Hepatitis A Immunoglobulin

Aka: Hepatitis A Immunoglobulin, Hepatitis A Ig

1. See Also
   1. Hepatitis A
   2. Hepatitis A Vaccine
2. Indications
   1. Also administer Hepatitis A Vaccine if not contraindicated
      1. Exceptions: Age <6 months (preexposure) or age <12 months (postexposure)
   2. High Risk Indications for Preexposure or Postexposure Prophylaxis
      1. Patient age <6 months (pre-exposure) or <1 year old (postexposure)
      2. Age over 40 years old
      3. Serious comorbidity
      4. Immunocompromised
      5. Chronic Liver Disease
      6. Severe allergy to Hepatitis A Vaccine or other contraindication
   3. Preexposure Travel to endemic areas Indications
      1. Give with Hepatitis A Vaccine if travel within next 4 weeks to endemic region
      2. Age under 6 months or Vaccine otherwise contraindicated
      3. Age over 6 months AND other high risk indications above (give Immunoglobulin AND Hepatitis A Vaccine)
   4. Postexposure (within 2 weeks to household or institutional contact or contaminated food) Indications
      1. Age under 12 months or Vaccine otherwise contraindicated
      2. Age over 12 months AND other high risk indications above (give Immunoglobulin AND Hepatitis A Vaccine)
      3. Not necessary for casual work contacts
3. Epidemiology
   1. Hepatitis A is the most frequent Vaccine preventable disease in travelers
4. Protocol
   1. Dose 0.1 to 0.2 ml/kg IM
   2. Use higher dose (0.2 ml/kg) for travel in next 1-2 months
   3. Provides up to 3 months of protection from Hepatitis A Virus
5. Preparation
   1. Immunoglobulin from pooled human plasma
   2. Considered safe from transmission of contagious disease
      1. Viruses inactivated
      2. Tested for Hepatitis B, Hepatitis C and HIV
6. Contraindications
   1. IgA Deficiency
   2. Not contraindicated in pregnancy or Lactation
7. Efficacy
   1. Pre-exposure before travel
      1. Prevents infection in up to 85%
   2. Post-exposure (if given within 2 weeks of exposure)
      1. Prevents infection in up to 89%
8. Adverse Effects
   1. Hypersenstivity reaction
   2. Thrombosis risk
9. Drug Interactions: Live Attenuated Vaccines
   1. Immunoglobulin decreases immunogenicity
   2. Delay MMR Vaccine and Varicella Vaccine for 2 weeks before and 6 months after Immunoglobulin
10. References
    1. Bianco (2004) Dig Liver Dis 36:834-42 [PubMed]
    2. Craig (2004) N Engl J Med 350:476-81 [PubMed]
    3. Langan (2021) Am Fam Physician 104(4): 368-74 [PubMed]