Emergency Departments Play Key Role in Preventing Hepatitis A Infections

September 27, 2019 2:59 PM | Sally Winkelman (Administrator)

Outbreaks of hepatitis A virus (HAV) have been reported across the U.S., with Minnesota being the most recent state affected. During these outbreaks, 24,952 individuals have become ill, and 60% of them needed to be hospitalized.

As of this writing, the Department of Health Services (DHS) has not detected HAV outbreaks in Wisconsin. However, most Wisconsin adults are not immune to HAV, making the state vulnerable to an outbreak unless HAV vaccination is scaled up. Because the current outbreaks of HAV are predominantly impacting communities with identifiable risk factors, including unstable housing, recent incarceration, and injection drug use, targeted efforts to vaccinate high-risk individuals could substantially reduce the risk of HAV outbreaks in the state. A single dose of HAV vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years.

Emergency departments are a critically important partner for providing HAV vaccine to patients in need because this setting provides care for many high-risk individuals who may not seek routine preventive care elsewhere.

We are asking you and your staff to work with your patients and clients to reduce the spread of hepatitis A infection. Please share the following information widely.

What can you do to help prevent hepatitis A infections?

  1. Check the immunization history of at-risk groups: Many individuals who are at risk of HAV have no consistent medical home. Checking their immunization history in the Wisconsin Immunization Registry (WIR) or in your organization’s Electornic Health Record (EHR) is a good way to make sure they are up-to-date on their vaccines, including HAV vaccine and influenza.
  2.  Provide HAV vaccine to patients who are unvaccinated and at-risk in the emergency department and urgent care clinics. Providers who do not have available vaccine may direct patients to local health departments or tribal health care clinics. Homeless individuals and injection and non-injection drug users are also at higher risk for other vaccine preventable diseases and should be brought up-to-date per the relevant CDC immunization schedule.
  3. Consider HAV infection in individuals, especially the homeless and those who use illicit drugs, with discrete onset of symptoms and jaundice or elevated liver function tests. Symptoms include nausea, vomiting, diarrhea, anorexia, fever, malaise, dark urine, light-colored stool, or abdominal pain.
  4. Promptly report all confirmed and suspect HAV cases. Please contact your local health department by telephone IMMEDIATELY upon identification of a confirmed or suspected case and report through the Wisconsin Electronic Disease Surveillance System (WEDSS) within 24 hours upon recognition of a case.
  5. 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) (0.02 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.
  6. Ensure that all health care workers use standard precautions in patient care to protect themselves against HAV. HAV, like norovirus, is a non-enveloped virus, and it may be similarly difficult to inactivate in the environment. Alcohol-based hand rubs and typically-used surface disinfectants may not be effective.
  7. Work with community partners for a second vaccine dose as needed. Many local health departments and pharmacies have the second dose in the Hepatitis A series. Find out where the second dose can be given so you can recommend your patient seeks out their services after they leave your care.

Who is at high risk for getting hepatitis A?

  • People who use drugs, whether injected or not (for example, cigarettes, joints, vaping products, pills)
  • People who have experienced unstable housing or homelessness
  • People who have sexual contact with someone who has hepatitis A (for example, engaging in oral-anal sex, also known as “rimming”)
  • Men who have sex with men
  • People who have close person-to-person contact with someone who has hepatitis A (for example, those who share bathroom facilities or a cell)
  • People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C
  • Individuals in correctional and jail settings, due to the close living conditions which allow the virus to spread easily

What is hepatitis A and how is it spread?

Hepatitis A is a highly contagious disease that is spread from person to person and is found in the feces (poop) of people with hepatitis A virus. Hepatitis A can be easily spread if someone does not wash their hands properly after using the bathroom.

How is hepatitis A different from other types of hepatitis?

Hepatitis A is different from hepatitis B and hepatitis C. While all three can damage the liver, they are caused by different viruses and are spread in different ways. Most often, hepatitis A is spread by eating or drinking food or water with the virus in it. In recent outbreaks, hepatitis A has been spread by sharing drugs or drug products, or having sexual contact with someone with hepatitis A.

What are the signs and symptoms?

Symptoms usually start four weeks after the individual has come in contact with the hepatitis A virus. However, they can start as early as two and as late as seven weeks after the virus enters the body. Symptoms can start quickly and can include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine (pee)
  • Diarrhea (loose stools)
  • Clay-colored stools
  • Joint pain
  • Jaundice (yellowing of the skin and eyes)

What should you know about the hepatitis A vaccine? 

The hepatitis A vaccine is safe and an effective tool for preventing the spread of disease. It is important to use the single-antigen hepatitis A vaccine when vaccinating staff.

One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A. It provides up to 95% protection against hepatitis A in healthy individuals for up to 11 years.

What resources are available to order from DHS?