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Know the Facts on Hepatitis A

Hepatitis A is making news this week after two cases of the illness were identified in employees of the "Pizza Ranch" restaurant in Slayton, Minnesota in Murray County.

Hepatitis A is making news this week after two cases of the illness were identified in employees of the "Pizza Ranch" restaurant in Slayton, Minnesota in Murray County. The restaurant serves nearly 1000 meals per week, and caters numerous local events; so, a large number of people may have been exposed.

Dr. Wendell Hoffman with Sanford Clinic Infectious Disease explains the illness, “hepatitis A is a viral infection that is spread person to person through fecal-oral contamination. Hepatitis A can cause an acute and serious illness, but rarely causes long term liver complications. The clinical spectrum of the illness varies widely from minimal symptoms to severe jaundice. You are most likely to contract hepatitis A from contaminated food or water or from close contact with someone who's already infected — even if that person doesn't appear sick.”

Dr. Hoffman adds, “Mild cases of hepatitis A don't require hospitalization, and again most people who are infected recover completely with no permanent liver damage. Unlike hepatitis B and C, hepatitis A doesn't develop into chronic hepatitis or cirrhosis — both potentially fatal conditions. There are no antiviral drugs available for hepatitis A, and immune serum globulin is used following exposure. Practicing good hygiene — including washing your hands often — is one of the best ways to protect against hepatitis A. An effective vaccine is available for groups at risk for hepatitis A.”

For more information on hepatitis A, visit www.cdc.gov.

HEPATITIS A INFORMATION

Signs and Symptoms
  • May be asymptomatic
  • Older persons are more likely to have symptoms. Symptoms usually occur abruptly and may include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, or jaundice.
  •  Symptoms generally last less than 2 months; occasionally, prolonged or relapsing illness can last up to 6 months.
  • Average incubation period is 28 days (range: 15-50 days)
Long-Term Effects
  • Chronic infection does not occur.
  • HAV infection confers life-long immunity.
  • 15% of HAV-infected persons will have prolonged or relapsing symptoms over a 6-month period.
Transmission

Fecal-oral transmission by:

  • person-to-person contact or
  • ingestion of contaminated food or water
Communicability 14 days before to 7 days after onset of symptoms 
Risk Groups
  • Household contacts of infected persons
  • Sexual contacts of infected persons
  • Persons, especially children, living in regions of the United States with high rates of HAV infection
  • Travelers to regions where HAV is common, including Central and South America, Africa, and Asia
  • Men who have sex with men
  • Injection and non-injection drug users
Prevention
  • HAV vaccine is best protection
  • Immune globulin (IG) provides short-term protection against HAV. IG is appropriate for both pre and post exposure prophylaxis; post-exposure prophylaxis can be given within 14 days after exposure to HAV.
  • Hand washing with soap and water after using the bathroom or changing diapers and before preparing or eating food.
Vaccine Recommendations*

HAV vaccine is recommended for:

  • travelers to areas with increased rates of HAV infection
  • men who have sex with men
  • injection and non-injection drug users
  • persons with chronic liver disease
  • persons with clotting-factor disorders (e.g., hemophilia)
  • children living in regions of the US with high rates of HAV infection
  • anyone who wants to be protected from contracting HAV

*HAV vaccine is licensed only to persons 2 years of age or older

Medical Management Supportive care
Postexposure Management IG for contacts of cases within 14 days of exposure. Contacts determined case-by-case, based on potential for transmission. 
Trends and Statistics
  • Occurs in epidemics nationally and locally
  • During the epidemic years, the number of HAV cases reported in the US has reached 35,000
  • Since the HAV vaccine was licensed in 1995, vaccine use has increased in the US and morbidity has reached historic lows. One-third of persons in the US are immune to HAV (i.e., have evidence of past infection). Approximately one-third of reported cases occur among children less than 15 years of age