Locations
Schedule Appointment
Contact Us

Hepatitis A

  1. Home
  2. Communicable Diseases
  3. Hepatitis A

Since August 1, 2016, Michigan has seen a sharp increase in cases of Hepatitis A. As of April 10, 2019, there were 913 cases, 733 hospitalizations, and 28 deaths associated to the Hepatitis A outbreak in Michigan.

Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus (HAV). It is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water. Hepatitis A is a self-limited disease that does not result in chronic infection. Most adults with hepatitis A have symptoms, including fatigue, low appetite, stomach pain, nausea, and jaundice, that usually resolve within 2 months of infection; most children less than 6 years of age do not have symptoms or have an unrecognized infection. Antibodies produced in response to hepatitis A infection last for life and protect against reinfection. The best way to prevent hepatitis A infection is to get vaccinated.

Stay Current On the Hepatitis A Outbreak

In some cases, people infected with hepatitis A 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.

    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

      Community Partners

      Food Establishments

      Medical Providers

      Manufacturers of Hepatitis A Vaccine

      Frequently Asked Questions

      How is Hepatitis A spread?

      Hepatitis A is usually spread when the Hepatitis A virus from an infected person’s feces (or stool, poop) gets into someone else’s mouth. This often happens when the infected person’s feces comes into contact with objects, food, or drinks. Most frequently, Hepatitis A is passed between people that spend a lot of time together, such as those that live together, share drugs, have sex, or someone that provides care to someone at risk. In the current outbreak in Southeast Michigan and other areas of Michigan, at least half of the cases appear to be linked to illicit drug use.

      Risks for Hepatitis A during this outbreak include:

      • Injecting drugs or using street drugs (including pain killers)
      • Going to jail
      • Paying for sex or trading sex for money or drugs
      • Being homeless or having an unstable living situation
      • Men that have sex with men

      Anyone with these risk factors, or living with someone with one of these risk factors, should get vaccinated for hepatitis A.

      How do you prevent Hepatitis A?

      Handwashing is one of the best ways to reduce your risk of getting hepatitis A. Hepatitis A is spread by the fecal-oral route, which means you can get ill if you eat, drink, or touch your mouth with any food, drink, object, or your hands that may have been in contact with stool (feces) from someone infected with hepatitis A. Washing your hands thoroughly after using the bathroom and before handling or eating food can help prevent this.

      Getting vaccinated for hepatitis A is also extremely effective. Anyone with the risk factors listed above or those that have regular, close contact to people with those risk factors, should get vaccinated. It is also being recommended that food handlers with one or more of the above risk factors and food handlers in outbreak areas as well as healthcare workers caring for patients in the outbreak areas get vaccinated.

      If you may have been exposed to someone infected with hepatitis A, you may be able to prevent illness by getting the hepatitis A vaccine or a dose of immunoglobulin (IG) within 2 weeks after you were exposed. This is referred to post-exposure prophylaxis (PEP).

      What should be given for PEP?

      If you have not been vaccinated for hepatitis A before or had a confirmed case of hepatitis A in the past, you should be given a hepatitis A vaccine* or IG (0.1 mL/kg) as soon as possible, again, within 2 weeks after exposure. Which one you get varies by age and health status:

      • For healthy people age 12 months to 40 years, Hepatitis A vaccine is preferred
      • For people age 41 years and older, IG is preferred because this age group wasn’t initially included in the studies done to determine if vaccination was effective to prevent infections after exposure. Also IG is recommended for older individuals because hepatitis A infection is usually more serious in older adults
        • However, vaccine should be given to individuals over 40 in addition to IG and can be used alone if IG is not available. Additional studies suggest vaccination alone is likely effective for PEP in healthy adults over 50 or 60 years old.
      • IG should be used:
        • For children aged less than12 months, immunocompromised persons, persons with chronic liver disease, and persons who are allergic to the vaccine or a vaccine component
        • Pregnant women that have been exposed should receive both the vaccine and IG (per recent unpublished recommendations from the CDC)

      NOTE: For complete and life-long protection against Hepatitis A, a second dose of Hepatitis A vaccine is needed at least 6 months later.

      How else can I prevent Hepatitis A?

      Hepatitis A vaccination is recommended for all children at age 1 year, for anyone at increased risk for infection, for anyone at increased risks for complications from Hepatitis A, and for anyone wishing to be protected. The Hepatitis A vaccination is recommended for the following groups:

      • All children at age 1 year (i.e., 12–23 months). Children who have not been vaccinated by age 2 can be vaccinated at any time.
      • Persons traveling to or working in countries that have higher risks of Hepatitis A. People from the United States who travel to developing countries are at high risk for Hepatitis A. The risk for Hepatitis A exists even for travelers to urban areas, those who stay in luxury hotels, and those who report that they are careful about what they drink and eat. Some experts feel that travel to any country is a risk and recommend Hepatitis A vaccination for any international travel.
      • Men who have sex with men. Sexually active men (both adolescents and adults) who have sex with men should be vaccinated.
      • Users of illegal injection and noninjection drugs (included pain killers). During the past two decades, outbreaks of Hepatitis A have been reported with increasing frequency among users of both injection and noninjection drugs in North America, Europe, and Australia. In fact, several large outbreaks are occurring around the country, including Southeastern Michigan, which appears to be linked at least in part to drug use.
      • Persons who have occupational risk for infection. Persons who work with HAV-infected primates or with HAV in a research laboratory setting should be vaccinated. No other groups have been shown to be at increased risk for HAV infection because of occupational exposure.
        • Also, it is currently being recommended that healthcare workers caring for patients in outbreak areas be vaccinated, primarily those in contact with high risk populations, such as workers in emergency departments, janitorial staff, EMS, paramedics, and other first responders.
        • Although they are not necessarily at higher risk for infection, it is being recommended that food handlers in outbreak areas be vaccinated. This is due to the risk a hepatitis A-infected food handler has in spreading disease to a large number of people due to contamination of food.
      • Persons who have chronic liver disease. Persons with chronic liver disease who have never had Hepatitis A should be vaccinated, as they have a higher rate of serious and life-threatening Hepatitis A. Persons who are either awaiting or have received liver transplants also should be vaccinated.
      • Persons who have clotting-factor disorders. Persons who have never had Hepatitis A and who are getting clotting-factor concentrates, especially solvent detergent-treated preparations, should be vaccinated.
      • Household members and other close personal contacts of adopted children newly arriving from countries with high prevalence of Hepatitis A.

      Where can I go to get a Hepatitis A vaccine?

      You can get your vaccine through you local health department, primary care provider, or visit by visting vaccinefinder.org. An appointment may be necessary.