Information about Hepatitis A for healthcare providers

There is no shortage of hepatitis A vaccine.  Please vaccinate anyone wishing to obtain immunity (https://www.cdc.gov/hepatitis/hav/havfaq.htm#B1).

If you have a patient at risk for both hepatitis A and hepatitis B, please take the opportunity to recommend coverage for both viruses and provide them with the combination vaccine (TwinRix).  The most recent adult vaccine schedule can be found at https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html.

The at-risk patients include:

◾Chronic liver disease (e.g., hepatitis C infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal) ◾ HIV infection ◾Percutaneous or mucosal risk of exposure to blood (e.g., household contacts of hepatitis B surface antigen [HBsAg]-positive persons; adults younger than age 60 years with diabetes mellitus or aged 60 years or older with diabetes mellitus based on individual clinical decision; adults in predialysis care or receiving hemodialysis or peritoneal dialysis; recent or current injection drug users; health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids) ◾Sexual exposure risk (e.g., sex partners of HBsAg-positive persons; sexually active persons not in a mutually monogamous relationship; persons seeking evaluation or treatment for a sexually transmitted infection; and men who have sex with men [MSM]) ◾Receive care in settings where a high proportion of adults have risks for hepatitis B infection (e.g., facilities providing sexually transmitted disease treatment, drug-abuse treatment and prevention services, hemodialysis and end-stage renal disease programs, institutions for developmentally disabled persons, health care settings targeting services to injection drug users or MSM, HIV testing and treatment facilities, and correctional facilities) ◾Travel to countries with high or intermediate hepatitis B endemicity

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1. Consider HAV infection in individuals, especially the homeless, people who use drugs and MSMs (Men who have Sex with Men) with discrete onset of symptoms (e.g., nausea, vomiting, diarrhea, anorexia, fever, malaise, dark urine, light-colored stool, or abdominal pain), and jaundice or elevated liver function tests. Test those suspected of having HAV for hepatitis A IgM antibody.

2. Promptly report all confirmed and suspect HAV cases. Providers should report all HAV cases within 24 hours to the Louisville Metro Department of Public Health and Wellness. Please use the EPID200 form found here and fax it to 502-574-5865. This is required reporting and is not a violation of HIPAA.

It's especially important to provide:

  • Patient’s demographics (patient name, date of birth, gender, race, ethnicity, patient address, county of residence, patient telephone number)
  • Name, address, and telephone number of reporting facility or provider
  • Laboratory information (including faxed lab results and sources of specimens submitted for laboratory testing)
  • Clinical and epidemiological information pertinent to disease

Since this outbreak involves homeless individuals, providers are urged to contact the Louisville Metro Department of Public Health and Wellness while suspected cases are still at the healthcare facility. This action will ensure that a public health investigator can interview the patient by phone for a risk history and will facilitate serum or stool specimen submission to the Kentucky State Public Health Laboratory for possible genotyping.

3. Provide post-exposure prophylaxis (PEP) for close contacts of confirmed HAV cases. Susceptible people exposed to hepatitis A virus (HAV) should receive a dose of single-antigen HAV vaccine or intramuscular (IM) immune globulin (IG) (0.1 mL/kg), or both, as soon as possible within 2 weeks of last exposure. The efficacy of combined HAV/Hepatitis B virus (HBV) vaccine for PEP has not been evaluated, so it is not recommended for PEP. 

4. Provide HAV vaccine to persons who are at increased risk for infection (especially unstable housing and PWUD), persons who are at increased risk for complication from hepatitis A and any person wishing to obtain immunity.The combined HAV/HBV vaccine may be used if the individual is not already immune to HBV.

5. Provide HAV vaccine to unimmunized school age children. Effective July 1, 2018 all Kentucky students in kindergarten through twelfth grade must show proof of having received two doses of Hepatitis A vaccine to attend school.  Providers should begin providing these immunizations to their patients.

The Kentucky Department for Public Health also has detailed statewide nformation on the hepatitis A outbreak. Click here to go to their website.

 

 

PHYSICIANS CAN HELP CONTROL Louisville's Current Hepatitis A Outbreak - An article written and published in the April issue of Louisville Medicine by Dr. Lori Caloia, Medical Director for LMPHW.

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