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Hepatitis A

Hepatitis A

Since August 1, 2016, Michigan has seen a sharp increase in cases of Hepatitis A.  Approximately 16 counties are currently in an outbreak situation, and 12 counties, including Mecosta and Newaygo, are on the verge of an outbreak.  As of September 14, 2018, there were 889 cases, 714 hospitalizations, and 28 deaths associated to the Hepatitis A outbreak in Michigan (data updated weekly).

Hepatitis A Overview

Hepatitis A is a serious, highly contagious liver disease caused by the hepatitis A virus (HAV). HAV is found in the feces (poop) of people with hepatitis A. You can get hepatitis A by eating contaminated food or water, during sex, or just by living with an infected person. Illness can appear 15-50 days after exposure and you can be sick for several weeks. In some cases, people can die. Although not all people infected with hepatitis A experience illness, symptoms can include:

  • nausea and vomiting
  • belly pain
  • feeling tired
  • fever
  • loss of appetite
  • yellowing of the skin and eyes
  • dark urine
  • pale-colored feces (poop)
  • joint pain

There are steps you can take to reduce the risk of Hepatitis A transmission. Hepatitis A is a vaccine-preventable illness. While the hepatitis A vaccine is recommended as a part of the routine childhood vaccination schedule, most adults have not been vaccinated and may be susceptible to the hepatitis A virus. The best way to reduce the risk of getting hepatitis A is to get vaccinated with two doses of Hepatitis A vaccine. It is also recommended to wash your hands after going to the bathroom and before preparing meals for yourself and others. Use your own towels, toothbrushes, and eating utensils. Do not have sex with someone who has HAV infection or share food, drinks, or smokes with other people.

What can the public do to protect themselves and their communities?

  • Get vaccinated against hepatitis A
  • Wash hands after using the restroom and before eating or preparing meals for yourself or others
  • Use your own towels, toothbrushes, and eating utensils
  • Do not have sex with someone who has HAV infection
  • Do not share food, drinks, drugs, or smokes with other people
  • If you think you may have hepatitis A, see your medical provider
  • If you have hepatitis A, please cooperate with your local public health to help protect others

Vaccination Information

Hepatitis A can be prevented with a safe and effective vaccine. Stop the spread of this infection.

Who Should Get the HAV Vaccine?

  • Persons who are homeless.
  • Persons who are incarcerated.
  • Persons who use injection and non-injection illegal drugs.
  • Persons who work with the high risk populations listed above.
  • Persons who have close contact, care for, or live with someone who has HAV.
  • Persons who have sexual activities with someone who has HAV.
  • Men who have sex with men.
  • Travelers to countries with high or medium rates of HAV.
  • Persons with chronic liver disease, such as cirrhosis, hepatitis B, or hepatitis C.*
  • Persons with clotting factor disorders.

*Note: individuals with chronic liver disease (e.g., cirrhosis and hepatitis C) may not be at increased risk of getting HAV infections but are at increased risk of having poor outcomes if they are infected with HAV.

Information for Specific Groups

Health Care Providers (HCPs)

Maintain a high index of suspicion for Hepatitis A infection in high-risk individuals who present with nausea, anorexia, fever, malaise, abdominal pain or jaundice.  Individuals in the following groups are at the highest risk of transmission:

  • Persons with a history of substance use
  • Persons currently homeless or in transient living
  • Men who have sex with men (MSM)
  • Persons incarcerated in correctional facilities
  • Food handlers
  • Healthcare workers
  • Persons with underlying liver disease
  • Persons who are in close contact with any of the above risk groups

When cases are suspected in a high-risk patient, they should be reported immediately to DHD#10 by calling the Communicable Disease and Epidemiology Unit at 231-876-3811. The ability for public health to contact the patient prior to leaving the health care facility can be key to preventing missed opportunities to implement control measures.

Suspect patients should be tested for serum aminotransferase levels to assess liver function. While Hepatitis A IgM is confirmatory for diagnosis, providers are encouraged to order a complete serology panel (Hepatitis A, B and C) as information garnered from these tests can be informative to the public health investigation.

There is currently a national shortage of adult Hepatitis A vaccine as US manufacturers have been unable to meet increased demand in the US and globally. HCPs with adequate vaccine supply are encouraged to promote the delivery of vaccine to those in high-risk groups. The Michigan Department of Health and Human Services has recommended postponing the administration of the second dose of Adult Hepatitis A vaccine to ensure vaccine supply for the high-risk groups.

Food Service Establishments and Food Handlers

  • All food employees must practice diligent handwashing and good personal hygiene
  • Food employees shall thoroughly wash their hands and arms with soap and warm water for at least 20 seconds; thoroughly rinse with clean running water and properly dry their hands and arms.
  • Ensure handwashing signs are posted in the appropriate locations.
  • Use utensils or gloves to eliminate bare hand contact with ready- to-eat food.
  • Thoroughly and continuously disinfect the facility and food areas. If hepatitis A is suspected or confirmed in your facility, disinfect using the cleaning guidelines below.

Employee Responsibilities

  • Notify the Person in Charge if you have been diagnosed with a Hepatitis A infection.
  • You should not work with food or utensils if you are sick with acute gastrointestinal illnesses. Acute gastrointestinal illness is diarrhea, either alone or with vomiting, fever or abdominal cramps.

Person in Charge Responsibilities

  • REPORT to DHD#10 when a food employee is diagnosed with hepatitis A. Call 231-876-3820.
  • EXCLUDE a food employee from the food facility if diagnosed with Hepatitis A. Only the DHD#10 can clear an excluded employee to return to work.
  • RESTRICT a food employee from working with exposed food, clean equipment, clean linens, clean utensils and unwrapped single-service articles if the food employee is suffering from symptoms of acute gastrointestinal illness or experiencing persistent coughing, sneezing or nasal discharges. Restrictions can be removed by the Person in Charge when the food employee states they no longer have symptoms of illness.

Facilities that Service High-Risk Individuals

(e.g. Substance Use Treatment, Homeless and Housing Assistance Providers, Food Pantry Providers)

  • Assess clients for potential signs of hepatitis A infection during and after intake
    • Screen clients for fever, fatigue, nausea, loss of appetite, yellowing of skin or eyes, stomach pain, vomiting, dark urine, pale stools and diarrhea.
    • Refer people with signs of hepatitis A for medical evaluation.
    • Report suspected cases to the DHD#10 at 231-876-3811
  • Remind staff and clients of the importance of handwashing with soap and warm water after using the bathroom and before preparing, serving or eating food. Waterless hand sanitizers are not effective against hepatitis A.  Consider posting hand washing posters in bathrooms and kitchens.
  • Ensure routine and consistent cleaning of bathrooms used by staff and clients. If hepatitis A is suspected or confirmed in your facility, follow the Environmental Cleaning guidelines listed below.

Environmental Cleaning Guidelines

Effective Disinfection for Surfaces Exposed to Hepatitis A

Chlorine Bleach: Mix the chlorine solution immediately before use and use it promptly.  Leave the solution on the surface you are cleaning for one minute and then rinse with clean water.

5000 ppm: 1 and 2/3 cups of bleach in 1 gallon of water.  This can be used on stainless steel, items that have contact with food, tile floors, non-porous surfaces, counters, sinks and toilets.

Other Disinfectants: If a surface will be damaged by the use of bleach, other products that are effective against hepatitis A can be used.  Some examples of products that are labeled as effective against hepatitis A include VIRKON and KLORSEPT.

Proper Cleaning Methods and Handling of Cleaning Agents

  • Wear rubber disposable gloves and protect your clothing when preparing/handling chemical products and while cleaning.
  • Use chemicals in well-ventilated areas
  • Avoid mixing chemicals
  • Prevent chemical contact with food while cleaning
  • Handle vomit or feces spills as little as possible. Clean up visible debris with disposable absorbent materials (paper towels or other disposable cloths).  Consider covering the spill with disposable towels or cloth while cleaning to avoid spreading germs to other surfaces.
  • Manage all waste safely and dispose in a secure trash container
  • Always wash your hands after handling any contaminated material, trash or waste

Quick Links

General Information/Information for Individuals and Families

About Hepatitis A (DHD#10)
Get Yourself Protected (DHD#10/MDHHS)
Hepatitis A General Fact Sheet (CDC)
Hepatitis A – What You Need to Know (MDHHS)
Protect Yourself from Hep A (MDHHS/DHD#10)
Help Stop Spread of Hepatitis A (MDHHS)
Hepatitis A Disinfection Tip Sheet (MDHHS/MDARD
Vaccination Information

Community Partners

Get Yourself Protected (DHD#10/MDHHS)
Hep A Is Spreading – Half Sheet Tear Offs (DHD#10/MDHHS)
Poster – Germs are Everywhere
Poster – Are You At Risk?
Poster – Hep A is Spreading-Are You Next?
Flyer – Protect Yourself from Hep A (MDHHS/DHD#10)

Food Establishments

Food Safety – MDARD
Hepatitis A Disinfection Tip Sheet (MDHHS/MDARD)

Medical Providers

Hepatitis A Flowchart
Hep A Vaccination Programs for Hospitals and ED-FAQ
Adult Vaccination Supply Management
Hep A Priority Group
Hep A Vaccination Priority – Hospitals
Hepatitis A – Interim Guidance for IG Use
Immune Globulin Information
Manufacturers of Hepatitis A Vaccine: