Hepatitis A Infection—Child Care and Schools

What is hepatitis A infection?

• Hepatitis A is a viral infection causing liver inflammation.

• Hepatitis A is an acute, usually self-limited illness.

What are the signs or symptoms?

• Children younger than 6 years usually have few or no signs or symptoms. Symptoms are common in older children and adults.

• Fever.

• Jaundice (ie, yellowing of skin or whites of eyes).

• Light-colored stools

• Abdominal discomfort.

• Fatigue.

• Dark-brown urine.

• Nausea, loss of appetite.

• Occasionally, diarrhea can occur.

What are the incubation and contagious periods?

• Incubation period: 15 to 50 days; average of 28 days.

• Contagious period: Most infectious in the 2 weeks before onset of signs or symptoms; the risk of transmission is low 1 week after symptoms start.

How is it spread?

• Fecal-oral route: Contact with feces from an infected person, typically when the person contaminates their fingers and touches an object another person then touches. Children who have contact with the contaminated surface may place their fingers into their own or another person’s mouth.

• Outbreaks have been associated with consumption of shared food (eg, fruits and vegetables).

How do you control it?

• Hepatitis A is a vaccine-preventable disease. The vaccine is recommended for all children 12 months and older and requires 2 doses: an initial dose followed by a second dose 6 to 18 months later. Knowledge of the vaccine status of children is desirable.

• Hepatitis A outbreaks are uncommon now because of widespread vaccination. The first signs of an outbreak often appear in adult caregivers, as young children may not show symptoms. An outbreak is if there are 1 or more cases of hepatitis A in a child or staff member in an early childhood education (ECE) program or 2 or more cases of hepatitis A in household members of children or staff members in an ECE program. Local health authorities should be notified as soon as possible. In an outbreak at a center with diapered children, all underimmunized staff and attendees at the center should receive the vaccine or an immune globulin shot within 14 days of exposure. In an outbreak at a center without diapered children, the vaccine or immune globulin should be given only to underimmunized classroom contacts.

• Staff members in ECE programs are not required to get the hepatitis A vaccine. However, the Centers for Disease Control and Prevention recommends vaccination for close contacts of children adopted from countries where hepatitis A is common. Educators should consider the potential for exposure to newly arrived international adoptees or children of newly immigrated families when deciding on hepatitis A vaccination.

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition , especially after toilet use or handling soiled diapers, and particularly before anything to do with food preparation or eating.

• ECE and school settings contribute significantly to the community-wide spread of hepatitis A, as young children usually have few or no signs or symptoms, allowing spread within and outside an ECE setting before the initial case is recognized.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the ECE program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members and the parents of underimmunized children to watch for symptoms and notifies the Child Care Health Consultant.

• Report the infection to the local health department. The health professional who makes the diagnosis may not report that the infected child is a participant in an ECE program or school, and this could lead to delay in controlling the spread.

• Teach children to wash their hands after using the toilet and before any activity that potentially involves food or the mouth.

• Reeducate staff members about strict and frequent handwashing, diapering, toileting, food handling, and cleaning and disinfection procedures. Hepatitis A virus can survive on surfaces for weeks.

• Ensure proper surface disinfection that includes cleaning and rinsing of surfaces that may have become contaminated with stool (feces) with detergent and water and application of a US Environmental Protection Agency–registered disinfectant according to the instructions on the product label. For guidance on disinfectants, refer to Selection and Use of a Cleaning, Sanitizing, or Disinfecting Product in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

• Contact a health professional and the local health department promptly to review the need for using vaccine or immune globulin for attendees and household members of attendees.

• Routinely check that children complete the hepatitis A vaccine series according to the most recent immunization recommendations.

Exclude from educational setting?

Yes.

• Children and adults, especially food handlers, with hepatitis A should be excluded for 1 week after onset of illness.

• Refer symptomatic people and close contacts of a symptomatic person (see section How do you control it?) to a pediatric health professional.

Readmit to educational setting?

Yes, when all the following criteria are met:

• One week after onset of illness for the infected individual

• For close contacts who meet criteria in the section How do you control it?, when they have received vaccine or immune globulin as recommended and do not have symptoms

• When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group