Lauren M. Weil
Texas Department of State Health Services, USA
Title: Hepatitis A Health Care-Associated Outbreak – Texas, USA, 2015
Biography
Biography: Lauren M. Weil
Abstract
August, 2015, the Texas Department of State Health Services received notification from two local health departments of confirmed hepatitis A virus (HAV) infections in two nurses (patients A and B) who worked for the same pediatric home health care agency. Symptom onset occurred within four days of each other and suggested a common source exposure. Interviews were conducted with the management of the home health care agency and with patients A and B. The goal was to identify contacts, offer PEP, and identify the exposure source. Patients A and B cared for 12 children during their infectious periods; they had one patient in common, and no other common exposures were identified. The shared patient was a hepatitis A-vaccinated pediatric transplant recipient. Contacts included 12 pediatric patients (2 under-vaccinated against HAV), their families, and other nursing staff (31 of 42 unvaccinated against HAV) assigned to the 12 children. Contacts were interviewed, offered PEP, and monitored for symptoms. Detectable HAV RNA with genetically identical sequences was confirmed in serum specimens from patients A and B and their shared patient (patient C). Further investigation identified a third HAV positive nurse (patient D) who cared for patient C in an inpatient setting. Health care transmission of hepatitis A is uncommon and usually occurs when the source patient is fecally incontinent or has diarrhea and the infection is undiagnosed. Undiagnosed HAV infections maybe particularly prevalent in patients ≤5 years of age, who typically are asymptomatic, or in immunocompromised patients of any age.