||KY17-089 Hepatitis A Outbreak
- In November 2017, the Kentucky Department for Public Health (DPH) identified an outbreak of acute hepatitis A. The increase in cases observed in Kentucky was well over the 10-year average of reported hepatitis A cases, and several cases have been infected with HAV strains genetically linked to outbreaks in both California and Utah. Similar to hepatitis A outbreaks in other states, the primary risk factors remain homelessness and illicit drug use. A contaminated food source has not been identified, and HAV transmission is believed to be occurring through person-to-person contact.
- Healthcare providers should prioritize the identification and reporting of cases of acute hepatitis A in their at-risk patients. Should acute hepatitis A be suspected, contact local or state public health within 24 hours, in accordance with 902 KAR 2:020 (http://www.lrc.ky.gov/kar/902/002/020.htm). Specimens for molecular testing should also be considered. Clinical advisories and laboratory guidance are available below. Vaccination of
at-risk individuals remains the best means of control. Please consider hepatitis A vaccination in accordance with ACIP recommendations. CDC recommendations for hepatitis A vaccination are available at https://www.cdc.gov/hepatitis/hav/havfaq.htm#vaccine.
- Facilities that provide services to at-risk populations should implement disinfection procedures that are effective against hepatitis A. DPH recommends that facilities review disinfection procedures to ensure products being used are both, effective against hepatitis A virus and are being used in accordance with the manufacturer’s label. Guidance on disinfection is available here. Additional materials are also available below.
||Hepatitis A is a liver disease caused by the hepatitis A virus.
Who Is At Risk For Infection
- Household/sexual contacts of an infected person;
- International travelers to countries with high or intermediate endemicity for hepatitis A virus infections. Countries outside the US other than Canada, Australia, New Zealand, Japan, and Western Europe should be considered to have high or intermediate endemicity for hepatitis A virus infections,
- Persons living in regions with endemic hepatitis A,
- During outbreaks, day care center employees or attendees,
- Men having sex with men,
- Drug users,
- Persons with contact to an international adoptee in the first 50 days after the US arrival of an adoptee,
- Persons with clotting factor disorders, such as hemophilia,
- Persons who are homeless (Identified in several US outbreaks in 2017).
How Hepatitis A Is Spread
Hepatitis A (HAV infection) is transmitted by the fecal-oral route (putting something in the mouth that has been contaminated with stool of a person infected with hepatitis A).
This transmission occurs through person-to-person contact or ingestion of contaminated food or water. On rare occasions, Hepatitis A is transmitted from transfusion of blood or blood products. Hepatitis is spread more easily in poor sanitary conditions or where good hygiene is not observed.
The Symptoms Of Hepatitis A
- Hepatitis A can have an abrupt onset of symptoms that can include:
- loss of appetite
- abdominal discomfort
- dark urine
- yellowing of the skin and eyes
- pale colored stools
- and joint pain
- People with hepatitis A virus infection may not have any signs or symptoms of the disease.
- Older people are more likely to have symptoms than children.
- About 70 percent of children younger than 6 who are infected have no symptoms.
- In adults and older children, most infections are accompanied by symptoms and more than 70 percent of those cases include yellowing of the skin and eyes (jaundice).
- Signs and symptoms usually last fewer than 2 months, although some people have prolonged or relapsing disease lasting as long as 6 months. Relapsing disease is usually less severe.
- There is no chronic form of hepatitis A.
How Hepatitis A Is Diagnosed?
A blood test is needed to diagnose hepatitis A. Talk to your doctor or someone from your local health department if you suspect that you have been exposed to a person with acute hepatitis A in the last 50 days or any type of viral hepatitis.
Healthcare providers should consider serology (IgM anti-HAV) and confirmatory molecular testing (HCV RNA) when ordering laboratory testing for patients suspected of having acute hepatitis A.
The Treatment For Hepatitis A
There is no specific treatment or cure for hepatitis A virus infection. Emphasis should be placed on preventive measures.
How Hepatitis A Can Be Prevented
- Close personal contacts (e.g., household or sexual contacts) of hepatitis A patients should be given age-appropriate post-exposure prophylaxis (PEP) with hepatitis A vaccine and/or immune globulin (IG) within two weeks of last exposure.
- All children aged 12 through 23 months should be routinely vaccinated with catch-up immunizations through age 18 years. Beginning July 2018, all Kentucky children must have received two doses of hepatitis A vaccine before entry into school.
- Vaccination against hepatitis A is recommended for persons at increased risk of hepatitis A or its consequences. This includes:
- Persons with chronic liver disease or clotting factor disorders;
- Men who have sex with men;
- Recreational drug users;
- Persons traveling to countries with high or intermediate endemicity for hepatitis A virus infections;
- Persons who work with hepatitis A infected primates or with hepatitis A virus in research laboratories and;
- Family and caregivers of adoptees from countries where hepatitis A is endemic.
- Careful handwashing with soap and water and good hygiene.
- Provide proper water treatment and distribution systems and sewage disposal.
- Oysters, clams, and other shellfish from contaminated areas should be heated to a temperature of 85 to 90 degrees C for 4 minutes or steamed for 90 seconds before eating.
- To disinfect use products as recommended by the manufacturer and as described on the product's label.
For more information about Hepatitis A virus, contact your health care provider, local health department, or the Kentucky Department for Public Health at (502) 564-3261.
||Reporting of Acute Hepatitis A by Healthcare Providers
Healthcare providers should report to the local or state health department any diagnosis of hepatitis A within 24 hours. Reporting should be in accordance with 902 KAR 2:020.
EPID 200 Form