Management
No specific treatment exists for acute hepatitis A illness. Supportive therapy is recommended. Hospitalization may be needed for patients who are dehydrated or have fulminant liver disease.
For persons experiencing homeless or who use illicit drugs, hospitalization can improve nutrition, reduce transmission risk, and provide linkages to services such as housing support. During the hepatitis A outbreak in San Diego during 2016–2018, PEH had 4-times higher odds of death compared with the general population.13
PEH with suspected or confirmed hepatitis A should not be discharged to the street, shelters, or any settings where they may transmit the infection to others. Under California Senate Bill 1152, hospitals are required to have written policies and procedures to ensure that patients experiencing homelessness have post-discharge plan that addresses their medical needs (see AFL 19-01). Discharge planning should identify a location with a private room and bathroom where the patient can isolate for the duration of their infectious period (i.e., 14 days after symptom onset) and arrange for transportation to that location.
Infected individuals should be instructed to wash their hands after using the bathroom and before handling food, especially during the first 2 weeks after symptom onset. Infected food handlers should be advised not to return to work until at least 2 weeks after symptom onset or 7 days after the onset of jaundice.
Reporting and Infection Control
Healthcare providers must report all patients with acute hepatitis A infection (defined as compatible symptoms or signs and positive anti-HAV IgM) to Public Health (Title 17, CCR, Section 2500). See box below for more detailed reporting information. In brief:
- Hepatitis A infection in patients experiencing homelessness should be reported to LAC DPH immediately upon receipt of a positive anti-HAV IgM result. Immediate reporting of PEH with acute hepatitis A is critical to control this outbreak. LAC DPH will attempt to interview the patient before they leave the facility to identify contacts who could benefit from post exposure prophylaxis (PEP).
- Patients with hepatitis A and stable housing must be reported within 1 working day of receiving the positive anti-HAV IgM result.
LAC DPH investigates all acute hepatitis A case reports to confirm infection, identify and control the source of infection, and protect those who already have been exposed. LAC DPH will attempt to identify and provide PEP to people who had close personal contact with the case such as household members or intimate contacts. For a case experiencing homelessness, this would include all residents and staff of a congregate setting such as a homeless shelter or all people living in the same encampment.
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 offered PEP within 2 weeks of exposure.