INFECTION CONTROL NEWSLETTER

December 1999
written by and for Long Term Care Infection Control Nurses

Broad Street Solutions
James Marx, RN, MS, CIC Editor
PO Box 16557
San Diego, CA 92176
(619) 656-7887 Voice/FAX
jmarx@concentric.net

What are the signs and symptoms of hepatitis A?
Persons with hepatitis A virus infection may not have any signs or symptoms of the disease. Older persons are more likely to have symptoms than children. If symptoms are present, they usually occur abruptly and may include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes). Symptoms usually last less than 2 months; a few persons are ill for as long as 6 months. The average incubation period for hepatitis A is 28 days (range: 15 to 50 days).

How is hepatitis A diagnosed?
A blood test (IgM anti-HAV) is needed to diagnose hepatitis A. Do not confuse this test for (IgG anti-HAV) which indicates past infection with hepatitis A, but no longer infectious.Reporting is mandatory to the local health department if you suspect that someone as hepatitis A or any type of viral hepatitis.

How is hepatitis A virus transmitted?
Hepatitis A virus is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. This type of transmission is called "fecal-oral." For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed. Most infections result from contact with a household member or sex partner who has hepatitis A. Casual contact, as in the usual office, factory, or school setting, does not spread the virus. Once you have been infected and developed the antibody, you can no be infected again. There is no chronic carrier state for hepatitis A.

What medciations are available to prevent hepatitis A virus infection?
Two products are used to prevent hepatitis A virus infection: immune globulin and hepatitis A vaccine.
 

1.Immune globulin is a preparation of antibodies that can be given before exposure for short-term protection against hepatitis A and for persons who have already been exposed to hepatitis A virus. Immune globulin must be given within 2 weeks after exposure to hepatitis A virus for maximum protection.
2.Hepatitis A vaccine has been licensed in the United States for use in persons 2 years of age and older. The vaccine is recommended (before exposure to hepatitis A virus) for persons who are more likely to get hepatitis A virus infection or are more likely to get seriously ill if they do get hepatitis A. The vaccines currently licensed in the United States are HAVRIX (manufactured by SmithKline Beecham Biologicals) and VAQTA (manufactured by Merck & Co., Inc).

PERSONS WHO SHOULD RECEIVE HEPATITIS A VACCINE

• Persons traveling to or working in countries that have high or intermediate rates of hepatitis A
• Children in communities that have high rates of hepatitis A and periodic hepatitis A outbreaks
• Anyone sexually active with multiuple partners
• Illegal-drug users
• Persons who have occupational risk for infection 2 Persons who have chronic liver disease
• Persons who have clotting-factor disorders

GROUPS FOR WHOM HEPATITIS A VACCINE IS NOT ROUTINELY RECOMMENDED

• Food service workers
• Sewerage workers
• Health-care workers
• Children under 2 years of age
• Day-care attendees

How are hepatitis A vaccines made?
There is no live virus in hepatitis A vaccines. The virus is inactivated during production of the vaccines, similar to Salk-type inactivated polio vaccine.

Is hepatitis A vaccine safe?
Yes, hepatitis A vaccine has an excellent safety profile. No serious adverse events have been attributed definitively to hepatitis A vaccine. Soreness at the injection site is the most frequently reported side effect. Any adverse event suspected to be associated with hepatitis A vaccination should be reported to the Vaccine Adverse Events Reporting System (VAERS). VAERS forms can be obtained by calling 1-800-822-7967.

Can other vaccines be given at the same time that hepatitis A vaccine is given?
Yes. Hepatitis B, diphtheria, poliovirus (oral and inactivated), tetanus, oral typhoid, cholera, Japanese encephalitis, rabies, yellow fever vaccine or immune globulin can be given at the same time that hepatitis A vaccine is given, but at a different injection site.

How long does immunity last after hepatitis A vaccination?
Although data on long-term protection are limited, estimates based on modeling techniques suggest that protection will last for at least 20 years.

When are persons protected after receiving hepatitis A vaccine?
Protection against hepatitis A begins four weeks after the first dose of hepatitis A vaccine.  Check with your doctor for when the next dose is due.

Can hepatitis A vaccine be given after exposure to hepatitis A virus?
No, hepatitis A vaccine is not licensed for use after exposure to hepatitis A virus. In this situation, immune globulin should be used.