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Hepatitis A virus infection

Key sources
The following summarized guidelines for the evaluation and management of hepatitis A virus infection are prepared by our editorial team based on guidelines from the British Association for Sexual Health and HIV (BASHH 2023; 2017), the European Association for the Study of the Liver (EASL 2023), the American Academy of Family Physicians (AAFP 2021), the Center for Disease Control (CDC 2021; 2020), and the American College of Gastroenterology (ACG 2016).
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Guidelines

1.Screening and diagnosis

Indications for testing, at-risk population
Consider obtaining testing for HAV in the sexual health setting in at-risk patients, especially MSM, injection drug users, patients with HBV, HCV, and HIV infections,
B
with unknown immune status and no definite history of completed HAV vaccination course, depending on local funding arrangements and the risk of not returning for vaccination.
C
Offer the first vaccine dose on the same day as testing in an outbreak situation or if the patient may not return.
Do not obtain screening for HAV infection in the sexual health setting in patients known to be immune or fully vaccinated against HAV.
D
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  • Indications for testing (contacts of patients)

2.Diagnostic investigations

Serologic testing: as per AAFP 2021 guidelines, obtain anti-HAV IgM to confirm suspected HAV infection.
B

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  • Screening for STIs

3.Medical management

Supportive care: as per CDC 2021 guidelines, provide supportive care in patients with acute HAV infection, with no restrictions on diet or activity.
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4.Specific circumstances

Pregnant patients, prevention, EASL
Offer HAV vaccination in pregnant women at risk for HAV infection during pregnancy.
B
Offer hepatitis A vaccine and immunoglobulin for post-exposure prophylaxis during pregnancy.
B

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  • Pregnant patients (indications for testing)

  • Pregnant patients (counseling)

  • Pregnant patients (delivery and breastfeeding)

  • Pregnant patients (newborn immunization)

5.Patient education

General counseling: provide health/sex education about the routes of HAV transmission and the higher incidence in developing countries.
B
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6.Preventative measures

Immunization, indications, BASHH: offer HAV vaccination in unimmunized patients with sexually transmitted enteric infections.
B

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  • Immunization (pre-vaccination testing)

  • Immunization (post-vaccination testing)

  • Post-exposure prophylaxis (vaccination)

  • Post-exposure prophylaxis (immunoglobulin)

7.Follow-up and surveillance

Follow-up
Monitor patients at 1-2 weekly intervals until aminotransferase levels are normal (usually 4-12 weeks).
B
Recognize that HAV immunity is usually lifelong.
B