Raising Awareness of Hepatitis A in Workers’ Comp

| | Evidence Based Medicine

Dr Cortes Hepatitis A Article from Oct 2017
The California Department of Industrial Relations, Department of Workers’ Compensation (DWC) issued a News Release that encourages employers and workers to protect against Hepatitis A. This is in response to reported outbreaks in San Diego, Santa Cruz and Los Angeles counties. The outbreaks have primarily been connected to the homeless population, and public health workers at risk by caring for this population. Several health care workers in Los Angeles became infected. Health care providers, food service workers and shelter employees were urged to immediately get vaccinated to prevent infection.

As background, Hepatitis A is one of the five known hepatitis viruses (A, B, C, D, and E) that result in infectious inflammation of the liver. Although Hepatitis B and C are considered to result in more serious illness, Hepatitis A can also sometimes result in life threatening illness. While my background is as an orthopedic surgeon, and not an infectious disease specialist, I still want to raise awareness of what Hepatitis A is and communicate a few things people can do to protect themselves.

Hepatitis A is a highly contagious infectious disease. The infection is spread by coming into contact with objects or liquid contaminated by an infected person, or ingesting food or drinking water contaminated with infected feces. It can also be transmitted by sexual contact and with use of recreational drugs, whether injected or not. As a way to try to control the spread of the infection, cities with outbreaks have begun using bleach to sanitize streets that have become fecally contaminated by the homeless. One interesting fact is that humans are the only natural reservoir of the virus. No known insect or other animal can transmit the virus.

The good news is that Hepatitis A is generally not life threatening, with many cases having few or no symptoms. However, while extremely rare, acute liver failure can occur, especially in older people, and ultimately require a liver transplant. Severe cases can even result in death.

In many developing countries, 90 percent of children have been infected by age 10, and are immune in adulthood. A blood test can determine if you have an infection. Since the vaccine was introduced in the United States in 1992, the incidence of Hepatitis A has decreased by 90 percent.

The bad news is that if you contract Hepatitis A there is no cure, and infected individuals are encouraged to rest and take medications for fever, nausea, joint pain or diarrhea on an as-needed basis. In other words, in most instances the virus simply needs to run its course, which unfortunately, can sometimes take several months.  As stated previously, there is a vaccine for Hepatitis A, and experts recommend all children be vaccinated. A vaccination is recommended for adults travelling to certain international countries where Hepatitis A is common. A great source of information on Hepatitis A is the CDC Hepatitis A Fact Sheet. The vaccine is safe and effective. It is given as two shots, six months apart. Both shots are needed to achieve long-term protection.

According to the DWC News Release, common jobs with increased exposure include health care and laboratory work, emergency medical services, sanitation and janitorial, and homeless services and substance use treatment facilities. In the work environment, the best way to protect oneself is frequent hand washing, properly cooking food, and keeping work areas clean and sanitary. In addition, all employees should wear all required and recommended protective equipment and clothing.

The bottom line is that prevention is key to avoiding Hepatitis A. The best course of action for most people is to get the vaccine. After that, proper hygiene can further prevent infection and the spread of the disease.

Zenia Cortes, MD, Orthopedic Surgeon

Dr. Zenia Cortes brings her combined expertise in sports and orthopaedic medicine to UniMed Direct, along with insights from her experience in peer and utilization review.