Hepatitis A

What's the Problem?

Hepatitis A is a liver disease caused by hepatitis A virus (HAV). HAV is found in the stool of infected people. Poor hygiene and unsanitary conditions facilitate the spread of HAV. HAV may spread within a household through close, intimate contact with an infected person. HAV can also be spread by eating food or drinking water contaminated with HAV. Hepatitis A can cause mild "flu-like" symptoms, such as fatigue and loss of appetite, or more serious symptoms such as jaundice (yellow skin or eyes), nausea, vomiting, diarrhea, fever, or severe stomach pains. Children under 5 years of age are less likely than older people to have symptoms; however, children can be reservoirs of infection for older persons who may become much sicker when they become infected.

Hepatitis A occurs in epidemics both nationwide and in communities. During epidemic years, the number of reported cases of hepatitis A has reached 35,000.

Who's at Risk?

Anyone can get hepatitis A, either as an isolated case or part of a widespread epidemic. Each year thousands of people in the United States are infected with HAV and about one-fifth of them need to be hospitalized. The highest rates of infection are among children 5 to14 years of age and nearly 30% of all reported cases are among children younger than 15 years of age. A large number occur under the age of 5, but many of these infections do not come to the attention of health professionals because young children do not often have symptoms.

A person is at increased risk for HAV infection if he or she: shares a household or has sex contact with someone who is infected with HAV; lives (especially children) in a region of the United States with consistently increased rates of hepatitis A; uses injection or non-injection illegal drugs; travels to countries where hepatitis A is common (e.g., Central or South America, Mexico, Asia [except Japan], and Africa); or is a man who has sex with another man.

People with chronic liver disease have greater risk of adverse consequences of HAV infection. Hepatitis A, however, does not cause chronic liver disease, but does occasionally cause severe, life-threatening disease, most commonly in adults over 50.

Can It Be Prevented?

Yes. Vaccines against HAV infection are licensed with recommendations for use in those at increased risk for HAV infection or for bad outcomes if they become infected. Hepatitis A vaccines are approved for persons 2 years of age and older and are only approved for pre-exposure use.

Immune globulin (a preparation of antibodies) can provide post-exposure protection for people who have been exposed to HAV. It should be given within 2 weeks of exposure to HAV to be effective. Immune globulin can also be used for pre-exposure (prior to exposure to HAV) protection from HAV infection.

Tips for Scripts

INFORM viewers of the risks of HAV, and identify groups at high risk for HAV.
INFORM viewers that Hepatitis A vaccines are safe, do NOT contain live virus, and are given in two doses, usually 6-18 months apart.
REMIND viewers to wash hands well before preparing food, before eating, after changing a diaper, and after using the bathroom.
REMIND viewers who travel to areas where Hepatitis A is common to be vaccinated against hepatitis A, avoid raw foods, and drink bottled water. Remind viewers that children under 2 years of age should receive immune globulin instead of hepatitis A vaccine.

Case Example

Three seventh-grade students complain they are feeling very tired and nauseous. One also has severe stomach pains, diarrhea, and vomiting. They go to the school nurse, who notes that one student has yellow eyes and skin. All three are sent home with directions to see their doctors. That afternoon, the jaundiced student is admitted to the hospital suffering from dehydration. Blood tests reveal the student has hepatitis A. The local health department is notified and a thorough investigation finds that all three students were recently infected with HAV and that they all ate salad at a local fast food restaurant about 5 weeks before the onset of symptoms. A food service worker who prepared the salads admits to having had diarrhea and stomach pains in the last couple of months. Blood tests on all food service workers at the restaurant reveal the symptomatic worker has evidence of recent infection with HAV

Daycare.com would like to thank the Centers for Disease Control and Prevention (CDC) and their contributors for this information in striving to make daycare and childcare a more productive and efficient service.

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