Hepatitis A Immunoglobulin

Aka: Hepatitis A Immunoglobulin, Hepatitis A Ig

1. See Also
   1. Hepatitis A
   2. Hepatitis A Vaccine
2. Indications (otherwise administer Hepatitis A Vaccine)
   1. Preexposure Travel to endemic areas
      1. Travel within 1 month (otherwise use Vaccine)
      2. Age under 1 year or Vaccine otherwise contraindicated
   2. Postexposure (within 2 weeks of exposure)
      1. Household and institutional contacts
      2. Not necessary for casual work contacts
3. Epidemiology
   1. Most frequent Vaccine preventable disease in travelers
4. Protocol
   1. Pre-exposure for travelers to endemic areas
      1. Travel <3 months
         1. Hepatitis A Immunoglobulin 0.02 ml/kg IM
      2. Travel Longer than 3 months (protective for 5 months)
         1. Hepatitis A Immunoglobulin 0.06 ml/kg IM q4 months
   2. Post-exposure (within 2 weeks)
      1. Hepatitis A Immunoglobulin 0.02 ml/kg IM
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. Drug Interactions: Live Attenuated Vaccines
   1. Immunoglobulin decreases immunogenicity
   2. Delay MMR for 3 months after Immunoglobulin
   3. Delay Varicella Vaccine for 5 months after Ig
9. References
   1. Bianco (2004) Dig Liver Dis 36:834-42 [PubMed]
   2. Craig (2004) N Engl J Med 350:476-81 [PubMed]