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

Although there is no consensus on the best management of acute hepatitis C or on optimal strategy of follow-up after potential contamination, 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 individuals consists of screening for the C virus as early as the fifteenth day after the potentially contaminating act and, in the case of virus transmission, 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 recoveries 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 status of the source and of the vaccination and vaccine-response status 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 vaccination with that of immunoglobin injections, it is at present proposed to provide only vaccination. The target groups eligible for post-exposure prophylaxis are evoked.