Hepatitis A and Pertussis Advisory for Health Care Providers

Hepatitis A Update

Hepatitis A continues to be of concern in our region with the illness being diagnosed in 28 Ada and Elmore county residents, including multiple food handlers, and 46 people statewide. Providers should continue to test patients with clinically compatible signs and symptoms and vaccinate susceptible adults and children.

Recommended testing for acute viral hepatitis includes hepatitis A IgM, hepatitis B core IgM, hepatitis B surface antigen, and hepatitis C antibody and liver function testing. Please note, hepatitis A total antibody does not distinguish acute infection from past infection or immunity, so it is not recommended. For more information about symptoms and laboratory testing please see our May 6, 2019 HAN at: hep-a-han-05-06-19.pdf

Prevention

Persons who have been recently exposed to hepatitis A virus who have not been previously vaccinated or who don’t know if they have been vaccinated should receive a dose of single antigen hepatitis A vaccine or immune globulin as soon as possible, but within two weeks of the exposure to prevent infection. Please note that Twinrix should not be used for post-exposure vaccination. More information regarding post exposure prophylaxis and when immune globulin is preferential to vaccine can be found at: https://www.cdc.gov/hepatitis/hav/havfaq.htm#protection. A listing of local food facility exposure dates can be found at: Viral Hepatitis

Pre-exposure vaccination is the best method to stop the spread of hepatitis A in a community-based outbreak. The hepatitis A vaccine is routinely recommended for children. It is recommended for adults wishing to obtain immunity or who are at higher risk for infection or severe disease. Adults in the high-risk group include:

• Persons experiencing homelessness
• Users of injection and non-injection drugs
• Men who have sex with men
• Persons with chronic liver disease
• Persons traveling to countries with moderate to high hepatitis A endemicity
• Others including persons having close contact with a newly arriving international adoptee, persons with clotting factor disorders, and persons who work with hepatitis A in a laboratory setting.

CDH is currently offering vaccine, at no cost to the patient (insurance may be billed), to people who are experiencing homelessness, users of injection or non-injection drugs, men who have sex with men, people who are uninsured or underinsured, and people who are contacts to a person with hepatitis A. Others not meeting these criteria may still receive vaccine at CDH, but will be charged for services. Patients may call 208-327-7400 to make an appointment. Patients may also search http://www.vaccinefinder.org for pharmacies and other locations providing the vaccine.

Pertussis Update

Since July 1, 2019, 24 pertussis cases have been reported among Ada and Elmore County residents. This includes multiple household clusters of illness. Roughly 60% of cases are in children and teens under the age of 18.

Some cases are being reported among vaccinated individuals and in many instances these people are exhibiting a milder cough without the classical “whoop”. Please consider testing for pertussis in patients with cough illness.

Laboratory Testing

Polymerase chain reaction (PCR) testing of a nasopharyngeal swab is optimal for testing within the first 4 weeks after cough onset. Serology should not be used unless the patient has been coughing longer than 3 weeks. Testing recommendations can be found at:
http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html

Prevention in the Household and Community

To stop the spread of disease, antibiotic treatment is recommended for the infected person and antibiotic prophylaxis is recommended for all household contacts. Azithromycin, clarithromycin, and erythromycin are all effective choices for both prophylaxis and treatment. Treatment information can be found at: https://www.cdc.gov/pertussis/clinical/treatment.html

Immunization continues to be an important part of the control for whooping cough, especially for families with infants. Immunization recommendations and schedules can be found on CDC’s website at: http://www.cdc.gov/vaccines/schedules/hcp/index.html

Additional Information and Reporting

For additional information or case reporting contact the Office of Communicable Disease Control at 208-327-8625. For immunization questions contact the CDHD Shot Line at 208-321-2229.