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hepa

hepatitis A

introduction

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

clinical presentation

  • 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).

immunisation

  • 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)

post-exposure prophylaxis

indications

  • 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.

prophylaxis

  • 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

Mx of hepatitis A

  • 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:
hepa.txt · Last modified: 2015/03/03 23:27 by gary1