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. Adults with symptoms of Hepatitis A experience fatigue, low appetite, stomach pain, nausea, and jaundice, which usually resolves within 2 months of infection. Children under the age of 6 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.
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.
Case Investigation
LHD Responsibility: If the case-patient is in a high-risk occupation or setting, the LHD will implement control measures upon notification from DPH.
DPH Responsibility: In order to screen out asymptomatic individuals with positive laboratory reports, DPH will contact the ordering physician to confirm that the patient has signs and symptoms of acute hepatitis. DPH will then interview the case to collect clinical and risk factor information and to identify individuals in high-risk occupations or settings (see below). DPH will provide educational materials describing the nature of the disease and preventive measures and will recommend that close contacts see a physician for prophylaxis as indicated below.
Control Measures
Food Handler: Refer to DPH Food Protection Program at 860-509-7297.
When to provide PEP for Hepatitis A: Because common-source 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 2 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 be considered for exposed persons (patrons during the time the food handler was symptomatic and worked) who are immunocompromised or have chronic liver disease.
For additional provider guidance information, read MMWR Supplement 1.
Health Care Worker with Direct Patient Care Duties:
Exclude individuals with laboratory-confirmed infection from direct patient care until 7 days after onset of jaundice or 10 days after onset of symptoms (if jaundice is absent) and providing all symptoms have subsided.
- 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:
- Post-exposure prophylaxis (PEP) should be administered to all previously unvaccinated staff and attendees of child-care centers or homes if 1) one or more cases of hepatitis A is recognized in children or 2) cases are recognized in two or more households of center attendees.
- If one or more cases of hepatitis A infection occurs among employees, PEP should be considered based on the duties, hygienic practices and presence of symptoms at work.
- In centers that do not provide care to children who wear diapers, PEP may be administered only to care center contacts of the index patient.
- When an outbreak occurs (i.e., hepatitis A cases in three or more families), PEP should also be considered for members of households that have diaper-wearing children attending the center.
Close Contacts:
HepA vaccine or IG should be administered to all previously unvaccinated persons who have been exposed or are at risk of exposure due to close personal contacts of persons with serologically confirmed hepatitis A (i.e., through a blood test), including:
- household and sex contacts and
- persons who have shared injection drugs with someone with hepatitis A
- caretakers not using appropriate personal protective equipment
Consideration should also be given to providing IG or hepatitis A vaccine to persons with other types of ongoing, close personal contact with a person with hepatitis A (e.g., a regular babysitter or caretaker).
This page last updated 9/16/2019.