410 Ind. Admin. Code 1-2.5-104

Current through May 29, 2024

Section 410 IAC 1-2.5-104 - Hepatitis, viral, type A; specific control measures

Authority: IC 16-19-3-4; IC 16-41-2-1

Affected: IC 16-41-2; IC 16-41-9

Sec. 104.

The specific control measures for hepatitis, viral, type A (infectious agent: hepatitis A virus) are as follows:

(1) An investigation by the local health officer shall meet the following conditions:

(A) Be performed immediately.

(B) Include a history of the following prior to symptom onset:

(i) Food and drink consumption.

(ii) Exposure to undercooked food items.

(iii) Domestic and international travel.

(iv) Sexual exposure during the fifteen (15) to fifty (50) day period prior to the onset of illness.

(C) Determine if the case is part of an outbreak.

(D) Determine if the case is a:

(i) food employee;

(ii) daycare worker;

(iii) health care worker; or

(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.

(E) Determine if the case is a contact of a food employee serving a highly susceptible population.

(F) If a commercial food product or restaurant is suspected, the local health officer shall initiate active surveillance immediately to identify additional cases.

(G) Determine the infectious period, which is defined as from seven (7) days before to fourteen (14) days after the onset of symptoms if no jaundice occurred; otherwise, the infectious period is defined as from fourteen (14) days prior to seven (7) days after the onset of jaundice.

(H) Prepare a list of all contacts during the infectious period and work schedules or school attendance records, or both, during the infectious period.

(2) In general, hospitalization is not required for patients with uncomplicated acute hepatitis A. When hospitalization is necessary, contact precautions are recommended in addition to standard precautions for diapered and incontinent patients for at least one (1) week after onset of symptoms. For others, the following guidelines apply:

(A) Cases who are food employees shall abide by the following criteria:

(i) Exclude from employment involving food handling if the case meets at least one (1) of the following criteria:

(AA) Is jaundiced and the onset of jaundice occurred within the last seven (7) calendar days, unless the food employee provides to the person in charge written medical documentation from a health practitioner specifying that the jaundice is not caused by hepatitis A virus or other fecal-orally transmitted infection.

(BB) Diagnosed with an infection from hepatitis A virus within fourteen (14) calendar days from the onset of any illness symptoms, or within seven (7) calendar days of the onset of jaundice.

(CC) Diagnosed with an infection from hepatitis A virus without developing symptoms.

(ii) Retain the exclusion until all of the following criteria are met:

(AA) The conclusion of the infectious period determined by the local health officer.

(BB) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.

(CC) The local health officer has discussed the following topics with the employer:

(aa) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.

(bb) The availability of required proper hand washing facilities for employees.

(cc) The correction of any observed lapses in hygienic measures by employees.

(DD) The local health officer has determined at least one (1) of the following occurs:

(aa) The employee has been asymptomatic for at least twenty-four (24) hours.

(bb) The food employee has been jaundiced for more than seven (7) calendar days.

(cc) The anicteric food employee has been symptomatic with symptoms other than jaundice for more than fourteen (14) calendar days.

(dd) The food employee provides to the person in charge written medical documentation from a health practitioner stating that the food employee is free of hepatitis A virus infection.

(B) Cases employed as daycare workers, health care workers, or in similar positions shall be excluded from employment involving food handling and direct care of children or hospitalized or institutionalized patients until all of the following have occurred:

(i) The conclusion of the infectious period determined by the local health officer.

(ii) The local health officer has determined the employee has been asymptomatic for at least twenty-four (24) hours.

(iii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.

(iv) The local health officer has discussed the following topics with the employer:

(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.

(BB) The availability of required proper hand washing facilities for employees.

(CC) The correction of any observed lapses in hygienic measures by employees.

(C) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:

(i) The conclusion of the infectious period determined by the local health officer.

(ii) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.

(iii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.

(iv) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:

(AA) for proper hand washing procedures and other infection control practices; and

(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.

(D) A case contact who is a food employee in a food establishment serving a highly susceptible population must abide by the following criteria:

(i) Restrict the contact if the contact meets one (1) of the following criteria:

(AA) Attended or worked in a setting of a confirmed disease outbreak of hepatitis A virus within the past thirty (30) days of last exposure.

(BB) Lives in the same household as, and has knowledge about, an individual who works in or attends a setting where there is a confirmed disease outbreak of hepatitis A virus within the past thirty (30) days of last exposure.

(CC) Lives in the same household as, and has knowledge about, an individual diagnosed with an illness caused by hepatitis A virus within the past thirty (30) days of last exposure.

(DD) Consumed food prepared by a person infected with hepatitis A virus within the past thirty (30) days of last exposure.

(EE) Consumed or prepared food implicated in a confirmed disease outbreak of hepatitis A virus within the past thirty (30) days of last exposure.

(ii) Reinstate the food employee who was restricted as specified in item (i) when all of the following have occurred:

(AA) The food employee receives additional training about the following:

(aa) Hepatitis A symptoms and preventing the transmission of infection.

(bb) Proper hand washing procedures.

(cc) Protecting ready-to-eat food from contamination introduced by bare hand contact.

(BB) At least one (1) of the following has occurred:

(aa) The food employee is immune to hepatitis A virus infection because of a prior illness from hepatitis A.

(bb) The food employee is immune to hepatitis A virus infection because of vaccination against hepatitis A.

(cc) The food employee is immune to hepatitis A virus infection because of immune globulin (IG) administration.

(dd) More than thirty (30) calendar days have passed since the last day the food employee was potentially exposed.

(ee) More than thirty (30) calendar days have passed since the food employee's household contact became jaundiced.

(ff) The food employee does not use an alternative procedure that allows bare hand contact with ready-to-eat food until at least thirty (30) days after the potential exposure.

(3) Sanitary disposal of feces, vomitus, and blood is required. Disposal through the sanitary system is acceptable.

(4) Quarantine is not required.

(5) People who have been exposed to HAV and previously have not received HAV vaccine should receive a single dose of single-antigen HAV vaccine or IG as soon as possible, but, to be effective, within two (2) weeks after the last exposure. Previously unvaccinated individuals who should receive postexposure prophylaxis include the following:

(A) Individuals with close personal contacts, such as household and sexual contacts (serologic testing of contacts is not recommended).

(B) Newborn infants of HAV-infected mothers if the mother's symptoms began between two (2) weeks before and one (1) week after delivery.

(C) Daycare or preschool workers, daycare or preschool attendees, and their household contacts or any sexual contacts.

(D) Schoolroom exposure generally does not pose an appreciable risk of infection, and postexposure prophylaxis is not indicated when a single case occurs; however, postexposure prophylaxis for unimmunized people who have close contact with the index patient if transmission within the school setting is documented.

(E) Health care-associated HAV in an identified outbreak for people in close contact with infected patients.

(F) If a food employee is diagnosed with hepatitis A, HAV vaccine or IG should be provided to other food employees at the same establishment unless the food employee is immune due to vaccination or past infection. Any susceptible food employee who refuses prophylaxis is to be restricted from working with:

(i) exposed food;

(ii) clean equipment, utensils, and linens; and

(iii) unwrapped single-service and single-use articles; for fifty (50) days.

(G) Food establishment patrons who ate in the establishment where hepatitis A occurred in a food employee within two (2) weeks of exposure, but only if the following events occurred:

(i) The food employee directly handled ready-to-eat food products during the time when infectious.

(ii) Poor hygiene practices were demonstrated or worked while ill with diarrhea.

(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.

410 IAC 1-2.5-104

Indiana State Department of Health; 410 IAC 1-2.5-104; filed 11/25/2015, 2:54 p.m.: 20151223-IR-410150039FRA

Readopted filed 11/12/2021, 8:41 a.m.: 20211208-IR-410210385RFA