Name: Spokane Regional Health District
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What is hepatitis A (hep A)?

Hep A is a highly contagious virus that can cause severe liver disease. Some people may not have symptoms while most have the symptoms described below. A small percentage of people can get liver failure from hep A infection (this is more common in people with other liver complications like cirrhosis or hepatitis C infection).

Hep A has been spreading in the United States among people living homeless, especially in crowded encampments without adequate sanitation. Several people experiencing homelessness in Spokane have been diagnosed with hep A since spring 2019.

What are the symptoms of hep A?

Some people with hep A do not have any symptoms. Others may have yellowing of the skin and eyes (jaundice), dark urine, pale stools, nausea, vomiting, diarrhea, abdominal pain, fatigue and loss of appetite. Some people may be so sick they need to be hospitalized.

How does hep A spread?

Hep A is spread through the stool of an infected person. If they haven’t washed their hands after using the restroom, microscopic amounts of stool can contaminate things they touch. People can then become infected by touching objects or eating food that someone with hep A handled. People can also get sick through close personal contact with someone infected with hep A, such as having sex or sharing needles or other items used to take drugs. Casual contact in the setting of most workplaces that interact with the homeless community are not at any significant increased risk of getting hep A.

Who is at risk of getting hep A?

Anyone can get hep A, but you are at increased risk if you are living homeless and/or use recreational drugs, live with someone who has hep A, are a man who has sex with men, has sexual contact with someone with hep A, or travel or live in countries where hep A is common.

Risk for getting hep A is associated with poor handwashing related to working with people who may be sick with hep A. Appropriate use of gloves and regular handwashing greatly reduces any risk in the healthcare or custodial work settings.

How is hep A prevented?

There is a safe and effective vaccine to prevent hep A. It is usually given in two doses six months apart. After two doses it is nearly 100 percent effective. It is recommended for:

All children at age 1 year
People with direct contact with others who have hep A
Any person wishing to obtain immunity (protection)
Users of recreational drugs, whether injected or not
People with unstable housing or experiencing homelessness
Travelers to countries where hep A is common
Family and caregivers of adoptees from countries where hep A is common
Men who have sex with men
People with chronic or long-term liver disease, including hepatitis B and C
People with clotting-factor disorders

Hep A can also be prevented by effective handwashing. Effective handwashing is using warm water and soap and scrubbing for 15–20 seconds. Hands should be washed after using the restroom, before preparing or serving food, before eating, after touching potentially contaminated surfaces, after cleaning potentially contaminated surfaces (i.e., restrooms), and before using recreational drugs.

What can people serving individuals living homeless do to prevent the spread of hep A?

Remind employees and volunteers that if they or anyone in their household have fever, jaundice, stomach pain, nausea, vomiting or diarrhea, they need to be excluded from food preparation or cleaning activities.
Remind employees and volunteers of the importance of regular handwashing with soap and warm water, especially after using the restroom, before preparing or serving food, before eating, and after touching potentially contaminated surfaces.
Coordinate with your occupational health provider to determine if hep A vaccine should be recommended to at-risk employees and volunteers.
For cleaning bathrooms: Maintain routine and consistent cleaning of bathrooms for employees and the public using a bleach disinfectant with a ratio of 1 2/3 cup bleach in 1 gallon of water. Due to the high bleach concentration in this mix, rinse surfaces with water after one minute of contact time and wear gloves while cleaning. Ensure good ventilation while applying and drying.
For employees and volunteers in physical contact with others, especially those at risk for hep A, wear disposable gloves and wash hands after each encounter.

How can shelters for people living homeless be kept safe and clean?

Make handwashing accessible and next to food prep areas and toilets.
Always stock handwashing stations with soap and water. Soap and water work best, but if not available, provide 70 percent alcohol hand gel.
Encourage handwashing among residents, especially before eating and after using the toilet.
Clean toileting areas at least daily including all surfaces, handles and floors.
Stock toilet paper and cleaning supplies (gloves, bleach or bleach wipes, garbage bags) for cleaning toilets.
Ensure sharps containers are available.
Anyone who might have hep A should NOT prepare or serve food to others.

What should I do if I think I have hep A?

If you have symptoms consistent with hep A, you should seek consultation from your healthcare provider. Your healthcare provider can run tests for hep A and provide supportive care. It is important to stay home from work while you are sick to protect others. It is also important to wash your hands often, especially after using the restroom, and not prepare or serve food while you are sick.

If you think you may have acquired hep A during your work or volunteer time, please contact your manager or human resources office.