Abstract
Hepatitis A is a vaccine preventable liver infection caused by the hepatitis A virus. The occupational health nurse should be aware of the signs and symptoms of the virus, educate workers about the infection, and recommend immunization for workers traveling or working in high-risk areas for hepatitis A.
Hepatitis A, a vaccine preventable acute liver infection caused by hepatitis A virus (HAV), affects about 1.4 million individuals globally every year (World Health Organization [WHO], 2015). Unlike the bloodborne Hepatitis B virus, HAV infection transmission occurs by the fecal-oral route, from direct contact with infected individuals, or after consuming contaminated food or water. Found in the blood and stool of those infected, the virus has an average incubation period of 14 to 28 days. Although some infected individuals may be asymptomatic, symptoms include fever, abdominal pain, nausea, malaise, and jaundice, which usually resolve within 2 months. HAV does not cause chronic liver disease and is rarely fatal, yet this infection is associated with debilitating symptoms. Without proper treatment, HAV infections can lead to acute liver failure and increased risk for death (Centers for Disease Control and Prevention [CDC], 2020b, 2020c; Nelson et al., 2020; WHO, 2015).
In the United States, HAV primarily spreads by person-to-person contact with only an occasional food outbreak. Since 2016, 35 US states have publicly reported outbreaks from person-to-person contact: 37,039 HAV infections; 22,674 (61%) hospitalizations; and 348 deaths were recorded thru December 11, 2020 (CDC, 2020d). These outbreaks primarily occurred among high-risk groups: men who have sex with men (MSM) as well as people who use drugs (injection or non-injection), with unstable housing or homelessness, who are currently or were recently incarcerated, and who have chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C (CDC, 2020d). HAV infections are higher among males, whites (non-Hispanic), and those aged 30 to 39 years (CDC, 2020c).
The recommended 2-dose vaccination series should begin at age 12 months followed by the second dose 6 months later. Unvaccinated toddlers, children, and adolescents under 18 years should receive the 2-dose vaccination. A combined Hepatitis A and Hepatitis B vaccine (Twinrex®) is available as a 3 or 4 dose series for unvaccinated workers aged 18 years and older. Unvaccinated workers should receive the first dose of the hepatitis A vaccine before traveling to an area with elevated or endemic levels of HAV infection (CDC, 2020a). Also, teach international workers about the signs and symptoms of hepatitis A, particularly if they are working, traveling, or living in an area of elevated risk.
The workplace with good hygiene practice seldom poses a higher risk for HAV exposure. There is no specific immunization recommendation for food handlers as the risk of transmission from a food handler to a consumer is extremely rare. Child care workers are also at minimal risk for hepatitis A transmission because of immunizations among young children. Neither is the vaccine routinely recommended for workers exposed to untreated sewage. However, to prevent community outbreaks, recommended postexposure prophylaxis immunization should start within 2 weeks of a known exposure. HAV-specific immunoglobulin (IG) is sometimes recommended post exposure (CDC, 2020c, 2020d). Guidance for risk assessment and clinical decision making is available @ https://stacks.cdc.gov/view/cdc/59777.
The occupational health nurse (OHN) should understand the distinct types of hepatitis and recognize signs and symptoms of HAV infection. The OHN can help control HAV infection outbreaks within the workplace and community; assess each worker’s immunization status and encourage immunizations if unvaccinated. A time for worksite campaigns to teach about HAV infections and encourage immunizations among workers and in the community each year is July 28, World Hepatitis Day. Hepatitis A is one of the most preventable viral infections when individuals are properly immunized.
