Hepatitis A exposure at Casey’s Bar & Grill, 1070 Kingsway Boulevard, Sudbury

Advisory Alert

January 29, 2015

*Cette information est seulement disponible en anglais.

I am writing to advise you that on January 28, 2015 the Sudbury & District Health Unit received a report of a confirmed case of hepatitis A infection in a food handler who works at Casey’s Bar & Grill located at 1070 Kingsway Boulevard in Sudbury, Ontario. The employee was involved in various aspects of food preparation for patrons of the restaurant who ate there between Jan 1 and Jan 20th, 2015. This advisory provides you with information on the clinical management of cases of hepatitis A infection as well as post‐exposure efforts being recommended for persons who have potentially been exposed to the infection.

Post‐exposure Prophylaxis (PEP) Considerations

Ideally, PEP should be offered with 14 days of last exposure to the case. The Sudbury & District Health Unit recommends that all individuals who ate at this restaurant between January 15, 2015 and January 20, 2015 should receive hepatitis A vaccine as soon as possible. In addition, healthy individuals 50 years of age and older will be eligible to receive immune globulin. Individuals who ate at this restaurant between January 1 and January 14 are advised to watch for signs and symptoms of infection and seek medical evaluations should symptoms of hepatitis A develop.

Several immunization clinics have been scheduled by public health to offer PEP to eligible persons. Clinics will be held at the Sudbury & District Health Unit main office, 1300 Paris Street at the dates and times noted below:

• Friday, January 30, 2015 from 9:00 a.m. to 9:00 p.m.
• Saturday, January 31, 2015 from 9:00 a.m. to 9:00 p.m.
• Sunday, February 1, 2015 from 9:00 a.m. to 9:00 p.m.
• Monday, February 2, 2015 from 9:00 a.m. to 9:00 p.m.

Vaccine is also available through Health Unit offices located in Espanola, Mindemoya and Chapleau. Media outlets, neighbouring health units, the Ministry of Health and Long‐Term Care and Public Health Ontario have all been advised of this situation.

Additionally, health unit staff are available through dedicated phone lines to answer any inquiries regarding the virus or the vaccine. You can contact them directly at 705.522.9200, ext. 1040.

Clinical Presentation

Hepatitis A usually results in an acute self‐limiting illness which only rarely leads to fulminant hepatitis. Those with underlying liver disease especially from chronic  hepatitis C are at greatest risk of poor outcomes. Hospitalization may occur in up to 20% of those who are symptomatic. Children are usually asymptomatic with jaundice developing in less than 10% of children age 6 years and under. Adults typically present with more severe disease, characterized by 1 to 7 days of prodrome then abrupt onset of fever, malaise, anorexia, nausea and abdominal pain, often followed by jaundice. Infants and the elderly are at greatest risk of mortality.

Transmission and communicability

Hepatitis A virus (HAV) infection is transmitted primarily by the fecal‐oral route, through direct contact with infected people or indirectly through ingestion of contaminated water or foods. Transmission may also occur through sexual activities that include direct or indirect oral‐anal contact, but not through exposure to saliva, semen or urine.
The incubation period ranges from 15 to 50 days with an average of 30 days. Individuals are infectious throughout the incubation period and for about 7 days after jaundice appears.

Testing, Treatment and Exclusion

Laboratory detection of anti‐HAV IgM, in the absence of recent hepatitis A vaccination, confirms a case of hepatitis A. Serum should be collected in a red top tube and submitted for anti‐HAV IgM (antibody) and anti‐HAV Total (IgG and IgM combined antibody) testing. Treatment is supportive only.

Exclude individuals such as food handlers, childcare staff and attendees, and healthcare workers from high‐risk settings for 14 days after onset of symptoms, or 7 days after onset of jaundice, whichever comes earlier.

Reporting

Under the Health Protection and Promotion Act, both suspected and confirmed cases of hepatitis A must be reported to the Medical Officer of Health. Laboratory‐confirmed cases should be reported immediately to Public Health by phone as soon as identified. Please report to 1.866.522.9200, ext. 301.

For more detailed information on hepatitis A refer to the MOHLTC Infectious Disease Protocol, Appendix A: Disease‐Specific Chapters, December 2014. A full copy can be accessed at http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/infdispro.aspx.

This item was last modified on September 9, 2016