Increase in hepatitis A
South Australia has seen an increase in hepatitis A cases, with three reported in the past week and a total of ten notifications in 2017, compared to seven in 2016. Hepatitis A is usually acquired overseas, but in 2017 six cases have occurred locally and one case interstate. From mid-2017 a large increase in locally acquired cases in men who have sex with men has been observed in New South Wales and Victoria. Several cases in South Australia have involved men who have sex with men.
Hepatitis A is spread through person-to-person transmission, including sexual activity, and through contaminated food and water. The incubation period is 15 to 50 days. Patients frequently experience fever, malaise, anorexia, right upper quadrant pain and nausea, followed a few days later by dark urine and jaundice. Cases are infectious for two weeks before to seven days after the onset of jaundice. There is no specific treatment and most cases fully recover, but ongoing monitoring is required as rarely complications including fulminant hepatitis can occur.
Medical practitioners are advised to:
- be alert for possible cases of hepatitis A in symptomatic individuals, request an urgent hepatitis A IgM (and IgG) for such cases, and consider hospitalisation if unwell
- advise symptomatic patients to avoid preparing food or providing personal care for others, and avoid sex or blood donation until no longer infectious
- initiate contact precautions for suspected or confirmed cases in healthcare facilities
- notify any suspected or confirmed cases to the Communicable Disease Control Branch (CDCB) on 1300 232 272.
Medical practitioners should offer hepatitis A vaccination to individuals at high risk, including:
- men who have sex with men
- people who use intravenous drugs
- people with chronic liver disease
- those with an occupational risk (e.g. sewerage workers, childcare workers)
- travellers to hepatitis A endemic areas and countries with current hepatitis A outbreaks
- Aboriginal and Torres Strait Islander children (included in the National Immunisation Program).
Recommend reducing hepatitis A exposure through safe sex practices including the use of condoms, and by hand washing after toileting, before eating or preparing food, after handling condoms and after sex.
The CDCB will follow up all notified hepatitis A cases and provide vaccine and/or normal human immunoglobulin (NHIG) to contacts exposed during the infectious period where indicated. Vaccine should be given within two weeks of exposure to the case.
For further information on immunisation see the Australian Immunisation Handbook: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home
For a fact sheet on hepatitis A for the public see: http://www.sahealth.sa.gov.au/youvegotwhat
For a video about vaccination in men who have sex with men see: https://www.youtube.com/watch?v=YOziZ6zdHHQ