hepatitis A

introduction

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.