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Resource Packages: Hepatitis A

Historical Overview

The disease known as hepatitis A has been recognised under a variety of names for many centuries. For example, Infectious hepatitis, Epidemic hepatitis and Epidemic jaundice to name just a few. It has long been associated with armies in the field and, during the First World War, hepatitis was a major problem. It also appeared during the Second World War, especially in the Mediterranean sphere where at least 35000 cases occurred in two years. It was during the Second World War that the viral aetiology of hepatitis was established. Experiments confirmed the existence of two distinct forms of the disease. These two forms became known as infectious hepatitis (hepatitis A) and serum hepatitis (hepatitis B). 

Recent Developments

Hepatitis caused by virus A (HAV) is transmitted almost exclusively by the faecal - oral route. Common source outbreaks have been related to faecal contaminated water and food, including milk, meats, salads and shellfish. Hepatitis A is enhanced by poor personal hygiene and crowded conditions. Transmission of hepatitis A in general hospitals is relatively uncommon. Nosocomial transmission from personnel to patient has rarely been reported. Transmission of hepatitis A infection from patients to personnel has occurred infrequently. Foodborne outbreaks involving hospital workers has also occurred infrequently.  

People who handle food or drink must be excluded from work for a least one week after the onset of jaundice.

Anyone who has not had hepatitis A in the past is at risk of acquiring the disease. Once a person has been infected with hepatitis A they are immune for life. 

Hepatitis A continues to be a problem for overseas travellers, especially Africa, the Middle East, Asia and Central and South America.

Patients with hepatitis A are not usually hospitalised unless the illness is of great severity or diagnosis uncertain.

Incubation Period is 15 to 50 days, but on an average 28 to 30 days. Faecal excretion of the virus occurs for several weeks before and one week after the onset of jaundice. 

Standard Precautions must be practiced at all times. 

Contact Precautions are recommended and should emphasise the importance of care when handling faeces, bedpans, equipment or instruments contaminated with faeces. 

Notification to the Public Health Unit: Hepatitis A is a notifiable disease to the Public Health Unit. 

Prophylaxis: (human) Immunoglobulin (IG) will not prevent infection, but may prevent or reduce illness if given within 2 weeks of contact with an infected person. 

Vaccine: A vaccine for hepatitis A has been available since 1992. Schedules are dependent on the strength of the vaccine administered. A combined hepatitis A and hepatitis B vaccine is now available. The new combined hepatitis A/B vaccine offers greater convenience, potentially better compliance and lower administration costs than monovalent vaccines. 

Occupations recommended for hepatitis A vaccination are:  

  • Child care workers
  • Teachers and other close contacts of the intellectually disabled
  • Staff and residents of residential facilities for the intellectually disabled
  • Health care workers and teachers in remote Aboriginal and Torres Strait Islander communities
  • Nursing staff and other health care workers in contact with patients in paediatric wards, infectious diseases wards, emergency rooms and intensive care units
  • Sewerage workers

The vaccine is also of value to persons who travel to areas of intermediate or high endemicity, homosexual men, individuals with chronic liver disease, recipients of blood products and food handlers.

References

Reid D, Grist N R, Pinkerton, I W, 1986, Infections in Current Medical Practice. Butterworth, London.

Benenson A S ed, 15th ed, 1990, Control of Communicable Diseases in Man. American Public Health Association, Washington.

Bennett J V, Brachman PS, and Sandford J P, eds, 1992 3rd edition, Hospital Infections.  Little, Brown and Company, Boston.

NSW Health Department, 1993, Hepatitis A Immunisation Policy, 93/32.

National Medical and Research Council, 1997, 6th edition, The Australian Immunisation Handbook.  Commonwealth of Australia.

NSW Health Department, 1999, Infection Control Policy 99/87, AIDS/Infectious Diseases Branch.

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150 - 154 Albion Street Surry Hills NSW 2010 Australia
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