Management of household and sexual contacts

Management of household and sexual contacts

• for household and sexual contacts who haven't received two doses of hepatitis A vaccine (or one dose within the past six months), do not have a history of laboratory confirmed hepatitis A and are seen within 14 days of exposure to infection:
  
  
  • healthy persons aged 12 months to 50 years
    • a single dose of monovalent hepatitis A vaccine should be given
    • if the patient is at continued risk of infection a second dose of vaccine at 6-12 months after the first dose should be advised
      
      
  • healthy infants <12 months
    • post exposure prophylaxis is not required
      
      
  • people aged over 50 years
    • monovalent hepatitis A vaccine + normal immunoglobulin (HNIG)
    • should receive a second dose at 6-12 months to ensure long term protection
      
      
  • people with chronic liver disease, pre existing chronic hepatitis B or C infection or HIV infection or immunosupression
    
    • monovalent hepatitis A vaccine + normal immunoglobulin (HNIG)
    • should receive a second dose at 6-12 months to ensure long term protection
      
      
  • pregnant or breast feeding women
    • same as for non pregnant contacts
      
      
  • for household contacts seen 14 days after exposure to infection:
    • consider HNIG up to 28 days post exposure for people with risk of severe disease (with chronic liver disease or pre existing hepatitis B or C)
      • two doses of hepatitis A vaccine given 6 months apart should also be considered in these patients to provide long term protection (irrespective of the time since exposure)
    • if there is more than one contact in the household, offer vaccination for all contacts seen within 8 weeks of onset of symptoms in the index case
    • household contact who attends nursery or infant school - proper hand washing technique (under supervision) should be followed to reduce the risk of asymptomatic transmission
      
      
  • for wider communities to control outbreaks
    • monovalent hepatitis A vaccine should be given (with the second dose given at 6-12 months if contacts are at continuing risk)
    • those who are at risk of severe infection additional HNIG should be offered (1)

Reference:

• 1. Health Protection Agency (HPA) 2009. Guidance for the prevention and control of hepatitis A infection