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Division of Public Health Services Disease Handbook for Childcare Providers Bureau of Infectious Disease Control REVISED –January 2018 HEPATITIS A Hepatitis A is an infection of the liver caused by the hepatitis A virus. Who gets this disease? Anyone can. It can spread quickly in groups of small children who are not yet toilet- trained and who cannot wash their own hands well. How is it spread? Hepatitis A virus is passed out of the body in the stool and is spread by the fecal-oral route, just like infectious diarrhea. Contact with stool - contaminated food, drink or environment surfaces (e.g., toilet seat, changing table) can spread t he infection. What are the symptoms? The symptoms vary greatly, ranging from none at all to severe illness. Early symptoms can include loss of appetite, nausea, aching, fever, and stomachache. Later signs can include dark colored urine, light colored s tools and jaundice (i.e., yellowing of white of eyes, eyes or skin). (Note: jaundice occurs more often among adults than children). These symptoms usually last from one to two weeks, although some adults may be sick for several months. How soon do symptoms appear? After the hepatitis A virus is ingested, it is between 15 -50 days before illness begins. Most commonly, it begins within 25-30 days. Can a person have this disease without knowing it? Yes. This is especially important in the childcare setting because most young children with hepatitis A do not become ill. Children with hepatitis A without symptoms who are in diapers could easily pass the virus to unsuspecting childcare facility staff and family members. In addition, people with hepatitis A are most likely to spread the disease to others during a period extending from 14 days before developing symptoms to one week after symptoms develop. This means that a person may be infectious to others before even realizing he or she is ill. What is the treatment? There is no treatment that cures hepatitis A. However, there are two shots available to help prevent illness in people exposed to patients with hepatitis A. These protective shots – either hepatitis A vaccine or Hepatitis A immune globulin (IG) – must be given within two weeks of a person’s exposure to hepatitis A in order for it to be helpful. A person’s healthcare provider and the New Hampshire Division of Public Health Services, Bureau of Infectious Disease Control will assist in making re commendations about administering hepatitis A vaccine or IG to contacts. How can the spread of this disease be prevented? 1. Hepatitis A vaccine is recommended for children 12- 23 months. The Advisory Committee on Immunization Practices (ACIP), recommends immunizing children against Hepatitis A. 2. The two dose series should be given at 12 and 18 months of age Children who are not vaccinated by age 2 years can be vaccinated at subsequent visits. 3. Wash hands thoroughly after using the toilet. 4. Wash hands thoroughly after diapering children. 5. Wash hands thoroughly before preparing food. HEPATITIS A (cont.) Division of Public Health Services Disease Handbook for Childcare Providers Bureau of Infectious Disease Control REVISED –January 2018 6. Clean toilet facilities thoroughly and wash hands afterward. 7. Discourage children from putting non- food items into their mouths since these items may be a source of the virus. Who should be excluded? Persons with hepatitis A (or suspected hepatitis A) should be excluded from daycare centers, food-handling occupations, and direct care of hospitalized and institutionalized patients for one week after the onset of symptoms (jaundice) or hepatitis A has been ruled out. A Public Health Professional will advise individuals regarding specific recommendations. Reportable? Yes, hepatitis A is reportable by New Hampshire law to the Division of Public Health Services, Bureau of Infectious Disease Control at (603) 271-4496. It is important that cases associated with a childcare center be reported as soon as possible. A Public Health Professional will give specific recommendations for immunization of the people exposed. |