Status:
Active
Health alert:
170014
Date Issued:
23 Nov 2017
Issued by:
Dr Brett Sutton, Deputy Chief Health Officer, Victoria
Issued to:
Health professionals

Key messages

  • An outbreak of hepatitis A has been identified in Victoria, with ten confirmed outbreak cases. All confirmed cases are adults, many of who are MSM or report male-to-male sexual activity and have not travelled overseas.
  • Outbreaks of hepatitis A can occur through person-to-person transmission, particularly sexual transmission, which includes but is not limited to MSM. Outbreaks can also occur through consumption of contaminated food\water.
  • Offer hepatitis A vaccine to MSM and people in other risk groups. Hepatitis A vaccination is strongly recommended for all MSM, and is also recommended for all travellers to countries where hepatitis A is endemic.
  • Consider hepatitis A infection in patients presenting with a compatible clinical illness who are MSM or have other risk factors, and take blood for serology (IgM). Sexual activity should be avoided whilst results are pending.
  • Notify suspected cases of acute viral hepatitis to the Department of Health and Human Services by calling 1300 651 160, without waiting for serology results. This will help with instituting immediate precautionary infection control measures. Early notification also helps with timely post-exposure prophylaxis for contacts, once infection is confirmed.

What is the issue?

An outbreak of hepatitis A has been identified in Victoria, with ten confirmed outbreak cases. An initial case was identified in March 2017, and a rapid increase has occurred in the last six to eight weeks. All cases are adults with most reporting men who have sex with men (MSM) sexual activity, and many have not travelled overseas. A number of cases have visited sex on premises venues.

Detailed laboratory analysis has found that the strains of hepatitis A virus in this outbreak are very similar to a currently circulating strain in Europe. Since mid-2016, several hepatitis A outbreaks associated with MSM sexual activity have been reported in many European countries and in the United States of America. A similar outbreak has been reported earlier in 2017 in New South Wales.

Who is at risk of getting hepatitis A?

In this outbreak, adults who identify as MSM appear to be at highest risk, however local transmission to others has also been found. High risk groups for hepatitis A infection include:

  • men who have sex with men, particularly if they have recently travelled to Europe or the United States of America. Sixteen European countries have been associated with recent outbreaks of hepatitis A infection linked to MSM (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, the Netherlands, Norway, Portugal, Slovenia, Spain, Sweden and the United Kingdom) and several states in the USA have also reported an increase in hepatitis A cases
  • people who have been assessed by public health as close contacts of people with hepatitis A infection, including sexual contacts
  • people whose lifestyle puts them at increased risk of acquiring hepatitis A, including sex industry workers and persons who inject drugs
  • travellers aged one year or more who are travelling to hepatitis A endemic areas
  • people whose occupation put them at increased risk of acquiring hepatitis A, including staff working in early childhood education and care, carers of persons with developmental disabilities and plumbers or sewage workers
  • with developmental disabilities, chronic liver disease, liver solid organ transplant recipients and those chronically infected with either hepatitis B or hepatitis C viruses.

Symptoms and transmission

The incubation period for hepatitis A infection is between 15 to 50 days with an average of 28 days.

Transmission is through the faecal-oral route and can occur when traces of virus are ingested, usually via contaminated hands, objects, water or food. People are infectious two weeks prior to symptom onset until around one week after the onset of jaundice or dark urine. This means people may transmit the infection to others for an extended period even before becoming unwell.

Initial symptoms typically include fever, malaise, anorexia, nausea, vomiting and abdominal discomfort, followed a few days later by dark urine and jaundice. Prodromal symptoms may mimic influenza, so hepatitis A should be considered in the differential diagnosis for patients presenting with an influenza-like illness who have recent overseas travel to a high-risk country and/or MSM sexual activity as risk factors

Symptoms usually last several weeks although convalescence may sometimes be prolonged.

Young children under 5 years of age infected with hepatitis A virus may have a mild illness with few or no symptoms, but can still transmit infection to others.

Collect blood for serology (IgM) in any patients presenting with symptoms consistent with hepatitis A. If hepatitis A is confirmed, further testing will be undertaken by the public health reference laboratory, which is the Victorian Infectious Diseases Reference Laboratory.

Prevention and treatment

Advice for patients

Consistent with the Australian Immunisation Handbook, hepatitis A vaccination is recommended for the following high risk groups:

  • all MSM and people whose lifestyle puts them at increased risk of acquiring hepatitis A, including sex industry workers and persons who inject drugs
  • travellers aged one year or more who are travelling to hepatitis A endemic areas
  • people whose occupation put them at increased risk of acquiring hepatitis A, including staff working in early childhood education and care, carers of persons with developmental disabilities and plumbers or sewage workers
  • people with developmental disabilities, chronic liver disease, liver solid organ transplant recipients and those chronically infected with either hepatitis B or hepatitis C viruses

People suspected to have hepatitis A should not prepare food or drink or share utensils, provide personal care for others, share linen or towels, have sex or donate blood until infection is excluded.

Advise MSM against engaging in high risk sexual practices, including attending sex on premises venues, as such practices may increase the potential for transmission.

Advice for health professionals

  • Offer hepatitis A vaccine to MSM and people in other risk groups.
  • If your patient presents with symptoms compatible with hepatitis, include a request for serology (IgM) for hepatitis A, in addition to usual tests.
  • While waiting for results of hepatitis A testing, advise your patient to avoid sexual activity, and advise your patient to avoid work as a food handler, as a child care worker and as a health care worker. They should also not prepare food for others during this time.
  • If hepatitis A is confirmed, your patient should avoid any sexual activity, and should not prepare food or drink or share utensils, nor provide personal care for others, share linen or towels, or donate blood until one week after the onset of jaundice, or if no jaundice was present, two weeks after the onset of symptoms.
  • If you suspect acute viral hepatitis, notify immediately by calling 1300 651 160. This will assist with patient assessment, consideration of public health control measures and will and enable rapid post-exposure prophylaxis for close contacts.

More information

Clinical information

Department of Health and Human Services disease information and advice - Hepatitis A

Consumer information

Better Health Channel - Hepatitis A https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hepatitis-a

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