Which patients should be considered for post-exposure prophylaxis following potential exposure to Hepatitis A?

Post-exposure prophylaxis (PEP) following potential exposure to hepatitis A should be considered for individuals who have had close contact with a confirmed case of hepatitis A and who have not previously been vaccinated or are not known to be immune. Immediate contact with the local Health Protection Unit (HPU) is essential to guide management, which may include administration of hepatitis A vaccine and/or human normal immunoglobulin depending on the timing of exposure, the person's age, and co-morbidities. This approach is particularly important for those at higher risk of severe disease or complications, such as older adults, people with chronic liver disease, and immunocompromised individuals. Children aged one year and older who are contacts and unvaccinated should also be considered for PEP. The vaccine is not licensed for children under one year old, and immunoglobulin may be preferred in this group. The timing of prophylaxis is critical; ideally, it should be given as soon as possible after exposure to be effective. Additionally, people at occupational risk or those in institutional settings where outbreaks occur may require PEP as advised by public health authorities. Overall, PEP decisions are individualized based on exposure circumstances, risk factors, and timing, with expert advice from the HPU guiding the optimal intervention NICE CKS[Langan & Goodbred 2021].