Hepatitis A

What is Hepatitis A (Hep A)?

Hepatitis A is a virus that causes belly pain, body aches, nausea and lack of appetite, followed by a yellowing of the skin. A person becomes infected when they swallow virus that is in the feces (poop) of someone who has hepatitis A. The virus can travel on unwashed hands or on food touched by unwashed hands.

It usually takes about a month after infection to notice symptoms, although it can be as short as two days and as long as 50 days. Sick people can spread Hep A to others for two weeks before they feel sick, and for about 2 weeks after their symptoms start.

Children tend to have few or mild symptoms. The majority of adults will feel sick if they get hepatitis A and a few will have serious liver problems. Most people recover completely, but hepatitis A can cause serious illness and death.

How is hepatitis A spread?
Hepatitis A virus spreads very easily. When someone is sick with hepatitis A, the virus is released in their feces (poop). A person with the infection can spread the virus even before they start to feel sick. Hepatitis A virus is usually spread by:

  • Touching objects or eating food that someone with hepatitis A virus infection handled.
  • Having sex with someone who has a hepatitis A infection.

What are the symptoms?
Hepatitis A infection does not always cause symptoms. Adults are more likely to have symptoms than children. Symptoms include:

  • fever,
  • feeling very tired,
  • nausea or loss of appetite,
  • yellowing of the eyes (jaundice),
  • stomach pain and/or vomiting,
  • dark urine, pale stools, and diarrhea.

How can hepatitis A be prevented?

  • Wash hands with soap and water often, especially before eating or preparing food and after using the toilet or changing diapers. Hand sanitizers are not very effective against hepatitis A. Washing with soap and warm water is the only effective way to remove hepatitis A from your hands. 
  • Hepatitis A can be prevented by getting the hepatitis A vaccine. Even just one shot gives a lot of protection. For more information on the vaccine and where to get vaccinated, go to your local health provider or pharmacy. If you do not have insurance you can contact Clackamas County Health Centers at 503-655-8471.

Tell me About the Vaccine

The hepatitis A vaccine is safe and effective. It has been required for children at public schools in Oregon since 1995, but many adults may not have been vaccinated.

There are hepatitis A vaccines that includes two shots several months apart. There is also a combination hepatitis A and B vaccine called Twinrix that includes three doses. Most people will be protected after one dose, but it is recommended to finish all doses for full protection.

People who have had close contact with someone with hepatitis A are the most likely to get sick with Hepatitis A. We make those people highest priority for getting protective vaccine regardless of their ability to pay.

Our public health officials recommend any hepatitis A vaccine for any unhoused person who has not already received the vaccine.

In general, the Centers for Disease Control (CDC) recommends the hepatitis A vaccine for any adult who:

  • Has chronic liver disease
  • Uses drugs
  • Is a man who has sex with other men
  • Plans to travel to a country where hepatitis A is common
  • Wants to be protected.

Anyone who wants to be vaccinated can visit their primary care provider or contact their local pharmacy.

How Many Cases Have we Seen in Clackamas County?

Between 2009 and 2013, Oregon averaged about 20 cases per year. Clackamas County had a general average of less than 5 cases of confirmed hepatitis A per year over the past five years.

Health care providers and labs in Clackamas County must report hepatitis A cases to the local health department. In our Public Health Division, the Infectious Disease Control and Prevention team confirms each case and talks to anyone who has had close contact with the sick person. The team ensures anyone exposed to the virus is already protected by vaccine or helps them get a just-in-time shot to protect against getting sick.

Why is hepatitis A in the News?

In March 2017, the Centers for Disease Control and Prevention began investigating several hepatitis A cases in California among people experiencing homelessness or who use drugs. By Sept. 2017, San Diego County had reported 481 cases - the most of any other jurisdiction. The San Diego County Public Health Officer declared a local public health emergency due to the outbreak.

Because people travel along the Interstate 5 corridor, we have been monitoring the California outbreak closely, along with other hepatitis A outbreaks in Utah and Michigan.

What is the Public Health Division Doing to Prepare?

We have not received any reports of hepatitis A among people known to be experiencing homelessness or using drugs as of January 2018.

We have a strategy: identify outbreaks of hepatitis A when they happen; communicate prevention messages to those at risk and their service providers; and limit the spread of disease through vaccination and reminders about good handwashing.

We are working closely with the state, other counties, cities and service providers across the region to prepare for the possibility of an outbreak here.

What Cleaners Work Against Hepatitis A?

Hepatitis A is a hardy germ. Soiled blankets and clothing should be washed with soap and a cup of bleach. A bleach solution of 5000 ppm is the best choice to disinfect hard surfaces.

To prepare a 1: 10 Household Bleach Solution (using 5.25% bleach):

  • 62 ml (1/4 cup) household bleach + 562 ml (2 1/4 cups) water
  • 250 ml (1 cup) household bleach + 2250 ml (9 cups) water

If using any hospital grade disinfectant, make sure that it lists effectiveness against hepatitis A and use exactly as directed (here's a list of EPA approved cleaners).