hepatic and biliary disorders
Hepatitis A
Prevention of Hepatitis A
Good personal hygiene helps prevent fecal-oral transmission of hepatitis A. Barrier protection is recommended, but isolation of patients does little to prevent spread of HAV. Spills and contaminated surfaces in the home of patients can be cleaned with dilute household bleach. (See also Hepatitis A (HepA) Vaccine ). The Hepatitis A (HepA) Vaccine is recommended for all children beginning at age 1 year, with a 2nd dose 6 to 18 months after the first (see Preexposure HAV vaccination (seeAdult Immunization Schedule) should be provided for adults with increased risk, including Vaccines for International Travel*, † to countries with high or intermediate HAV endemicity Diagnostic laboratory workers Men who have sex with men People who use injection or noninjection illicit drugs People with chronic liver disorders (including chronic hepatitis C) because they have an increased risk of developing fulminant hepatitis due to HAV People who anticipate close contact with an international adoptee during the first 60 days after arrival from a country with high or intermediate HAV endemicity People who do not have stable housing or who are homeless Preexposure HAV prophylaxis can be considered for day-care center employees and for military personnel. Previously, travelers were advised to get thehepatitis A vaccine≥2 weeks before travel; those leaving in<2 weeks should also be given standard immune globulin. Current evidence suggests immune globulin is necessary only for older travelers and travelers with chronic liver disease or another chronic disorder. Postexposure prophylaxis should be given to family members and close contacts of patients with hepatitis A. For healthy, unvaccinated patients aged 1 to 40 years, a single dose ofhepatitis A vaccineis given. For other patients, particularly those>75 years old, those with chronic liver disease, and immunocompromised patients, standard immune globulin (formerly immune serum globulin) prevents or decreases the severity of hepatitis A. A dose of 0.02 mL/kg IM is generally recommended, but some experts advise 0.06 mL/kg (3 to 5 mL for adults). It can be given up to 2 weeks after exposure, but the earlier, the better. 