hepatitis A

see also:

• hepatitis
• Vic Health - information on hep A
• Vic Health - health alerts

• currently there is an outbreak in Australia due to imported frozen berries (Feb 2015), so have a low index of suspicion.

• incubation period is 15 to 50 days.
• transmission occurs via the faecal-oral route through the ingestion of contaminated food or water, or through direct hand-to-mouth contact with the faeces of an infectious case.
• patients may present with symptoms such as loss of appetite, nausea and vomiting, tiredness, fever, abdominal pain, dark urine, pale faeces and jaundice.
• Cases are infectious two weeks before and one week after the onset of jaundice/dark urine (whichever is first).

• hepatitis A vaccination generally lasts ~10 years
• recommended for:
  • travelers to high risk countries
  • health care workers in higher risk categories such as paediatric care, emergency departments, infectious diseases wards
  • post-exposure (see below)

• important that close contacts receive post-exposure prophylaxis as soon as possible, and within 14 days after their last contact with the case during their infectious period.
• these include:
  • household contacts (including people who have had an overnight stay at the case’s house during their infectious period).
  • sexual contacts.
  • people who have consumed food prepared by the case.

• Normal Human Immunoglobulin (NHIG) or the hepatitis A vaccine can be given as post-exposure prophylaxis.
• The health department currently provides NHIG free of charge to contacts of hepatitis A cases. This can be arranged by the department and delivered to your practice during normal working hours.
• If required urgently, NHIG can be obtained after hours by contacting the CSL after hours telephone number on 0413 027 298.
• NHIG doses: <25kg = 0.5ml; 25-50kg = 1.0ml; >50kg = 2.0ml;
• NHIG injection should be given by deep IM injection using a large (19 or 20) gauge needle.
• Please note that NHIG can potentially interact with vaccines

• supportive care
• food handlers, child care workers and health care workers should be excluded from work until one week after the onset of jaundice/dark urine.
• notification:
  • Under the Victorian Health (Infectious Diseases) Regulations 2001, hepatitis A is required to be notified to the Victorian Department of Health by medical practitioners within five days.