Reporting and Infection Control
In the context of the current outbreak, any homeless person, IDU, or MSM with symptoms or signs consistent with hepatitis A infection should be immediately reported to DPH instead of waiting for anti-HAV IgM results. Immediate reporting allows the health department to interview cases on-site, which facilitates investigation and prevention of transmission if the patient tests positive. DPH also can facilitate expedited anti-HAV IgM testing through the DPH Public Health Laboratory, if needed. Importantly, homeless persons or persons using illicit drugs should not be discharged to the street because they may be lost to follow-up. If necessary, DPH can assist with finding housing for persons with suspected hepatitis A who are ready for discharge from the hospital.
For non-outbreak associated cases of hepatitis A, clinical providers should continue to report infected persons (defined by the presence of compatible symptoms or risk factors and presence of positive anti-HAV IgM) to DPH within one working day of receiving the laboratory results. See box below for reporting information.
DPH investigates all acute hepatitis A case reports to confirm infection and to identify and control the source of infection, and protect those who already have been exposed. DPH will attempt to identify and provide post-exposure prophylaxis (PEP) to persons who had close personal contact with the case such as household members or persons with intimate contact. For the homeless, this would include persons who are in the same encampment as a case. Hepatitis A illness occurring in a food handler is investigated urgently to assess the likelihood of transmission to facility patrons during the infectious period. A public notification might be considered if potentially exposed patrons can be identified and provided with PEP within two weeks of exposure.