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Groups at increased risk include international travelers, men who have sex with men, and injecting and non-injecting drug users. Another group at increased risk are persons who work with primates that are infected with hepatitis A. Persons with clotting-factor disorders may be at increased risk because of the administration of solvent-detergent-treated factor VIII and IX concentrates. Persons at increased risk for HAV infection, or complications of HAV infection should be routinely vaccinated. HAV Vaccine recommendations CHART
Persons traveling or working in countries with high or intermediate risk of hepatitis A should be vaccinated. Even though vaccinated persons are protected 4 weeks after receiving the first dose they need to return for a second dose 6 to 12 months later for long-term protection. Frequently outbreaks have been reported among this group. Cyclic outbreaks have occurred in urban areas in the United States, Canada, Europe, and Australia. In serologic surveys, anti-HAV-positive persons reported more frequent oral-anal contact, longer duration of homosexual activity, and a larger number of sexual partners than persons without serological evidence of HAV infection. More recently, outbreaks involving drug users have been reported in many communities in the Midwestern and western United States. This accounts for up to 30% of reported cases in these areas. Serologic surveys have shown that injecting-frug users have a higher anti-HAV seropositivity than the general population in the United States. Among injecting-drug users transmission likely occurs through percutaneous and fecal-oral routes. Persons with clotting-factor disorders who had received solvent-detergent-treated factor VIII concentrates reported outbreaks of hepatitis A in Europe during 1992-1993. Data from one serologic study in the United States, suggests that hemophilic patients might be at increased risk for infection. Persons working with Nonhuman Primates Outbreaks of hepatitis A have been reported among persons working with non-human primates that are susceptible to HAV infection included several Old World and New World species. Primates that were infected were those that had been born in the wild and not raised in captivity. Persons with Chronic Liver Disease Persons who have chronic liver disease are at an increased risk for fulminant hepatitis A although not at increased risk for HAV infection. Health-care workers and food handlers make up this group along with persons attending or working in a day care center or persons who work in liquid or solid waste management. Persons with chronic liver disease are not at increased risk for HAV but are at increased risk for fulminant hepatitis A if they become infected. Susceptible persons who have chronic liver disease or who are either waiting or have received a liver transplant should be vaccinated. HAV vaccination not routinely recommended CHART:
Outbreaks of hepatitis A is usually caused by transmission from adult patients with fecal incontinence to health-care workers. Neonatal intensive-care transmission has occasionally been reported because of infants acquiring infection from transfused blood and transmitting the virus to other infants and staff. Because the infection among children is usually mild or asymptomatic, outbreaks often are recognized only when the adult contact becomes ill. The infection is spread by poor hygiene among children who wear diapers and the handling of those diapers by staff. In day-care centers in which children are toilet trained, outbreaks rarely occur. These outbreaks of hepatitis A are usually associated with contamination of food during preparation by a HAV-infected food handler. Outbreaks associated with shellfish and raw produce that has been contaminated before reaching the food establishment have been increasing in recent years. Person working with liquid or solid waste Recently, two serologic surveys were conducted in the United States that compared the prevalence of anti-HAV among sewage workers to that among other municipal workers. Neither survey found a substantial increase in prevalence among sewage workers. There have been no reported work related instances of HAV transmission among sewage workers in the United States.
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