Understanding Hepatitis
and the Appropriate Barrier Protection

Hepatitis A DEFINITION Hepatitis A is one of the most frequently reported diseases and the oldest form of hepatitis known to man. Hepatitis A is also referred to as Acute Infective Hepatitis. It is a single-strand RNA picornavirus.6 CLINICAL MANIFESTATIONS The clinical manifestations that might be present with hepatitis A infection include: Jaundice Fatigue Nausea Diarrhea Abdominal discomfort Anorexia Fever The illness increases in severity in adults, while children may present mild signs and symptoms or be completely asymptomatic.7,8 INCUBATION PERIOD The incubation period is anywhere from 15-50 days. The average incubation period is 28-30 days.9 CAUSE The cause of the disease is the Hepatitis A Virus (HAV). It is classified within the enterovirus group of the Picornaviridae family.10 DIAGNOSIS The clinical manifestations of hepatitis A cannot be differentiated from other types of viral hepatitis. Serologic testing is necessary in order to obtain a valid diagnosis. Acute HAV infection can be determined by the confirmed presence of anti-HAV IgM antibody to serum. Liver enzymes AST and ALT are elevated, resulting from damaged liver cells. IgM is usually detected 5-10 days before the onset of symptoms, and can continue up to 6 months, but then dissipates.11 POST-EXPOSURE PROPHYLAXIS If someone has already been exposed to HAV, short-term protection is available from immune globulin. It can be taken within 2 weeks after being exposed to HAV.12 LONG-TERM EFFECTS Chronic infection is not known to occur with this type of hepatitis, but approximately 15% of people infected with hepatitis A will experience continual or persistent symptoms over a 6-12-month period.13,14 TRANSMISSION HAV is usually spread person to person by the fecal-oral route. The disease is transmitted via the stool of a person infected with the disease. Therefore, in order for someone to become infected, they must come in contact with the infected fecal matter, spread by contaminated hands or objects.15 WHO IS AT RISK? People living in the household and sexual contacts of a person infected with HAV. Injecting and non-injecting drug users. Men who have sex with other men. Daycare center workers. Persons with chronic liver disease. People who travel to countries where hepatitis A is prevalent. Persons with blood clotting factor disorders. Persons who consume raw shellfish. Persons, especially children, living in areas with increased rates of hepatitis A during the baseline period from 1987-1997. Persons who consume foods handled by infected restaurant workers/food handlers. Persons who work with hepatitis A virus-infected primates or the hepatitis A virus in a research laboratory. Persons who are American Indian or Alaskan Native.16,17 Other modes of transmission that have occurred are as follows: According to the FDA, there was an outbreak of hepatitis A from the consumption of raw uncooked green onions.18 Healthcare institutions have had outbreaks in their neonatal intensive care units from infants that have acquired the infection from blood transfusions and subsequently pass on the disease to other patients and staff.19 In the past, there was a high incidence of hepatitis A in institutions for persons who have developmental disabilities. This has decreased in the past decade because fewer children are institutionalized and conditions in institutions have improved.20 TREATMENT Overall, the treatment for hepatitis A is supportive care. To meet this goal, treatment includes keeping the patient comfortable during their period of recovery, ensuring infection control measures, and striving to prevent further liver damage by encouraging the patient to avoid substances (medications, alcohol) that might strain the liver while it heals. In rare cases, hepatitis A infection can be so severe that a liver transplant may be necessary. In most cases, the disease will generally resolve without treatment within 2-5 weeks.21,22 INFECTION CONTROL AND PREVENTION Hand washing is the number one way to reduce the spread of this disease.Wash hands immediately after having a bowel movement, and always wash your hands before touching or preparing food. Universal vaccination is the only way to eradicate hepatitis A. Currently, limited availability and high cost prevent this from being a feasible option.23 Always follow routine Standard Precautions that include the following: Hand Washing Wash hands after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. Gloves Wear gloves manufactured from proper barrier protection materials when touching blood, bodily fluids, secretions, excretions, and contaminated items. Put on clean gloves just before touching mucous membranes and broken skin. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms. Remove and dispose of gloves promptly after use. Immediately after glove removal, wash hands thoroughly to avoid transfer of microorganisms to other patients or environments. Masks, Eye Protection, Face Shields Wear a standard surgical mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and activities that are likely to generate splashes or sprays. VACCINE RECOMMENDATIONS Vaccination is recommended for people 2 years of age and older that fall into the following risk categories: People living in the household and sexual contacts of a person infected with HAV. Injecting and non-injecting drug users. Men who have sex with other men. People who travel to countries where hepatitis A is prevalent. Persons, especially children, living in areas with increased rates of hepatitis A during the baseline period from 1987-1997. Persons with clotting-factor disorders (e.g., hemophilia).24,25 Vaccination has not been recommended for the following: Daycare center workers. Food service workers. Sewage workers. Children under 2 years of age. Healthcare workers. Persons who reside in institutions for developmentally disabled persons.26 FACTS, STATISTICS, AND TRENDS HAV accounts for as many as 65% of all viral hepatitis cases in the U.S. each year. Worldwide, there are an estimated 1.4 million cases reported annually. Approximately 22% of cases will be hospitalized. Approximately 45% of persons with HAV cannot identify a recognized risk factor associated with their disease. The annual direct and indirect costs of treating cases and controlling outbreaks of hepatitis A in the U.S. are estimated to be $200 million. The average worker who contracts this disease will miss an average of 27 days of work. Hepatitis vaccine provides protection for at least 20 years. The virus can be killed by heating food to 185 degrees Fahrenheit (85 degrees Celsius) for 1 minute. Chlorinated water also kills the virus.27

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