Hepatitis A Clinical Information

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Hepatitis A in Minnesota
Epidemiology of hepatitis A
Communicability of hepatitis A
Recommendations: suspect cases
Lab testing encouraged
Post-exposure prophylaxis recommendations
Immune globulin (IG) delivery can be arranged
Vaccination recommendations

Hepatitis A in Minnesota

Hepatitis A is endemic in Minnesota. The most frequently reported source of hepatitis A infection is contact with a person with hepatitis A.

Epidemiology of hepatitis A

The clinical course of hepatitis A varies greatly.  Symptoms (listed below) typically have an abrupt onset. The likelihood of having symptoms with hepatitis A infection is related to a person’s age.  In children less than 6 years of age, most (70%) hepatitis A infections are asymptomatic. Among older children and adults, infection is usually symptomatic, with jaundice occurring in more than 70% of cases.

Communicability of hepatitis A

Hepatitis A virus is transmitted primarily by the fecal-oral route. Persons with hepatitis A are infectious from approximately 2 weeks before symptom onset to up to 2 weeks after symptoms begin.

Recommendations: Suspect cases

  • Symptoms of hepatitis A include acute onset of any of the following: fatigue, anorexia, nausea with or without vomiting, abdominal pain, dark urine, fever, headache, diarrhea, or jaundice.
  • Hepatitis A cannot be differentiated from other hepatitides on symptoms alone.  Laboratory confirmation is needed when diagnosing hepatitis A.
  • The incubation period for hepatitis A is usually 4 to 6 weeks (28 to 42 days) after exposure but can range from 2 to 7 weeks (15 to 50 days).
  • Suspect cases of hepatitis A are reportable to the Minnesota Department of Health (MDH) at 651-201- 5414 or 1-877-676-5414 (toll-free).     

Lab testing encouraged for symptomatic persons only

Hepatitis A infection is confirmed by the presence of hepatitis A-specific IgM antibody. Hepatitis A IgM antibody testing and liver function tests should be performed on suspect cases. Testing is not indicated for exposed persons who do not exhibit symptoms.

Post-exposure prophylaxis recommendations

  1. Persons exposed within the past 2 weeks should receive post-exposure treatment in accordance with new ACIP recommendations (published in the MMWR, October 19, 2007)
    • For healthy persons 12 months - 40 years of age, hepatitis A vaccine at the age-appropriate dose is preferred. (Persons who receive a first dose of vaccine as post-exposure prophylaxis should receive a second dose at least 6 months later to confer ongoing protection.)
    • For persons over 40 years of age, immune globulin (IG) is preferred; vaccine may be used if IG cannot be obtained.
    • For children under 12 months of age, immunocompromised persons, persons with diagnosed chronic liver disease, and persons for whom vaccine is contraindicated, IG should be used.
  2. Persons exposed more than 2 weeks ago may develop symptoms within the next few weeks, regardless of whether they received treatment for a more recent exposure. The incubation period for hepatitis A is generally about one month, but may be 2 to 7 weeks.

Immune globulin (IG) delivery can be arranged

When the need arises, you can arrange for IG to be delivered. Overnight shipping may be available. Contact one of these distributors:

Alternative Site Distributors 1-800-837-5403
Health Coalition                         1-800-456-7283
Chapin Medical 1-800-221-7180
FFF Enterprises 1-800-843-7477
Nationwide   1-800-997-8846
NHS  1-800-344-6087

Vaccination recommendations

Hepatitis A vaccine is available for persons 12 months of age and older. The vaccine series consists of 2 doses given 6 months apart. The vaccine is recommended for routine vaccination of all children 12 months of age and older, certain high-risk groups (e.g., international travelers), as well as anyone desiring protection against hepatitis A. The vaccine takes 2 to 4 weeks after the first dose to confer immunity.  

 

Updated Tuesday, 16-Nov-2010 12:21:31 CST