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Hospital outbreak of hepatitis A: risk factors for spread
Insights
Hepatitis A outbreaks in hospitals can occur when patients are incontinent and in the early stages of infection. This poses a significant risk to healthcare workers, especially with factors promoting fecal-oral transmission.
Area of Science:
- Infectious Diseases
- Hepatology
- Epidemiology
Background:
- A pediatric patient with Down's syndrome and an imperforate anus requiring a colostomy was hospitalized for cardiac evaluation and surgical repair.
- The patient developed jaundice and serologic evidence of Hepatitis A infection.
Observation:
- Eight hospital personnel, including nurses, nursing assistants, and a physician, contracted Hepatitis A following direct contact with the patient.
- The patient exhibited fecal incontinence and was hospitalized during the incubation period of Hepatitis A, a time of maximal viral shedding.
Findings:
- Nosocomial transmission of Hepatitis A occurred from an index patient with fecal incontinence and pre-symptomatic infection.
- Factors such as fecal incontinence, infancy, mental retardation, and diarrhea can enhance the fecal-oral spread of Hepatitis A in healthcare settings.
Implications:
- Hospitalized patients in the prodromal stage of Hepatitis A infection represent a significant transmission risk to healthcare personnel.
- Vigilance and adherence to infection control protocols are crucial to prevent Hepatitis A outbreaks in hospitals, particularly in vulnerable patient populations.
Abstract:
A 34-month-old girl with Down's syndrome from the Marshall Islands was hospitalized in September, 1981, at Tripler Army Medical Center for evaluation of a heart murmur and definitive repair of an imperforate anus for which she had had a colostomy since birth. She became jaundiced and had serologic evidence of hepatitis A infection. Over the next month eight hospital personnel (four nurses, three nursing assistants and one physician) who had had direct contact with the patient became ill with hepatitis A. Our patient, like the index cases in five previous reports of nosocomial hepatitis A outbreaks, was incontinent of feces. In addition she was hospitalized during the incubation period before clinical illness when virus fecal excretion is likely to be maximal. Patients in the prodromal stage of hepatitis A infection who are hospitalized pose a significant risk to exposed hospital staff. This risk is enhanced if there are additional factors present which promote spread of disease by the fecal-oral route such as infancy, mental retardation, diarrhea and fecal incontinence.