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Division of Public Health Services Disease Handbook for Childcare Providers
Bureau of Infectious Disease Control REVISED –January 2018
HEPATITIS A
Hepatitis A is an infection of the liver caused by
the hepatitis A virus.
Who gets this disease?
Anyone can. It can spread quickly in groups of
small children who are not yet toilet- trained and
who cannot wash their own hands well.
How is it spread?
Hepatitis A virus is passed out of the body in the
stool and is spread by the fecal-oral route, just like
infectious diarrhea. Contact with stool -
contaminated food, drink or environment surfaces
(e.g., toilet seat, changing table) can spread t he
infection.
What are the symptoms?
The symptoms vary greatly, ranging from none at
all to severe illness. Early symptoms can include
loss of appetite, nausea, aching, fever, and
stomachache. Later signs can include dark
colored urine, light colored s tools and jaundice
(i.e., yellowing of white of eyes, eyes or skin).
(Note: jaundice occurs more often among adults
than children). These symptoms usually last from
one to two weeks, although some adults may be
sick for several months.
How soon do symptoms appear?
After the hepatitis A virus is ingested, it is
between 15 -50 days before illness begins. Most
commonly, it begins within 25-30 days.
Can a person have this disease without
knowing it?
Yes. This is especially important in the childcare
setting because most young children with hepatitis
A do not become ill. Children with hepatitis A
without symptoms who are in diapers could easily
pass the virus to unsuspecting childcare facility
staff and family members.
In addition, people with hepatitis A are most
likely to spread the disease to others during a
period extending from 14 days before developing
symptoms to one week after symptoms develop.
This means that a person may be infectious to
others before even realizing he or she is ill.
What is the treatment?
There is no treatment that cures hepatitis A.
However, there are two shots available to help
prevent illness in people exposed to patients with
hepatitis A. These protective shots – either
hepatitis A vaccine or Hepatitis A immune
globulin (IG) – must be given within two weeks
of a person’s exposure to hepatitis A in order for
it to be helpful. A person’s healthcare provider
and the New Hampshire Division of Public Health
Services, Bureau of Infectious Disease Control
will assist in making re commendations about
administering hepatitis A vaccine or IG to
contacts.
How can the spread of this disease be
prevented?
1. Hepatitis A vaccine is recommended for
children 12- 23 months. The Advisory
Committee on Immunization Practices
(ACIP), recommends immunizing children
against Hepatitis A.
2. The two dose series should be given at 12
and 18 months of age Children who are
not vaccinated by age 2 years can be
vaccinated at subsequent visits.
3. Wash hands thoroughly after using the
toilet.
4. Wash hands thoroughly after diapering
children.
5. Wash hands thoroughly before preparing
food.
HEPATITIS A (cont.)
Division of Public Health Services Disease Handbook for Childcare Providers
Bureau of Infectious Disease Control REVISED –January 2018
6. Clean toilet facilities thoroughly and wash
hands afterward.
7. Discourage children from putting non-
food items into their mouths since these
items may be a source of the virus.
Who should be excluded?
Persons with hepatitis A (or suspected
hepatitis A) should be excluded from daycare
centers, food-handling occupations, and direct
care of hospitalized and institutionalized
patients for one week after the onset of
symptoms (jaundice) or hepatitis A has been
ruled out. A Public Health Professional will
advise individuals regarding specific
recommendations.
Reportable?
Yes, hepatitis A is reportable by New
Hampshire law to the Division of Public
Health Services, Bureau of Infectious Disease
Control at (603) 271-4496.
It is important that cases associated with a
childcare center be reported as soon as
possible. A Public Health Professional will
give specific recommendations for
immunization of the people exposed.