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Hepatitis A exposure — MSRA MCQ

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HardInfectious DiseasesHepatitis A exposureMSRA

A 68-year-old man requests advice after his wife is admitted with PCR-confirmed hepatitis A. Her jaundice began 9 days ago. Until her admission this morning, they had shared a home, meals and toilet facilities throughout her prodromal illness and after the onset of jaundice. He has chronic hepatitis C infection but no cirrhosis. He is well and has no history of hepatitis A infection. Before travel 14 months ago, he received one documented dose of monovalent hepatitis A vaccine but did not attend for the second dose. What is the most appropriate post-exposure management today?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Administer hepatitis A vaccine today without human normal immunoglobulin

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · C = shown as D · B = shown as E

He is a household-type close contact with continuous exposure, so the relevant interval is calculated from the onset of his wife’s jaundice, not from her hospital admission. He requires post-exposure prophylaxis. However, one documented hepatitis A vaccine dose more than 12 months ago classifies him as susceptible but primed, rather than fully susceptible. UKHSA guidance recommends post-exposure hepatitis A vaccination for this group but specifically states that HNIG should not be given, irrespective of age or comorbidity. His age and chronic hepatitis C would make HNIG a consideration if he were fully susceptible, because chronic hepatitis B or C infection increases the risk of severe hepatitis A and can justify HNIG up to 28 days after exposure. That exception does not override his primed status. A is wrong because anti-HAV IgG testing is not a prerequisite and must not delay vaccination. B is the attractive option for an older close contact with chronic liver disease, but HNIG is inappropriate after prior priming. C omits the mainstay of prophylaxis, active vaccination. E is wrong because a single dose given more than 12 months previously does not meet the definition of immune contact for this purpose.

Reference: Hepatitis A immunoglobulin (issued 2024) — UK Health Security Agency (2024) — https://www.gov.uk/government/publications/immunoglobulin-when-to-use/hepatitis-a-immunoglobulin-issued-2024 Hepatitis A immunoglobulin (issued 2024) — UK Health Security Agency (2024) — https://www.gov.uk/government/publications/immunoglobulin-when-to-use/hepatitis-a-immunoglobulin-issued-2024 Hepatitis A immunoglobulin (issued 2024) — UK Health Security Agency (2024) — https://www.gov.uk/government/publications/immunoglobulin-when-to-use/hepatitis-a-immunoglobulin-issued-2024