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As treatment possibilities are limited, the most important is to try and avoid viral hepatitis. Prevent the spread of hepatitis A is by:
- Good sanitation systems
- Clean tap water
- Safe preparation of food
- Implementing basic hygiene, such as washing one's hands after using the toilet, after changing a nappy and before preparing food.
(Note that the virus is present in the faeces of an infected person from two weeks before symptoms begin to about a week after the start of the illness.) - Not preparing food at home or at work if you have hepatitis A
- Notifying staff and parents if your child has hepatitis A and attends a crèche or school, so that preventive steps can be taken
If well, children can return to school and adults to work one week after the onset of hepatitis A, as they will no longer be significantly infectious.
Food handlers should not return to work for one to two weeks after onset of jaundice.
Prevention before exposure (pre-exposure prophylaxis)
Vaccination before exposure
Hepatitis A vaccines have a remarkable effectiveness and safety record. Immunisation with two doses – usually six to 18 months apart – will generate long-lasting, life-long protection against hepatitis A virus infection.
Some developed countries like the USA introduced routine hepatitis A vaccination from 1996 for children older than one year, as well as high risk adults. As a result, the number of new hepatitis A infections in all age groups has decreased substantially in these countries.
In South Africa, hepatitis A vaccination is also available in the private health sector as part of routine infant immunisation at 12 to 15 months, with the second dose six months later.
It is not part of the routine Expanded Programme on Immunisation (EPI) in the public health sector in South Africa.
Hepatitis A vaccination is also recommended for non-immune individuals who are at risk for acquisition of hepatitis A, or at-risk for more severe disease. These include the following:
- Travellers from countries with low rates of hepatitis A travelling to countries where hepatitis A virus infection is common. The vaccine can be given at any time before travelling. If a person does not have time to receive both doses before travelling, the first dose can be given for short term protection before travel, and the second dose six to 12 months later for longer term protection.
- Individuals with chronic liver disease (e.g. chronic hepatitis B or C infection), history of excessive alcohol use, or liver cirrhosis
- People requiring life-long treatment with blood products e.g. haemophiliacs
- Men who have sex with men
- Injection and non-injection illegal drug users
- People who are at risk for infection at work. These include raw sewage workers, people working in health care facilities and care centres for young children and the mentally handicapped (especially those working with incontinent patients and/or infants in nappies) and workers in the food industry.
Immunoglobulin before exposure
Immunoglobulin, given by injection, can provide an "instant immunity" against the virus. However, this only lasts for a few months.
Immunoglobulin can be used within two weeks before travel in those who cannot receive the hepatitis A vaccine (for example, children younger than one year of age or those allergic to components in the vaccine).
Travellers who stay in high risk areas for more than five months will need a second dose of immunoglobulin after four months.
Some people’s immune systems may not react optimally to the vaccine. These include the elderly and people with weakened immune systems, chronic liver disease or underlying medical conditions. These individuals can be given a dose of immunoglobulin simultaneously with the first dose of hepatitis A vaccine within two weeks before travel to a high risk area.
Prevention after exposure to prevent infection (post-exposure prophylaxis, PEP)
Immunoglobulin or hepatitis A vaccination that is administered preferably within 72 hours, but up to 14 days, of exposure can prevent hepatitis A infection in a non-immune individual. This means someone with no previous hepatitis A infection, receipt of vaccination or no hepatitis A IgG in the blood.
The following exposure to hepatitis A may be considered for PEP:
- Close personal contact with a person with acute hepatitis A (examples include anybody living with an infected person, sexual contact within one month of infection, sharing intravenous drugs, food handlers working with an infected person and someone changing nappies of an infected person)
- An individual with acute hepatitis A infection at a child or other care centre where there are incontinent patients and/or infants wearing nappies or where hygiene is considered to be poor (e.g. homes for the physically or mentally disabled) – all staff and children are considered exposed
- An individual with acute hepatitis A infection at a child care centre where there are no children wearing nappies – only staff and children in the same class considered exposed
- People who ate at a restaurant where an individual with acute hepatitis A infection was working – only if the infected person had diarrhoea and handled food, and only if within two weeks after the exposure
- Any contacts exposed to faecal material without proper infection control measures
Vaccination after exposure
One dose of vaccine within 14 days of exposure is recommended for non-immune, exposed individuals aged one to 40 years of age, without underlying risk factors. A second dose of vaccine can be administered after six to 12 months for long term protection.
Immunoglobulin after exposure
One dose of immunoglobulin within 14 days of exposure is recommended for the following non-immune, exposed individuals:
- Individuals younger than one year and older than 40 years of age
- People with weakened immune systems
- People with chronic liver disease
- People who are allergic to any component in the vaccine
Notifiable disease
Hepatitis A infection is a notifiable condition in South Africa. The person who diagnoses the disease must notify the Local or District Health Service within seven days of diagnosis, as stipulated by law. Written notification, using the GW17/5 form, is required.
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Revised and reviewed by Dr Karin Richter, MMed Path (Medical Virology), FC Path(SA) Viro, Dip HIV Man (SA), Dip Obst (SA), MBChB , Clinical Virologist, Senior Lecturer, Department of Medical Virology, University of Pretoria, Faculty of Health Sciences, and Consultant Pathologist, Tshwane Academic Division, National Health Laboratory Services (NHLS) February 2015.
