• Hepatitis A in Childcare Settings

    IMAGE If you have a young child who attends daycare or if you work as a childcare provider, you know how easily illness can spread. Cold and flu viruses seem to make their rounds no matter how hard you try to avoid them. Hepatitis A is a viral infection that is easily spread in childcare settings. Learn more about hepatitis A and how it can be prevented.

    What Is Hepatitis A?

    Hepatitis A is an infection of the liver caused by the hepatitis A virus. It can cause flu-like symptoms, like:
    • Fever
    • Tiredness
    • Loss of appetite
    • Nausea and vomiting
    • Abdominal pain
    • Dark urine
    • Clay-colored bowel movements
    • Joint pain
    • Jaundice (yellowing of skin and/or eyes)
    Hepatitis A is often not serious, especially in young children. Symptoms usually last less than two months. In some cases, they may last as long as six months. In rare cases, the virus can cause liver failure and death. (This is more common in people > 50 years of age.)

    How Is Hepatitis A Spread?

    Hepatitis A is spread when the virus is taken in by mouth from contact with objects or foods that have been contaminated by the stool of an infected person. In childcare settings, this can happen easily, such as if a caregiver does not wash her hands after changing a soiled diaper.
    Young children can have hepatitis A but show only mild symptoms or none at all. Hepatitis A is much more likely to cause symptoms in adults and older children. Because of this, outbreaks of hepatitis A may not be discovered until caregivers begin to show symptoms.
    In recent years, only a small number of hepatitis A cases in the United States have been associated with daycare centers. The majority of cases can be linked to people who travel abroad or those who have had contacted with an infected person.

    How Is Hepatitis A Treated?

    Mild, flu-like symptoms are treated with rest, a balanced diet, and lots of fluids. If you or your child gets hepatitis A, talk to your doctor before taking any medicines, including over-the-counter medicines or supplements. Some medicines, like acetaminophen (Tylenol), could damage your liver if you take them while infected with hepatitis A. Also, you should not drink alcohol if you have hepatitis A.

    How Can I Keep My Child Free From Hepatitis A?

    If your child goes to daycare, you may be wondering how you can keep her from contracting hepatitis A. The best way to do this is to have your child vaccinated. The hepatitis A vaccine is recommended for children over 12 months of age and is almost completely protective against this infection.
    Another way to prevent the spread of hepatitis A is by practicing good hand hygiene. In addition, follow these steps:
    • Always wash your hands with soap and water after using the bathroom or changing your child’s diaper.
    • If your child is potty-trained, teach her to wash her hands after using the bathroom.
    • Talk to the staff at the daycare. Ask about their policies for hand washing, food preparation, and diaper changes.
    • Carefully dispose of soiled diapers.

    What If There is an Outbreak at My Child’s Daycare?

    If your child is exposed to hepatitis A, take these steps to minimize symptoms and to prevent the virus from spreading to others:
    • If recommended by the doctor, have your child receive an injection of immune globulin. This must be given within two weeks of exposure. It can provide temporary immunity for your child.
    • If your child is over one year of age and has not been vaccinated, talk to your child’s doctor about getting her vaccinated against hepatitis A. Since your child could expose you to infection even if she never shows signs of illness, consider immunization for yourself and other family members, as well.
    • Do not transfer your child to another daycare. This could potentially spread the disease to others.
    If your child does get hepatitis A, she can safely return to daycare one week after her symptoms began. Talk to the daycare center about their policy.
    No parent ever likes to see their child sick. And working parents know how difficult it can be to find childcare at the last minute when your child cannot go to their usual daycare because of illness. Follow the tips above for good hand hygiene and make sure your daycare does, too!


    American Academy of Pediatrics http://www.aap.org/

    Hepatitis Foundation International http://www.hepfi.org/


    Canadian Paediatric Society http://www.cps.ca/

    Health Canada (Santé Canada) http://www.hc-sc.gc.ca/


    Hepatitis A. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/health-issues/vaccine-preventable-diseases/Pages/Hepatitis-A.aspx. Updated June 8, 2011. Accessed October 21, 2011.

    Hepatitis A in daycare. Utah Bureau of Epidemiology website. Available at: http://health.utah.gov/epi/fact%5Fsheets/hepadcc.html. Published August 2001. Accessed October 21, 2011.

    Hepatitis A FAQs for the public. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/hepatitis/A/aFAQ.htm. Updated September 17, 2009. Accessed October 21, 2011.

    Infectious disease in child care settings. State of Colorado Department of Public Health and Environment website. Available at: http://www.cdphe.state.co.us/dc/epidemiology/ChildCareflipchart02a.pdf. Accessed October 21, 2011.

    Klevens RM, Miller JT, Iqbal K, et al. The evolving epidemiology of hepatitis a in the United States: incidence and molecular epidemiology from population-based surveillance, 2005-2007. Arch Intern Med. 2010;170(20):1811-1818.

    Van Herck K, Jacquet JM, Van Damme P. Antibody persistence and immune memory in healthy adults following vaccination with a two-dose inactivated hepatitis A vaccine: long-term follow-up at 15 years. J Med Virol. 2011;83(11):1885-1891.

    Viral hepatitis: A through E and beyond. National Digestive Disease Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/viralhepatitis/. Updated February 2008. Accessed October 21, 2011.

    What you can do to stop disease in your child’s day care center. New York City Department of Health and Mental Hygiene website. Available at: http://www.nyc.gov/html/doh/html/dc/dcstop.shtml. Accessed October 21, 2011.

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