Hepatitis A Virus: Essential Knowledge and a Novel Identify-Isolate-Inform Tool for Frontline Healthcare Providers

Kristi L. Koenig, MD; Siri Shastry, MD; Michael J. Burns, MD


Western J Emerg Med. 2017;18(6):1000-1007. 

In This Article

Transmission and Personal Protective Equipment

The fecal-oral route is the primary mechanism of transmission for HAV. Transmission typically occurs via close person-to-person contact (sexual or household) or via exposure to food or water contaminated by human feces, even in minute amounts. For all practical purposes, humans are the only host for the HAV virus. The incubation period for HAV is about 28 days on average, but can range from 15–50 days. Patients are considered contagious for both two weeks prior to, and up to 1–2 weeks after symptom onset.[41] Rarely, the virus can be excreted in the stool for weeks to months, especially in immunocompromised children. The virus can be contracted from cooked food if the food is either not heated to an adequately high temperature (>185° F, >85° C) or if it is contaminated after being cooked.[43] Healthcare providers treating potentially infected patients should observe standard precautions including using gloves and handwashing with soap and warm water. Importantly, HAV virus may not be inactivated by alcohol-based hand rubs.

Infectious virus may remain viable on surfaces for months and is resistant to many chemical agents, but is killed by household bleach (hypochlorite). Chlorine bleach solution should be used to disinfect frequently touched surfaces. Some outbreak cities have initiated power-washing of sidewalks and street areas with a bleach and chlorine solution in areas with a high density of homeless populations. Gown and gloves should be worn prior to disinfecting and cleaning affected areas. Further isolation measures are not routinely recommended.[45,46]