Hepatitis A

1
Hepatitis (A B)

• A School Health Perspective

2
What is Hepatitis?

• Hepatitis is a viral infection causing liver
  inflammation.
• It is an acute, usually self-limited illness.

3
What are the signs and symptoms?

• Children with Hepatitis infection may show the
  following symptoms
• Fever
• Jaundice
• Tiredness
• Loss of appetite, nausea
• Children younger than 6 typically have few or no
  signs or symptoms

4
What are the incubation and contagious periods?

• Hepatitis A
• Incubation period 15 to 50 days with an average
  of 25 to 30 days.
• Contagious period Most infectious in the two
  weeks before onset of signs or symptoms the risk
  of transmission is minimal one week after onset
  of jaundice.
• Hepatitis B
• Incubation period 45 to 160 days with an average
  of 90 days.
• Contagious period As long as the virus is
  present in the blood of the infected person.

5
How is it spread?

• Hepatitis A Fecal-oral route
• Hepatitis B
• Blood/blood products, sexual contact
• Less commonly through saliva, contact with open
  sores, direct exposure to blood after injury,
  bites, scratches
• Virus can remain contagious on surfaces for 7 days

6
How can I control it?

• Vaccination for both Hepatitis A (2years) and
  Hepatitis B (shortly after birth)
• Hepatitis A
• Good hand washing (esp. in daycare/schools)
• Hepatitis B
• Standard universal precautions should be followed
  when blood or blood-contaminated fluids are
  handled.
• Sanitize surfaces with bleach solution
• Cover open wounds or sores.

7
What are the roles of the teacher and family?

• Report infections to staff in charge of decision
  making.
• Practice good hand washing and hygiene.
• Teach children to wash their hands at appropriate
  times.
• Clean and sanitize all surfaces often.
• When an outbreak of Hep A is noted in at least
  two children in a school/daycare in which
  children arent toilet trained, immune globulin
  is recommended for any non-immunized staff and
  children. Larger outbreaks may mean immune
  globulin for families too.
• Check records for immunizations.
• Practice universal precautions.

8
Exclude from group settings?

• Hepatitis A Yes
• Adults and children with the disease should be
  excluded for one week after onset of illness and
  referred to a health professional.
• Hepatitis B Yes
• A child with weeping sores, biting or scratching
  behavior, generalized dermatitis, and/or a child
  meeting other exclusion criteria

9
Conditions for Exclusion

• The illness prevents the child from comfortably
  participating in school activities.
• The illness results in greater need for care that
  the staff determine they can provide without
  compromising care for other children.
• The child appears severely ill, has a fever above
  101 (oral), 102 (rectal), or 100 (armpit), has
  diarrhea, blood in stool, vomits more than twice
  in 24 hours, abdominal pain for more than 2
  hours, mouth sores with drooling, rash with
  fever, Conjunctivitis, Tuberculosis, Impetigo,
  Strep, Head lice, Scabies, Chickenpox, Pertussis,
  Mumps, Measles, or Hepatitis A.

10
Readmit to Group Setting?

• Hepatitis A
• One week after onset of illness and after immune
  globulin has been given.
• When the child is able to participate and staff
  determine they can care for the child.
• Hepatitis B
• When skin lesions are dry or covered.
• When the child is cleared to return by a health
  professional.
• When the child is able to participate and staff
  determine they can care for the child.

11
Hepatitis in Louisiana

• 8 Cases of Hepatitis A in 2006
• 30 Cases of Hepatitis B in 2006

12
Hepatitis Ouachita Parish

• For Louisiana in 2002, the incidence rate of
  hepatitis A was 2.0 per 100,000 population.
• In 2002, Louisiana had a rate of 2.9 cases of
  acute hepatitis B per 100,000 population.
• In 2002, Louisiana had a rate of 2.9 cases of
  acute hepatitis C per 100,000 population.

13
Hepatitis Prevention in La.

• Department of Health and Hospitals
• Hepatitis A
• Hepatitis B
• Hepatitis C