Cleanliness Is the First Step in Hepatitis A Protection

Cal/OSHA continues to warn employers and employees that the major outbreak of hepatitis A in parts of the state is ongoing and that California law requires that employers take measures to stop or reduce the spread of this highly contagious disease in the workplace. Most of the essential measures involve keeping a clean workplace and providing hand-washing facilities. Some public health specialists believe that vaccinations are essential in outbreak areas.

A Hardy Virus

Hepatitis A, B, and C infections can cause similar symptoms. Each affects the liver, but they are caused by different viruses that infect people in different ways. The hepatitis A virus is spread when the virus is ingested by mouth from contact with hands, objects, food, or drinks that are contaminated by the feces of an infected person; the disease can be transmitted even if the amount of the contaminant is microscopic in size.

Hepatitis A infections typically cause fever, a general ill feeling, yellowness of the skin, lack of appetite, and nausea. A severe hepatitis A infection is rare but is more common in people with underlying liver disease; such an infection can cause the liver to fail, which can lead to death. Infected people are most contagious during the 2 weeks before developing yellowness of the skin. The usual time period from exposure to showing symptoms is 15–50 days.

The hepatitis A virus is very hardy in the environment and can live for months outside the human body. It is difficult to kill, and most common cleaning fluids are not effective. Hand-washing with water and soap is needed, since waterless hand sanitizers are also not effective.

San Diego Is a Hot Spot

In California, the major outbreak is in San Diego. According to the California Department of Public Health (CDPH), as of March 23, 2018, the area has 586 reported cases, with 401 hospitalizations and 20 deaths. Santa Cruz, Los Angeles, and Monterey are among the other areas where cases have been reported.

The CDPH has not cited any single population group as the main carrier of the disease, but the CDPH notes that infected homeless people and those who use illicit drugs are particularly difficult to locate and treat. The main challenge for employers is that these individuals often use portable toilets at construction worksites.

Protective Measures

California law requires that employers maintain a clean and sanitary workplace; under U.S. OSHA regulations, employers have a general duty to provide their employees with a place of employment that is free from recognizable hazards that are causing or likely to cause death or serious harm to employees. Hepatitis A and any infectious disease that employees can contract from workplace surfaces are clearly among those hazards that employers must address.

In California, in addition to the clean workplace requirement, employers must follow other measures that can prevent the spread of hepatitis A. These requirements should be followed at any construction site in the country where outbreaks of hepatitis A or any infectious disease have occurred:

• Provide hand-washing facilities at construction sites. Employees should wash their hands with soap and water after using the toilet; touching any object that may have been contaminated with fecal matter; and before eating, drinking, or smoking.
• Provide appropriate personal protective equipment, and particularly gloves, to employees who clean up or otherwise come into contact with hazardous materials, such as fecal matter.  Employees should wash their hands after disposing of used gloves.
• Provide training. Employers should provide training to employees when a new hazard is presented in the workplace. For example, when a hepatitis A outbreak occurs that could affect employees, the employer should provide information and training to the employees on how hepatitis A is transmitted and how to prevent infection. Employees should follow the training they have received on how to prevent infection.
• Vaccinations. As part of their duty to correct unsafe or unhealthy conditions in the workplace, employers should ask their local health departments whether hepatitis A vaccinations should be offered to employees who are at increased risk and, if so, whether the local health department is available to assist. The hepatitis A vaccination consists of two shots 6 months apart.

A Centers for Disease Control and Prevention fact sheet on hepatitis A is at https://www.cdc.gov/hepatitis/hav/pdfs/hepageneralfactsheet.pdf.