EEIP RIDRM Hepatitis A Infection

 

Hepatitis A is a liver disease caused by the hepatitis A virus (HAV), which is generally transmitted through the fecal-oral route. Infection usually occurs when contaminated food or water is consumed or through close personal contact with an infected person. Adults with symptoms of hepatitis A experience fatigue, low appetite, stomach pain, nausea, and jaundice, which usually resolves within two months of infection. Children under the age of six years typically do not show symptoms of infection. The illness is self-limited and does not result in chronic infection. Once infected, antibodies will protect a person against reinfection for life. Hepatitis A infection is a vaccine-preventable disease.

About Hepatitis A

 

Actions Required and Control Measures

Reporting Requirements - Category 2

Hepatitis A is physician reportable by mail within 12 hours of recognition or strong suspicion to both the Connecticut Department of Public Health (DPH) and the local health department (LHD). The director of any clinical laboratory must also report laboratory evidence of Hepatitis A to both the DPH and the LHD. To assure you have the most up-to-date information concerning reportable diseases, please visit the Reporting of Diseases, Emergency Illnesses, Health Conditions, and Laboratory Findings page.

National Surveillance Case Definitions

 

Case Investigation

LHD Responsibility: Upon notification by DPH of a confirmed case, interview the case using the Hepatitis A Surveillance Form, being sure to identify individuals in a high-risk occupation or setting (see below). Collect information on close contacts and recommend that close contacts see a physician for prophylaxis as indicated below. Enter interview information directly into CTEDSS using the Hepatitis A Wizard. If the case-patient is in a high-risk occupation or setting, consult with DPH to implement control measures.

DPH Responsibility: For positive laboratory reports, DPH will contact the ordering physician to confirm that the patient has signs and symptoms of acute hepatitis. DPH will notify the LHD of any confirmed cases. DPH will make a note in CTEDSS for HAV IgM+ reports that do not meet the surveillance case definition; no follow-up is recommended for these individuals.  

 

Control Measures

Post-Exposure Prophylaxis (PEP) for Close Contacts

Persons exposed to hepatitis A within the last two weeks (e.g., close personal contact with persons with confirmed hepatitis A or known contaminated food source) and who have not been vaccinated previously should receive 1 dose of single-antigen hepatitis A vaccine, immune globulin (IG), or both depending on the clinical situation. Immunocompromised patients previously vaccinated may require PEP. Close personal contacts include the following:

Consideration should also be given to providing PEP to persons with other types of ongoing, close personal contact with a person with hepatitis A (e.g., a regular babysitter or caretaker). Considerations for food service, health care and daycare settings are below. For additional guidance on PEP, refer to MMWR Supplement 1 and 2020 Recommendations of the Advisory Committee on Immunization Practices (see Table 4 for recommendations on use of vaccine, IG or both). While only one dose of vaccine is necessary for PEP, a second dose should be administered six months after the first to previously unvaccinated persons for long-term immunity.

Food Handler:

Refer to DPH Food Protection Program at 860-509-7297 and Epidemiology at 860-509-7994 for detailed guidance. The information below is from the FDA Employee Health and Personal Hygiene Handbook.

Food handlers diagnosed with hepatitis A:

• Exclude symptomatic food handlers (or employees whose symptoms recently resolved) if within 14 days of onset of any symptom or within seven days of onset of jaundice. Return to work requires approval of the regulatory authority and more than seven days since jaundice onset or more than 14 days since symptom onset (if no jaundice), or provision of medical documentation.
• Food handlers who never develop gastrointestinal symptoms should be excluded until approval to return to work is granted by the regulatory authority and the employee has had symptoms for more than 14 days (no jaundice), or provision of medical documentation.
  

Food handlers with a history of exposure and no symptoms or diagnosis:

• Food handlers serving highly susceptible populations should be restricted until evidence of immunity is provided (prior hepatitis A illness, vaccination, or IgG administration), or more than 30 days have passed since last exposure, or the employee does not use an alternative procedure that allows bare hand contact with ready to eat foods for at least 30 days after exposure and receives additional training.
• Food handlers not serving highly susceptible populations should be educated on symptoms to watch for and ensure compliance with good hygiene practices, handwashing, and no bare hand contact with ready to eat foods.
  
  

When to provide PEP:

Because transmission to patrons is unlikely, PEP administration to patrons typically is not indicated but may be considered if 1) during the time when the food handler was likely to be infectious, the food handler both directly handled uncooked foods or foods after cooking and had diarrhea or poor hygienic practices, and 2) patrons can be identified and treated within two weeks of exposure, though the risk for individual patrons remains low.

In settings in which repeated exposures to HAV might have occurred (e.g., institutional cafeterias), consideration of PEP use is warranted. PEP in this scenario should generally consist of vaccination for all age groups, though IG may also be considered for exposed persons (patrons during the time the food handler was symptomatic and worked) who are immunocompromised or have chronic liver disease.

Health Care Worker with Direct Patient Care Duties:

Exclude individuals with laboratory-confirmed infection from direct patient care until seven days after onset of jaundice or 10 days after onset of symptoms (if jaundice is absent) and providing all symptoms have subsided. The information below is from CDC guidance.

• If a healthcare provider receives a diagnosis of hepatitis A infection, PEP should be administered to other healthcare personnel at the same facility.
• In a setting containing multiple enclosed units or sections (e.g., hospital, psychiatric facility), PEP administration can be limited only to health care personnel in the area where there is exposure risk (e.g., cardiology ward, intensive care unit).
• PEP administration to patients can be considered if during the time of patient care the infected healthcare provider was likely to be infectious, did not use gloves when appropriate, and head diarrhea or poor hygienic practices.
• Consider the possibility of PEP for patients who may have received dental/oral/mouth care from the infected individual, and PEP can be given within 2 weeks of last exposure.

Day Care Setting:

This page last updated 08/21/2023.

 

 

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