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Hepatitis A exposure — MSRA MCQ

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HardInfectious DiseasesHepatitis A exposureMSRA

A 66-year-old man is contacted by his GP after his adult daughter is diagnosed with acute hepatitis A. They share a household, including a bathroom and meals. Her jaundice began 5 days ago and they have had continuous close contact until today. He is asymptomatic. He has compensated cirrhosis due to chronic hepatitis C infection. Before travel 20 months ago, he received one documented dose of monovalent hepatitis A vaccine but did not attend for the second dose. He has no history of hepatitis A infection. An anti-HAV IgG result could be available in 48 hours. UKHSA has confirmed that he is an eligible household contact. What is the most appropriate management today?

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

He should receive hepatitis A vaccine today, without HNIG. Household exposure is continuous, so the relevant interval is measured from onset of jaundice in the index case; at 5 days, prompt post-exposure prophylaxis remains appropriate. His chronic hepatitis C infection and cirrhosis would place him at risk of severe hepatitis A and would normally support adding HNIG if he were fully susceptible. However, one documented hepatitis A vaccine dose given more than 12 months previously classifies him as susceptible but primed, rather than fully susceptible. UKHSA advises post-exposure vaccination for this group but specifically advises against HNIG regardless of age or comorbidity. Anti-HAV IgG testing may occasionally avoid unnecessary HNIG, but must not delay vaccine administration. HNIG alone is not the preferred strategy when vaccine can be given. Vaccine plus HNIG would be appropriate for a fully susceptible close contact aged over 60 years or with chronic liver disease. No prophylaxis would be appropriate after a complete course within 10 years, or one dose within the preceding 12 months.

Reference: Hepatitis A immunoglobulin (issued 2024) - GOV.UK (2024; checked 16 August 2026) — https://www.gov.uk/government/publications/immunoglobulin-when-to-use/hepatitis-a-immunoglobulin-issued-2024 Hepatitis A immunoglobulin (issued 2024) - GOV.UK (2024; checked 16 August 2026) — https://www.gov.uk/government/publications/immunoglobulin-when-to-use/hepatitis-a-immunoglobulin-issued-2024