Immune Globulin (IG)
Anyone who comes into contact with an HAV-infected individual should receive an intramuscular injection of immune globulin (IG), which contains antibodies to the hepatitis A virus. IG is prepared from pooled donor plasma and is treated to ensure that the final product is not contaminated with hepatitis B or C or with HIV. Immune globulin provides rapid immunity to hepatitis A that lasts for three to five months, depending on the dosage used. If given within two weeks of exposure, IG prevents infection in 85% of cases. The remaining 15% of patients experience a significant reduction in the severity of their illness.
Travelers who plan to visit areas where hepatitis A is common should schedule a hepatitis A vaccination at least one month prior to travel. Both hepatitis A vaccines licensed for use in the are safe for use in pregnant women and nursing mothers. If a vaccine is not available, immune globulin (IG) should be administered instead.
Travelers can further decrease their risk of infection by avoiding unpeeled fruits and vegetables or uncooked seafood and by drinking and brushing their teeth with bottled water. Because many countries lack adequate hand washing facilities, travelers should carry a supply of packaged hand-cleansing wipes.
Did You Know?
The purpose of a preventive vaccine is to protect you against a specific infectious disease. To do this, you will be injected with weakened, dead, or a partial version of a virus or bacterium. This preparation is not strong enough to cause a severe infection, but it will stimulate your immune system to produce antibodies against the pathogen. Later, if you are exposed to that pathogen, your immune system will recognize and eliminate it.
Preventive Vaccine for Hepatitis A
The most recent advancement in preventing new cases of hepatitis A has been the development of a vaccine against the hepatitis A virus.
Two vaccines licensed for use in the since 1995 provide nearly total protection against hepatitis A infection:
- Havrix (GlaxoSmithKline); and
- Vaqta (Merck and Co.).
These two vaccines are equally effective at generating immunity to the hepatitis A virus. Both vaccines are given as an initial dose, followed by a booster dose six to 12 months later.
The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommends vaccination with hepatitis A vaccine for anyone who is at increased risk for infection or serious consequences of infection, and for any person who wants to obtain immunity.
Who's at Highest Risk for Hepatitis A?
The following groups are at increased risk for infection:
- those who travel to countries with high or intermediate rates of hepatitis A, especially Africa, Asia (except Japan), Eastern Europe, the Middle East, South and Central America, Mexico, and Greenland;
- those who have oral-anal sexual contact;
- those who use illegal drugs;
- those with chronic liver disease;
- those who work with hepatitis A in a laboratory setting;
- those with blood clotting disorders or who receive clotting factor concentrates; and
- children living in U.S. communities with high rates of hepatitis A, especially in the Southwestern U.S., Oregon, Washington, and Alaska.
In addition to the above groups, people who should consider vaccination include:
- food handlers;
- children in day-care and their supervisors;
- residents and staff of institutions that care for the chronically ill or disabled; and
- people with an immune system that has been weakened from cancer, HIV, chronic steroid medications, or organ transplantation.
It is not necessary to be tested for immunity before receiving hepatitis A vaccine. However, people over age 40 who live in areas with high rates of hepatitis A may already be immune and may wish to be tested for immunity first, in order to avoid receiving an unnecessary vaccination.
Is the Hepatitis A Vaccine Safe for Everyone?
The only group of people for whom the hepatitis A vaccine is not safe is those who are allergic to alum or any of the vaccine's other components.
Havrix and Vaqta have been used safely worldwide for many years in thousands of children and adults. Both vaccines are safe for use in pregnancy and in nursing mothers. The rates of reported side effects are similar between the two vaccines and, when they do occur, are usually limited to redness and soreness at the site of injection, headache, fatigue, and low-grade fever. Each dose of Havrix or Vaqta costs approximately $50 to $60 for the adult dose and $35 to $45 for the children's dose.