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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.

Acute Hepatitis A Outbreak Week 22 Report.pdf

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 .  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 are also available.

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.

Who Is At Risk For Infection

  • Household/sexual contacts of an infected person;
  • International travelers;
  • Persons living in regions with endemic hepatitis A;
  • During outbreaks, day care center employees or attendees;
  • Men having sex with men; and
  • Injecting drug users.

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:

  • Fever;
  • Fatigue;
  • Loss of appetite;
  • Nausea;
  • Abdominal discomfort;
  • Dark urine; and
  • Yellowing of the skin and eyes. 

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.

How Hepatitis A Is Diagnosed?

A blood test (IgM anti-HAV) 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 hepatitis A or any type of viral hepatitis.

The Treatment For Hepatitis A

Close personal contacts (e.g., household, sexual) of hepatitis A patients should be given post exposure prophylaxis with IG (immune globulin) within two weeks of last exposure.

There is no specific treatment or cure for hepatitis A virus infection.

How Hepatitis A Can Be Prevented:

  • Careful handwashing and good hygiene.
  • Provide proper water treatment and distribution systems and sewage disposal.
  • Vaccination against hepatitis A is recommended for persons at increased risk for HAV infection or its consequences:
    • Persons with chronic liver disease or clotting factor disorders;
    • Men who have sex with men;
    • Injecting drug users;
    • Persons traveling to countries where HAV is endemic;
    • Persons who work with HAV infected primates or with HAV in research laboratory settings; and
    • Children living in communities that have consistently elevated rates of hepatitis A.
  • Close personal contacts (e.g., household, sexual) of hepatitis A patients should be given postexposure prophylaxis with IG within two weeks of last exposure.
  • 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.