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Brief Summary

GUIDELINE TITLE

Hepatitis A.

BIBLIOGRAPHIC SOURCE(S)

  • New York State Department of Health. Hepatitis A. New York (NY): New York State Department of Health; 2007 Jul. 4 p. [13 references]

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: New York State Department of Health. Hepatitis A virus. New York (NY): New York State Department of Health; 2006 Apr. 4 p.

BRIEF SUMMARY CONTENT

 
RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

What's New – July 2007 Update

  • The Committee now recommends that clinicians vaccinate all human immunodeficiency virus (HIV)-infected patients who are negative for hepatitis A virus (HAV) immunoglobulin G (IgG) (2006 version recommended that clinicians offer the hepatitis A vaccine to patients who are at increased risk for hepatitis A).
  • New recommendation to obtain a post-vaccination antibody measurement in patients who are at increased risk for hepatitis A infection to verify vaccine efficacy and to identify patients who might benefit from vaccine boosting. Persons who are at increased risk are listed below.

Key Point:

Currently, no specific treatment is available for HAV, although infection can be prevented by both pre-exposure vaccination and post-exposure serum immune globulin administration.

Prevention of HAV Infection

Pre-Exposure Vaccination

Clinicians should administer the HAV vaccine to HIV-infected patients who are negative for HAV IgG. The full series consisting of an initial dose and a second dose 6 to 12 months later should be given to ensure maximal antibody response.

Clinicians should administer HAV vaccination early in the course of HIV infection. If a patient's CD4 count is <300 cells/mm3 or the patient has symptomatic HIV disease, it is preferable to defer vaccination until several months after initiation of antiretroviral (ARV) therapy in an attempt to maximize the antibody response to the vaccine.

Clinicians should obtain a post-vaccination antibody measurement in patients who are at increased risk for hepatitis A infection:

  • Men who have sex with men (MSM)
  • Travelers to countries with high endemicity of infection
  • Persons who live in a community experiencing an outbreak of HAV infection
  • Illicit drug users, particularly injection drug users
  • Persons who have clotting-factor disorders
  • Persons at occupational risk for infection
  • Persons with chronic liver disease (e.g., hepatitis B or C) (Persons with chronic liver disease are at increased risk for severe infection if they become coinfected with hepatitis A)

Post-Exposure Immune Globulin

Clinicians should administer immune globulin (0.02 mL/kg intramuscularly [IM]) as HAV post-exposure prophylaxis to non-immune or non-vaccinated patients within 2 weeks of a potential HAV exposure. HAV vaccine is not indicated for post-exposure prophylaxis; however, it should be administered concurrently with serum immune globulin for the long-term prophylaxis of an at-risk individual.

CLINICAL ALGORITHM(S)

None provided

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically stated.

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • New York State Department of Health. Hepatitis A. New York (NY): New York State Department of Health; 2007 Jul. 4 p. [13 references]

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2003 Mar (revised 2007 Jul)

GUIDELINE DEVELOPER(S)

New York State Department of Health - State/Local Government Agency [U.S.]

SOURCE(S) OF FUNDING

New York State Department of Health

GUIDELINE COMMITTEE

Medical Care Criteria Committee

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Chair : Jessica E Justman, MD, Columbia University, New York, New York

Vice-Chair: Barry S Zingman, MD, Montefiore Medical Center, Bronx, New York

Members: Judith A Aberg, MD, New York University School of Medicine, New York, New York; Bruce D Agins, MD, MPH, New York State Department of Health AIDS Institute, New York, New York; Barbara H Chaffee, MD, MPH, Binghamton Family Care Center, Binghamton, New York; Steven M Fine, MD, PhD, University of Rochester Medical Center, Rochester, New York; Barbara E Johnston, MD, Saint Vincent's-Manhattan Comprehensive HIV Center, New York, New York; Jason M Leider, MD, PhD, North Bronx Healthcare Network of Jacobi and North Central Bronx Hospitals, Bronx, New York; Joseph P McGowan, MD, FACP, Center for AIDS Research & Treatment, North Shore University Hospital, Manhasset, New York; Samuel T Merrick, MD, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York; Rona M Vail, MD, Callen-Lorde Community Health Center, New York, New York

Liaisons: Sheldon T Brown, MD, Liaison to the Department of Veterans Affairs Medical Center, Bronx Veteran Affairs Medical Center, Bronx, New York; Douglas G Fish, MD, Liaison to the New York State Department of Corrections, Albany Medical College; Albany, New York; Peter G Gordon, MD, Liaison to the HIV Quality of Care Advisory Committee, Columbia University College of Physicians and Surgeons, New York, New York; Fabienne Laraque, MD, MPH, Liaison to the New York City Department of Health and Mental Hygiene, Treatment and Housing Bureau of HIV/AIDS Prevention and Control, New York, New York; Joseph R Masci, MD, Liaison to New York City Health and Hospitals Corporation, Elmhurst Hospital Center; Elmhurst, New York

AIDS Institute Staff Physician: Charles J Gonzalez, MD, New York State Department of Health AIDS Institute, New York, New York

Principal Investigator: John G Bartlett, MD, The Johns Hopkins University, Baltimore, Maryland

Principal Contributor: Barry S. Zingman, MD, Montefiore Medical Center, Bronx

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: New York State Department of Health. Hepatitis A virus. New York (NY): New York State Department of Health; 2006 Apr. 4 p.

GUIDELINE AVAILABILITY

AVAILABILITY OF COMPANION DOCUMENTS

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was prepared by ECRI on January 22, 2004. This NGC summary was updated by ECRI Institute on January 11, 2005, September 18, 2007, and again on June 5, 2008.

COPYRIGHT STATEMENT

DISCLAIMER

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