Background

Nosocomial hepatitis A occurs infrequently, and transmission to personnel usually occurs when the source patient has unrecognized hepatitis and is fecally incontinent or has diarrhea. Other risk factors for hepatitis A virus (HAV) transmission to personnel include activities that increase the risk of fecal-oral contamination such as (a) eating or drinking in patient care areas, (b) not washing hands after handling an infected infant, and (c) sharing food, beverages, or cigarettes with patients, their families, or other staff members.

HAV is transmitted primarily by the fecal-oral route. It has not been reported to occur after inadvertent needlesticks or other contact with blood, but it has rarely been reported to be transmitted by transfusion of blood products. The incubation period for HAV is 15 to 50 days. Fecal excretion of HAV is greatest during the incubation period of disease before the onset of jaundice. Once disease is clinically obvious, the risk of transmitting infection is decreased. However, some patients admitted to the hospital with HAV, particularly immunocompromised patients, may still be shedding virus because of prolonged or relapsing disease, and such patients are potentially infective. Fecal shedding of HAV, formerly believed to continue only as long as 2 weeks after onset of dark urine, has been shown to occur as late as 6 months after diagnosis of infection in premature infants. Anicteric infection is typical in young children and infants.

Personnel can protect themselves and others from infection with HAV by adhering to standard precautions. Food-borne transmission of hepatitis A is not discussed in this guideline, but it has occurred in health care settings.

Two inactivated hepatitis A vaccines are now available and provide long-term preexposure protection against clinical infection with greater than 94% efficacy. Serologic surveys among health care personnel have not shown greater prevalence of HAV infection than in control populations; therefore, routine administration of vaccine in health care personnel is not recommended. Vaccine may be useful for personnel working or living in areas where HAV is highly endemic and is indicated for personnel who handle HAV-infected primates or are exposed to HAV in a research laboratory. The role of hepatitis A vaccine in controlling outbreaks has not been adequately investigated. Immune globulin given within 2 weeks after an HAV exposure is more than 85% effective in preventing HAV infection and may be advisable in some outbreak situations.

Restriction from patient care areas or food handling is indicated for personnel with HAV infection. They may return to regular duties 1 week after onset of illness.

Recommendations

1. Do not routinely administer inactivated hepatitis A vaccine to health care personnel. Susceptible personnel living in areas where hepatitis A is highly endemic should be vaccinated to prevent acquisition of community-acquired infection. Category IB
2. Do not routinely administer immune globulin as prophylaxis for personnel providing care or who are exposed to a patient with hepatitis A. Category IB
3. Administer immune globulin (0.02 ml/kg) to personnel who have had oral exposure to fecal excretions from a person acutely infected with HAV (Table 1). Category IA
4. In documented outbreaks involving transmission of HAV from patient to patient or from patient to health care worker, use of immune globulin may be indicated in persons with close contact with infected persons. Contact the local health department regarding control measures (Table 1). Category IB
5. Exclude personnel who have acute hepatitis A from duty until 1 week after the onset of jaundice (Table 3). Category IA

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