All,
In case you haven’t heard, we’re in the midst of a Hepatitis A outbreak in Louisville (there’s been much larger ones elsewhere, including San Diego). I apologize if this is a long post and will try to keep organized but want to get this out sooner rather than later. Some things I think you should know:

• It’s transmitted via the fecal-oral route (hence why food handlers with HepA should not be working)
• High risk patients include Homeless patients, IV drug users, and Men who have sex with men (so a big portion of our patients)
• Consider Hepatitis in patients with: Fever, malaise, N/V/D, abdominal pain + either jaundice or elevated AST or ALT.
• It requires reporting to the Health Dept
• Patients should be placed in contact/enteric isolation (similar to C. Diff).
• Hands must be washed with soap and water (hand sanitizer isn’t good enough)!
• Rooms must be cleaned by EVS with Bleach. Please clean your stethoscopes as well.
• The incidence of fulminant hepatic failure is <1% (it’s higher in those with liver disease and with concomitant Hep B or C)
• Treatment is generally supportive, with hydration and electrolyte replacement as needed. Infection with Hepatitis A generally leads to immunity, thus do not need to vaccinate those with a diagnosis of Acute Hepatitis A.
• Patients are contagious until ~1 week after appearance of jaundice
• Patients and family members should be counseled on the route of transmission and should receive a dose of the Hepatitis A Vaccine (they can be directed to the Louisville Metro Dept of Public Health and Wellness at 400 E. Gray St.)
• There is no chronic Hep A State.
• The Acute Hepatitis Panel checks for HAV IgM, HepB Core Antibody, IgM, HepB Surface Antigen, and Hepatitis C antibody (thus can tell you if Acute A, and maybe B, but not whether Hep C is acute or chronic). You can order the specific Hep A IgM in Cerner, though it’s probably good to know whether B or C is present also.
• Those with Altered sensorium, INR > 1.5, a PT > 5 seconds above normal or with concomitant illnesses may require admission.
•  One of the recommendations is to administer the vaccine to our at risk populations, but PLEASE wait on this until I have further info on our stock/supply of the vaccine.
• The attached PDF has a questionnaire that the health dept is requesting be filled out and sent to them in order to reduce the spread of HAV, so please be aware of it and remind the nursing staff to try to get it filled out. If they’re unsure about it discuss with charge nurse to get the form.

Sorry this is so long but hope this helps. For any issues just email me and I’ll try to sort it out.

*See the attached PDF for information from the Health Dept/ULH. as well as the CDC link on Hepatitis A

Hep A Provider Recommendations 12.2017

https://www.cdc.gov/hepatitis/hav/havfaq.htm