disease who are more likely to suffer devastating fulminant HAV if infected. The hepatitis vaccine is safe for women who are pregnant or breastfeeding.
Two hepatitis A vaccines, Harvix (GlaxoSmithKline) and Vaqta (Merck & Co, Inc.), are licensed in the United States. Both vaccines are inactivated and have age-based dosing schedules. They are approved for individuals aged 12 months and older. An inactivated hepatitis A and B combination vaccine, Twinrix (GlaxoSmithKline), was licensed in 2001 for persons older than 18 years. Twinrix may be used on an accelerated schedule for persons susceptible to hepatitis A and B who are planning imminent travel to endemic areas.
The hepatitis A vaccine should not be given to patients who have had a severe allergic reaction (eg, anaphylaxis) after a previous vaccine dose or to a vaccine component (eg, alum, 2-phenoxyethanol). Vaqta should not be given to individuals with a neomycin allergy. The tip caps of prefilled syringes for Havrix may contain natural rubber latex; patients allergic to latex should be given Vaqta with caution.
For more information, visit the CDC's Heptatitis A section for health care professionals.
Hepatitis A Information for Patients
Hepatitis A virus(HAV) is a contagious infection of the liver. It spreads by accidental contact with infected feces. HAV infection can cause sudden fever, loss of appetite, nausea, stomachache, dark urine, jaundice, and a general feeling of being unwell.
These symptoms typically last about 2 months, but HAV infection may last for up to 6 months. It is diagnosed by liver function tests. It can incubate in the body for 15–50 days but usually for about 28 days. HAV infection is most contagious 2 weeks before jaundice appears. One week after jaundice appears, the infection is usually no longer contagious. People who get HAV infection once become immune to it for life. Although serious infection is rare, some people die from HAV infection.
People who are at increased risk for infection should get the HAV vaccine. These people include:
• Those traveling to or working in countries with increased rates of the disease
• Men who have sex with men
• Users of illegal drugs
• Those who have received a blood transfusion or blood products
• Those who work with primates infected with HAV such as in a laboratory
• Those with chronic liver disease.
HAV vaccine is safe for women who are pregnant or breastfeeding. The specific dosage varies according to the age of the patient and is approved for people ages 12 months and older. There are two HAV vaccines available. Havrix should not be given to people allergic to latex. Vaqta should not be given to those allergic to the antibiotic neomycin. There is also a third type called Twinrix that protects against both hepatitis A and hepatitis B for people ages 18 and older at increased risk for infection. Neither HAV vaccine should be given to patients who have had a severe allergic reaction after a previous vaccine.
Visit theCenters for Disease Control and Prevention's Hepatitis A sectionfor more information.