A 34-year-old woman returns to the physician for the results of her liver function tests, which were initially drawn 2 days ago when she presented with malaise, low-grade fever, and scleral icterus. She reports no significant change in her symptoms. Her medical problems include migraine headaches and irritable bowel syndrome. She takes intermittent ibuprofen for headaches. She denies tobacco, alcohol, or any recreational drug use. She works as a flight attendant and recently returned from Thailand. Her household contacts include her 36-year-old husband and 2 healthy children (ages 5 and 8). None of the family members have ever received any hepatitis vaccine.
Her physical examination is unremarkable except for mild abdominal discomfort in the right upper quadrant and mild scleral icterus.
Laboratory results are as follows:

Which of the following is the most appropriate course of action?

Question

A 34-year-old woman returns to the physician for the results of her liver function tests, which were initially drawn 2 days ago when she presented with malaise, low-grade fever, and scleral icterus.  She reports no significant change in her symptoms.  Her medical problems include migraine headaches and irritable bowel syndrome.  She takes intermittent ibuprofen for headaches.  She denies tobacco, alcohol, or any recreational drug use.  She works as a flight attendant and recently returned from Thailand.  Her household contacts include her 36-year-old husband and 2 healthy children (ages 5 and 8).  None of the family members have ever received any hepatitis vaccine.
Her physical examination is unremarkable except for mild abdominal discomfort in the right upper quadrant and mild scleral icterus.
Laboratory results are as follows:

Which of the following is the most appropriate course of action?

Quizplus · Accepted Answer

11ec193a_984b_6ca2_853d_3f9b913cfe6a_MD0002_00 The hepatitis A virus (HAV) usually spreads via the fecal-oral route, has an incubation period of 30 days, and can be associated with food borne outbreaks. Unvaccinated adults exposed to household contacts with acute HAV infection are at high risk for HAV infection and should receive postexposure prophylaxis (PEP) as soon as possible (Choice E). Current PEP options include single dose inactivated HAV vaccine or immune globulin (IG). Both HAV vaccine and IG given to healthy individuals (ages 12 months to 40 years) within 14 days of HAV exposure provide similar protection, but the HAV vaccine is usually preferred. The HAV vaccine produces active immunity with longer protection, is more available than IG, and is easier to administer. Immune globulin provides protection against hepatitis A through the passive transfer of anti-HAV antibodies. Immune globulin is preferred in children < 12 months of age and in immunocompromised individuals (e.g., advanced AIDS, chronic liver disease, or those taking immunosuppressive medications), since they are less likely to respond to the HAV vaccine (Choices A and B). This patient's family members are unvaccinated, close contacts of an index case, and would benefit most from HAV PEP. (Choice C) Either the HAV vaccine or IG should be given to the household contacts, but not both. Educational objective: Postexposure prophylaxis for hepatitis A is indicated as soon as possible in all unvaccinated household contacts including adults < age 40 and children > age 12 months. The hepatitis A virus vaccine is preferred over immune globulin in these patients; however, immune globulin is recommended in children < 12 months and immunocompromised individuals. __________ References: Hepatitis A vaccine versus immune globulin for postexposure prophylaxis (http://www.ncbi.nlm.nih.gov/pubmed/17947390)

A 34-Year-Old Woman Returns to the Physician for the Results