Hepatitis Blog

What the Hell is Hepatitis A?

marler@marlerclark.com (Hepatitis Attorney) — Sun, 19 Feb 2012 09:37:18 -0800

What is hepatitis A?

Hepatitis A is one of five human hepatitis viruses (hepatitis A, B, C, D, and E) that primarily infect the liver and cause illness. An estimated 80,000 cases occur each year in the U.S., although much higher estimates have been proposed based on mathematical modeling of the past incidence of infection. Each year, an estimated 100 persons die as a result of acute liver failure in the U.S. due to hepatitis A, but the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

Hepatitis A is a communicable (or contagious) disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Food contaminated with the virus is the most common vehicle transmitting hepatitis A. The food preparer or cook is the individual most often contaminating the food, although he or she is generally not ill at the time of food preparation. The peak time of infectivity, when the most virus is present in the stool of an infectious individual, is during the two weeks before illness begins. Although only a small percentage of hepatitis A infections are associated with foodborne transmission, foodborne outbreaks have been increasingly implicated as a significant source of hepatitis A infection.

Hepatitis A may also be spread by household contact among families or roommates, sexual contact, ingestion of contaminated water, ingestion of raw or undercooked fruits and vegetables or shellfish (like oysters), and from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play to family members and other children and adults.

Symptoms of hepatitis A Infection

Hepatitis A infection may cause no symptoms at all when it is contracted, especially in children. Such individuals will only know they were infected (and have become immune ñ you can only get hepatitis A once) by getting a blood test later in life. The incubation period (from exposure to onset of symptoms) is 15-50 days, with an average of 30 days. Many children and most adults will experience the sudden onset of flu-like symptoms. After a day or two of muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever and malaise, jaundice (also termed icterus) sets in. Jaundice is a yellowing of the skin, eyes and mucous membranes that occurs because bile flows poorly through the liver and backs up into the blood. The urine will turn dark with bile and the stool will be light or clay-colored from lack of bile. When jaundice sets in, the initial symptoms begin to subside.

In general, the period of acute illness lasts from 10 days to three weeks, at which time affected individuals tend to recapture some sense of wellness. It is not unusual for blood tests to remain abnormal for six months (or more), prolonging recovery for up to a year. Most affected individuals show complete recovery within three to six months of the onset of illness. Relapse is possible, and although more common in children, it does occur with some regularity in adults.

Diagnosis and treatment of hepatitis A

There are blood tests widely available to accurately diagnose hepatitis A; blood samples are tested for hepatitis antibodies, which are present when the immune system responds to the hepatitis virus. Antibodies of the immune globulin (Ig) M variety, which indicate acute disease, and IgG antibodies, which stay positive for life, should both be measured.

Hepatitis A infection is an acute self-limiting disease. There is no specific treatment; treatment and management is merely supportive. The liver function tests generally improve as the affected individual begins to feel better. It is therefore well accepted that the need for rest is best determined by the person’s own perception of the severity of fatigue or malaise.

Preventing hepatitis A Infection

Hepatitis A infection is totally preventable. Ill food-handlers should be excluded from work. Commercial food workers and other individuals who prepare food for others must always wash their hands with soap and water after using the bathroom, changing a diaper, and before preparing food. Cooking food to a temperature of 185∞F or higher will inactivate hepatitis A.

After a known exposure to hepatitis A, administration of a shot of immune globulin should be considered. If administered within two weeks of the exposure, it will usually be effective in preventing or at least ameliorating the disease.

Hepatitis A vaccine is the best protection from hepatitis A infection. The vaccine is recommended for persons traveling to areas with increased rates of hepatitis A, men who have sex with men, injecting and non-injecting drug users, persons with blood clotting factor disorders (such as hemophilia), persons with chronic liver disease, and children living in regions of the U.S. with increased rates of hepatitis A. The vaccine may also help protect household contacts of those with hepatitis A infection. Vaccination of food handlers would likely substantially diminish the incidence of hepatitis A outbreaks. The vaccine is licensed for individuals aged two and older, but there is good evidence that the vaccine is safe and effective at one year of age.

References

Advisory Committee on Immunization Practices (ACIP), Fiore AE, Wasley A, Bell BP. (2006). Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep.55(RR-7):1-23.

Bialek SR, Thoroughman DA, Hu D, Simard EP, Chattin J, Cheek J, Bell BP. (2004). Hepatitis A Incidence and Hepatitis A Vaccination Among American Indians and Alaska Natives, 1990–2001. Am J Public Health. 94(6):996-1001.

Bownds L, Lindekugel R, Stepak P. (2003). Economic impact of a hepatitis A epidemic in a mid-sized urban community: the case of Spokane, Washington. J Community Health. 28(4):233-246.

Butot S, Putallaz T, Sánchez G. (2008). Effects of sanitation, freezing and frozen storage on enteric viruses in berries and herbs. Int J Food Microbiol. 126(1-2):30-35.

Calder L, Simmons G, Thornley C, Taylor P, Pritchard K, Greening G, Bishop J. (2003). An outbreak of hepatitis A associated with consumption of raw blueberries. Epidemiol Infect. 131(1):745-751.

Centers for Disease Control and Prevention (2009a). Disease Burden from Viral Hepatitis A, B, and C in the United States. Available at http://www.cdc.gov/hepatitis/PDFs/disease_burden.pdf).

Centers for Disease Control and Prevention (2009b). Surveillance for Acute Viral Hepatitis—- United States, 2007. Surveillance Summaries. 58 (SS03):1-27.

Centers for Disease Control and Prevention (2009c). Hepatitis A. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Wolfe S, Hamborsky J, McIntyre L, eds. 11th ed. Washington DC: Public Health Foundation, pp. 85-97.

Centers for Disease Control and Prevention (2009d). Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees. Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 58(36):1006-7.

CDC (2007). Update: Prevention of Hepatitis A after Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 56(41);1080-1084.

Detry O, De Roover A, Honore P, Meurisse M. (2006). Brain edema and intracranial hypertension in fulminant hepatic failure: pathophysiology and management. World J Gastroenterol. 12: 7405-7412.

Feldman, M, Friedman, LS, Sleisenger, MH. (2002). Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 80: 1571.

Fiore, AE. ( 2004). “Hepatitis A Transmitted by Food.” Clinical Infectious Diseases. 38:705-715.

Gilkson M, Galun E, Oren R, Tur-Kaspa R, Shouval D. (1992). Relapsing hepatitis A. Review of 14 cases and literature survey. Medicine. 71:14-23.

Hutin YJF, Pool V, Cramer EH, et al. (1999). A multistate, foodborne outbreak of hepatitis A. N Engl J Med. 340:595–602.

Jaykus L. (1997). Epidemiology and Detection as Options for Control of Viral and Parasitic Foodborne Disease. Emerg Infect Dis. 3(4):529-539.

Mayo Clinic. (2009). Hepatitis A. Available at http://www.mayoclinic.com/health/hepatitis-a/DS00397.

Piazza M, Safary A, et al. (1999). Safety and immunogenicity of hepatitis A vaccine in infants: a candidate for inclusion in the childhood vaccination program. Vaccine. 17:585-588.

Rawls RA and Vega KJ (2005). Viral Hepatitis in Minority America. J Clin Gastroenterol. 39:144–151.

Sagliocca L, Amoroso P, et al. (1999). Efficacy of hepatitis A vaccine in prevention of secondary hepatitis A infection: A randomized trial. Lancet. 353:1136-39.

Scharff RL, McDowell J, Medeiros L. (2009). Economic Cost of Foodborne Illness in Ohio. J Food Prot. 72(1):128-136.

Schiff ER. (1992). Atypical Manifestations of hepatitis-A. Vaccine. 10(Suppl. Vol. 1): 18-20.

Taylor R, Davern T, Munoz S, Han S-H, McGuire B, Larson AM, et al. (2006). Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes. Hepatology. 44:1589-1597.

Todd EC, Greig JD, Bartleson CA, Michaels BS. (2009). Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 6. Transmission and survival of pathogens in the food processing and preparation environment. J Food Prot. 72(1):202-219.

Wheeler C, Vogt TM, Armstrong GL, et al. (2005). An Outbreak of Hepatitis A Associated with Green Onions. N Engl J Med. 353: 890-897.

Willner IR, Uhl MD, Howard SC, Williams EQ, Riely CA, Waters B. (1998). Serious hepatitis A: an analysis of patients hospitalized during an urban epidemic in the United States. Ann Intern Med. 128:111-114.

Lubbock's Cheddar's Casual Café Costs Public Health $250,000 Due to Hepatitis A

marler@marlerclark.com (Hepatitis Attorney) — Sun, 19 Feb 2012 08:47:03 -0800

Lubbock Avalanche-Journal reports that leftover vaccines from a Hepatitis A scare last year will be administered to those who took the first vaccination in hopes of providing extended protection against the disease.

An employee at Cheddar’s Casual Café contracted the viral illness last September, potentially exposing anyone who ate at the restaurant.

Bridget Faulkenberry, director of the Health Department, said about 2,200 vaccinations are left over — some for children and some for adults — for those who took the first vaccine.

Since this vaccination is not mandatory, the department will charge $15 per vaccine. The Health Department spent about $240,000 on the initial doses of vaccine last September, Faulkenberry said.

The charge will help recuperate some of that money spent last year, Faulkenberry said.

She said she expects to have leftover vaccines this time around, too, as not everyone will take another one, and some people who took the first vaccine were from out of town.

The vaccines will be administered by nurses from 11 a.m. to 6 p.m. April 3 and 9 a.m. to 3 p.m. April 5 in the Health Department at 1902 Texas Ave., Faulkenberry said.

The Health Department will send letters to those eligible for the vaccine, and the recipients must bring the letter to get the vaccination. The letter states clinic will be cash only.

About 2,700 people took the vaccine the first time, said Faulkenberry. There were no cases reported other than the initial one, Faulkenberry said.

Hepatitis A is a viral disease, affecting the liver and causing inflammation and malfunction of the liver cells, said Dr. Joe Sasin, medical director for the emergency department at University Medical Center.

Sasin said the second immunization, which is purely preventative, should last for several decades.

“It’s very, very important to get that second immunization, and high-risk groups definitely should get the vaccine,” Sasin said.

He said Hepatitis A usually is not life threatening unless dealing with the very young or very old, or people who have other health complications. Most people who have Hepatitis A get over it on their own, and are immune to it the rest of their lives.

Boise Idaho Cheesecake Factory Linked to Hepatitis A Risk

bmarler@marlerclark.com (Bill Marler) — Fri, 10 Feb 2012 17:11:53 -0800

According to the Idaho Statesman, an employee at the Cheesecake Factory on Milwaukee Avenue in Boise may have exposed some diners at the restaurant to Hepatitis A this winter. The Statesman's report is based on information from the Central District Health Department.

Health officials said the exposure may have occurred between Dec. 13 and Jan. 22.

The employee who was confirmed to have Hepatitis A wasn't involved in food preparation, and the risk to the public is "extremely low" -- but there was some possibility of exposure to diners, the health department said. The employee is said to have used good hand hygiene.

Hepatitis A is a liver disease caused by the hepatitis A virus. It is usually spread by eating or drinking food items that have been contaminated with hepatitis A from someone who hasn’t properly washed their hands after using the bathroom, but it is also spread easily when a person doesn't wash his or her hands after changing a baby's diaper.

Symptoms of the disease include: fever, loss of appetite, abdominal discomfort, jaundice, tiredness, nausea and dark urine. Anyone who ate at the Cheesecake Factory between Dec. 13. and Jan. 22 and has these symptoms is advised to see their doctor. Symptoms vary from mild to severe, lasting anywhere from a couple weeks to several months.

Health officials said the Cheesecake Factory, which is at 330 N. Milwaukee Ave., fully cooperated with the investigation.

Deadliest Outbreaks - Hepatitis A - Chi Chi's Restaurant Green Onions 2003

marler@marlerclark.com (Hepatitis Attorney) — Fri, 03 Feb 2012 19:31:16 -0800

At least 565 cases of hepatitis A were associated with an outbreak at the Chi Chi’s Restaurant in Monaca, Pennsylvania, in 2003. There were 128 hospitalizations and three deaths. As a result of exposure to the restaurant food or outbreak cases, more than 9,000 persons were given an injection of immune globulin to prevent hepatitis A. Numerous secondary illnesses occurred when infected persons who had eaten at the restaurant infected their close contacts. This outbreak, and concurrent outbreaks, were associated with eating raw, or undercooked, green onions that had been grown in Mexico and served in restaurants.

Link.

Possible Hepatitis A Exposure for Fruity Yogurt Patrons in Goldsboro, NC

marler@marlerclark.com (Hepatitis Lawyer) — Wed, 21 Dec 2011 09:17:11 -0800

Patrons who ate at the Fruity Yogurt restaurant in Goldsboro, North Carolina on December 7, 2011 may have been exposed to Hepatitis A through a sick employee. The Wayne County Health Department announced that an employee who worked at the Fruity Yogurt on that date was diagnosed with Hepatitis A on December 14.

Wayne County Health Department is holding a vaccine clinic today, December 21, 2011 from 7 AM to 6 PM located at 301 N. Herman Street, Goldsboro, North Carolina. Anyone who ate at the restaurant on December 7 is being asked to go to the clinic and receive a shot.

The symptoms of Hepatitis A usually begin about 28 days after exposure to the virus, but can appear as early as 15 days or as late as 50 days after exposure.

The symptoms include muscle aches, headache, loss of appetite, abdominal pain, fever, and malaise. After a few days of the aforementioned symptoms, jaundice (yellowing of the skin, eyes and mucous membranes) sets in. A person infected may also notice that urine turns dark in color and stools become light or clay-colored.

In general, symptoms usually last less than 2 months, although 10% to 15% of symptomatic persons have prolonged or relapsing disease for up to 6 months. It is not unusual, however, for blood tests to remain abnormal for six months or more.

Allentown Pennsylvania Pasta Alla Rosa Linked to Hepatitis A

marler@marlerclark.com (Hepatitis Attorney) — Fri, 07 Oct 2011 22:32:23 -0800

A warning for recent guests at an Allentown restaurant; you may have been exposed to Hepatitis A.

The Allentown Health Bureau is investigating a confirmed case of Hepatitis A in an employee at the Pasta Alla Rosa Restaurant on Hamilton Street.

While the Bureau says the employee only had limited food handling duties, they still recommend that anyone who ate at the restaurant between September 23 and October 7 receive vaccinations or immune globulin (antibodies).

The Bureau says that unvaccinated guests who ate at the restaurant during the previously mentioned time period should contact their health care provider to discuss post-exposure prophylaxis (prevention). The prevention is only beneficial if taken within 14 days of exposure. Guests at the restaurant who have already been vaccinated against Hepatitis A are protected and don’t need to take action.

The Bureau recommends that unvaccinated guests between the ages of 1 year and 40 years be vaccinated while unvaccinated guests over the age of 40 receive immune globulin.

Unvaccinated guests who don’t receive vaccination or immune globulin are advised to seek medical treatment if they begin to experience the following symptoms:

• Yellowing of eyes or skin

• White stool

• Dark urine

• Nausea

• Vomiting

• Diarrhea

The Allentown Health Bureau will make vaccine available next Monday. From 9 a.m. to 4 p.m., they will have a walk-in clinic at 245 North Sixth Street for unvaccinated guests between the ages of 1 and 40.

The Bureau also requested a supply of immune globulin from the Pa. Department of Health. The Bureau will offer it to unvaccinated guests over 40 once it becomes available.

1000 Get Hepatitis A Shots in Lubbock

marler@marlerclark.com (Hepatitis Attorney) — Fri, 16 Sep 2011 18:34:01 -0800

More than a thousand people came to the Lubbock Civic Center to get a hepatitis A vaccination on Friday after a scare at a local restaurant.

City health care workers will be on site administering shots until 7 p.m Friday.

The Lubbock Health Department is urging anyone who ate at Cheddar's Restaurant from Aug. 31 through Sept. 8 to come to the civic center for a precautionary vaccination.

Early lines were more than an hour long as concerned citizens said they'd rather be safe than sorry.

Lubbock Cheddar's Linked to Hepatitis A Scare

marler@marlerclark.com (Hepatitis Attorney) — Thu, 15 Sep 2011 02:32:25 -0800

Lubbock City health officials Tuesday night warned anyone who ate at Cheddar’s Casual Cafe earlier this month they may have been exposed to hepatitis A after an employee there was diagnosed with the viral disease.

Diners who ate at the restaurant at 4009 S. Loop 289 from Aug. 31 through Sept. 8 may have been exposed, said Lubbock Health Director Bridget Faulkenberry.

The employee, who worked in food preparation, has not worked at the restaurant since Sept. 8, Faulkenberry said.

Meanwhile, the city is working to obtain vaccine to offer anyone who patronized the restaurant during that period. Information about immunization clinics will be announced when the vaccine is available.

3,000 Hepatitis A Shots Given in Fayetteville North Carolina

bmarler@marlerclark.com (Bill Marler) — Fri, 12 Aug 2011 17:50:16 -0800

The Cumberland County Health Department will offer hepatitis A vaccines for two hours Saturday for those who may have been exposed to the virus at the Olive Garden.

The clinic at 1235 Ramsey St. will be 9 a.m. to 11 a.m. for those who worked or dined at the North MacPherson Church Road restaurant on July 31. The clinic will resume normal hours Monday from 8 a.m. to 5 p.m. for those who ate there Aug. 1, 2 or 8.

Fort Bragg officials have also set up on-post screening clinics for soldiers and their families who may have been exposed to hepatitis A.

The vaccine is effective only within 14 days of infection. Those who dined or worked at the Olive Garden prior to July 31 should watch for signs of the illness and contact a doctor if they get sick.

2,700 Hepatitis A Shots Needed at Fayetteville North Carolina Olive Garden

bmarler@marlerclark.com (Bill Marler) — Thu, 11 Aug 2011 19:29:20 -0800

Cumberland County health officials administered an estimated 2,700 doses of hepatitis A immunizations as of Thursday to people who may have been exposed at the Olive Garden.

The Health Department reported administering 570 shots through 3 p.m. Thursday in addition to an estimated 2,100 on Tuesday and Wednesday.

Starting today, only those who dined or worked at the restaurant on July 29 and 31, and Aug. 1, 2 and 8, are eligible for free shots at the Health Department's Ramsey Street office. Officials say an employee who worked at the restaurant on those dates later tested positive for the illness.

The vaccine is effective only within 14 days of infection. Those who dined or worked at the Olive Garden prior to July 29 should watch for signs of the illness and contact a doctor if they get sick.