Health Professionals Update – Vol. 18, No. 32

From:
Nicholas Brandon, MD, MA, MSc, CCFP, FRCPC, Associate Medical Officer of Health

In this issue

• Alert: Possible hepatitis A exposure in Peel
• Hepatitis A is a disease of public health significance and is reportable to public health
• Reminder: Ordering hepatitis A vaccine for post-exposure prophylaxis (PEP)

Key messages

• A Peel resident was recently diagnosed with hepatitis A following international travel.
• Post-exposure prophylaxis (PEP) may be recommended for close contacts within 14 days of exposure.
• Health care providers can order publicly funded hepatitis A vaccine for PEP.
• Follow the Public Health Ontario Laboratory (PHOL) instructions when testing for acute hepatitis A infection, and for investigations of recent exposures and outbreaks.
• Report clinical diagnoses of hepatitis A to Peel Public Health by calling 905-799-7700.

Alert: possible hepatitis A exposure in Peel

A Peel resident has recently tested positive for hepatitis A, leading to potential exposure to hepatitis A virus in a child care centre in Peel and a workplace in Halton. The infection was likely acquired during international travel to an endemic area. The risk of transmission is low, however individuals who have been identified by Peel Public Health as close contacts have been notified and have been encouraged to:

• Get the hepatitis A vaccine for post-exposure prophylaxis within 14 days of exposure
• Monitor for signs and symptoms until late January 2026
• See their health care provider if they develop symptoms (jaundice, dark urine or pale feces)

Close contacts may contact their health care provider for advice or to request vaccine for post-exposure prophylaxis (PEP).

Hepatitis A is a disease of public health significance

Report clinical diagnoses of hepatitis A to Peel Public Health by calling 905-799-7700. This will enable prompt follow up with the case and coordination of post-exposure prophylaxis for eligible patients.

Clinical features

• Consider hepatitis A in patients with compatible symptoms including fever, malaise, loss of appetite, nausea and vomiting, dark urine, and abdominal pain followed by jaundice or elevated aminotransferase levels.
• Symptom onset is generally 28 to 30 days after exposure (but can range from 15 to 50 days).
• Infection is typically self-limiting, though severe cases can last several months.

Transmission

• Hepatitis A is most frequently transmitted by the fecal-oral route or through contaminated food or water.
• Generally, the risk of acquiring hepatitis A in Canada is low. People are at higher risk if they visit, live or work in countries where hepatitis A is common.

Testing

• Testing for hepatitis A serology may be indicated for the work-up of patients with suspected acute viral hepatitis, to determine immune status (following recovery from natural infection or as a result of immunization), or as part of an epidemiologic investigation (e.g., outbreak investigation).
• If hepatitis A infection is suspected, please order both IgG and IgM serology by selecting “immune status” AND “acute infection for hepatitis A” on the PHO General Test Requisition Form (publichealthontario.ca).

Reminder: Ordering hepatitis A vaccine for PEP

Health care providers can order the hepatitis A vaccine for individuals that received instructions from Peel Public Health to receive hepatitis A post-exposure prophylaxis by completing this requisition form and submitting by fax to 905-565-9874.

Note: Immune globulin (Ig) is not available at Peel Public Health. Individuals eligible for Ig would need a referral to a hospital emergency department along with a note requesting Ig administration.

For more information about hepatitis A PEP refer to the Canadian Immunization Guide.

Travel precautions

Individuals travelling to parts of the world where hepatitis A is more common, are recommended to obtain the hepatitis A vaccine, or the combination hepatitis A and B vaccine prior to travel. Areas of the world where hepatitis A is more common includes Africa, South America, the Middle East, Central America, the Indian subcontinent, particularly, India, Nepal, Pakistan and Bangladesh and the rest of Asia (except Japan). Hepatitis A vaccines for the purpose of travel are not publicly funded.

Contact us

The Health Professionals Update (HPU) is distributed to physician offices in Peel region via fax or email. Share this update with other health professionals in your clinic.

More information:

• Review past HPUs.
• Subscribe to HPU emails.
• For questions about this update, email us.