Hepatitis A outbreak alert - April 2009

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Overview

The Victorian Department of Human Services has recognised an increase in the number of hepatitis A cases across the state. Please consider the diagnosis of hepatitis A in any person presenting with acute hepatitis.

As you are aware, patients may present with symptoms such as loss of appetite, nausea and vomiting, tiredness, fever, abdominal pain, dark urine, pale faeces and jaundice. The incubation period is 2 to 8 weeks, and transmission occurs via the faecal-oral route through the ingestion of contaminated food or water, or through direct hand-to-mouth contact with the faeces of an infectious case.

Cases are infectious two weeks before and one week after the onset of jaundice/dark urine (whichever is first). It is therefore important that close contacts receive post-exposure prophylaxis as soon as possible, and within 14 days after their last contact with the case during their infectious period.

These include:

• Household contacts (including people who have had an overnight stay at the case’s house during their infectious period).
• Sexual contacts.
• People who have consumed food prepared by the case.

Normal Human Immunoglobulin (NHIG) vaccine

Normal Human Immunoglobulin (NHIG) or the hepatitis A vaccine can be given as post-exposure prophylaxis. The department currently provides NHIG free of charge to contacts of hepatitis A cases. Access to NHIG after hours can be obtained by contacting the CSL after hours telephone number 0413 027 298. Alternatively, the department can organise for the NHIG to be delivered to your practice during normal working hours.

Information relating to the dosage and administration of NGIH is available from the Australian Immunisation Handbook 9th Edition (2008), pages 146–148 and 175–183, and summarised below:

The injection should be given by deep IM injection using a large (19 or 20) gauge needle. Please note that NGIH can potentially interact with vaccines—refer to pages 175–183 of the Australian Immunisation Handbook for further information.

Food handlers, child care workers and health care workers should be excluded from work until one week after the onset of jaundice/dark urine.

Notification

Under the Health (Infectious Diseases) Regulations 2001, hepatitis A is required to be notified to the Department of Human Services by medical practitioners within five days. Notifications can be made online at:

• Notification page of Infectious Diseases website
• via telephone on 1300 651 160, or
• fax on 1300 651 170.

An after hours telephone number is also available: 1300 790 733. Information about hepatitis A is available on the Infectious Diseases website.

Yours sincerely

Dr John Carnie
Chief Health Officer

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Hepatitis A alert - April 2009 (45kb, pdf)

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