Postexposure management of hepatitis A, Treatment, postexposure prophylaxis and B or C : recommendations

Although there is no consensus on the best management of acute hepatitis C or on optimal strategy of follow-up after potential con- tamination, certain guidelines can nevertheless be proposed for the care of these patients in practice. It is now recommended that acute hepatitis C be treated by interferon monotherapy in the presence of a C viremia, detectable by polymerase chain reaction, and an elevation of the transaminases. The earlier the treatment is started after appearance of symptoms, the more effective it is. Management of a potentially contaminated individual consists of screening for the C virus as early as the fifteenth day after the potentially contaminating act and, in the case of virus transmis- sion, starting interferon treatment as soon as elevation of the transaminases appears. No special precautions are to be taken by the person potentially contaminated for avoiding possible secondary C virus transmission during the follow-up period. In the case of acute hepatitis B, antiviral treatment should not be started, in view of the high percentage of spontaneous recover- ies and the potentially negative effect of treatment on the chances of spontaneous recovery. Post-exposure prophylaxis by anti- hepatitis B immunoglobin injections and/or vaccination should be considered after evaluation of the hepatitis B surface antigen sta- tus of the source and of the vaccination and vaccine-response sta- tus of the exposed person. The classic scheme for selecting the most appropriate postexposure prophylaxis is reminded. In post-exposure prophylaxis for hepatitis A virus, although there have been no studies comparing the effectiveness of vaccina- tion with that of immunoglobin injections, it is at present proposed to provide only vaccination. The target groups eligible for post- exposure prophylaxis are evoked. (Acta gastroenterol. belg., 2003, 66, 250-253).