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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.