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Second case of hepatitis A exposure at Real Canadian Superstore, 1485 Lasalle Blvd., Sudbury

Advisory Alert

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Dear Colleagues:

Re: Second case of hepatitis A exposure at Real Canadian Superstore, 1485 Lasalle Blvd., Sudbury

I am writing to advise you that on January 1, 2020, Public Health Sudbury & Districts received a report of a second case of hepatitis A infection. This second case involves an employee who, along with the first case, worked at the deli department at the Real Canadian Superstore, Sudbury. Public Health reported on the first case on December 16, 2019.

This alert contains information on the following:

Post‐exposure prophylaxis (PEP)

PEP is highly recommended for individuals as soon as possible and up to 14 days since their last exposure to an infectious case or affected food items. We have determined that at-risk individuals are those who have consumed clerk-served deli meat or cheese, or meat and cheese from prepared deli trays purchased between November 27, 2019 and January 2, 2020. The public is being notified of this via local and social media.

“Clerk-served” refers to food products that are offered for sale unpackaged and then packaged by a clerk upon request by the consumer (for example, deli meat for sale at the deli counter that is sliced and packaged by a clerk).

In this incident, Public Health Sudbury & Districts is advising PEP for individuals who in the last 14 days consumed the affected food items as described above. These individuals should receive hepatitis A vaccine as soon as possible. In addition, some individuals may be eligible for immune globulin as follows:

Individuals who ate affected foods more than 14 days ago are advised to contact Public Health, monitor their health for signs and symptoms, and follow up with their health care provider if symptoms develop. People are also reminded to discard or return to point of purchase any uneaten affected food items.

Free vaccination clinics (no appointment necessary) will be held at Public Health Sudbury & Districts’ main office at 1300 Paris Street in Sudbury.

Clinics will also be available throughout Public Health Sudbury & Districts’ service area. If needed, additional clinic hours will be posted on our website.

Additionally, Public Health staff are available through dedicated phone lines to answer any inquiries regarding this incident. They can be contacted directly at 705.522.9200 (toll-free 1.866.522.9200).

Clinical presentation

Hepatitis A usually results in an acute self‐limiting illness which only rarely leads to fulminant hepatitis. 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.

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. Infants and the elderly are at greatest risk of mortality.

Transmission and communicability

Hepatitis A virus 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. Maximum communicability occurs during the latter part of the incubation period with peak levels in the 2 weeks before clinical illness. Communicability diminishes rapidly thereafter and ends shortly after the onset of jaundice. Cases are considered non-infectious 7 days after onset of jaundice although prolonged viral excretion up to 6 months has been documented in infants and children and immunocompromised individuals.

Testing, treatment, and exclusion

Laboratory detection of anti‐HAV IgM, in the absence of recent hepatitis A vaccination, confirms a case of hepatitis A. It is not recommended to perform anti-HAV IgM serum testing in the absence of symptoms of acute disease. 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. Individuals are generally excluded from work during their infectious period (14 days after symptom onset or 7 days after jaundice onset, which occurs earlier) if they work in high risk settings such as food handlers, childcare staff and attendees, and healthcare workers.

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 1.888.522.9200, ext. 301.

Sincerely,

Ariella Zbar, MD, CCFP, MPH, MBA, FRCPC
Associate Medical Officer of Health

This item was last modified on January 10, 2020