Hepatitis A Prevention: Free Cleanup and Disinfection Posters

Recent multistate outbreaks of hepatitis A among homeless populations and their contacts prompted the US Centers for Disease Control and Prevention (CDC) to issue an official Health Advisory in June 2018. The advisory provides guidance on hepatitis A infection to employees in health departments, healthcare facilities, and programs providing services to vulnerable populations. Several months before the advisory was issued, I was part of a collaborative group to develop a set of “pictogram posters” that communicate how to use chlorine bleach solutions to disinfect surfaces against the hepatitis A virus.

A Proactive Approach to Recent Hepatitis A Outbreaks

What is Hepatitis A?

According to CDC, Hepatitis A is a highly contagious liver disease caused by the hepatitis A virus. Hepatitis A is transmitted primarily through the fecal-to-oral route by eating contaminated food or drinking contaminated water, coming in contact with contaminated surfaces or through contaminated hands or close personal contact, e.g., sexual contact with or caring for an infected person. Lacking access to clean water and food, poor sanitation, and crowded living conditions all favor the spread of hepatitis A. The infection begins in the intestinal tract and moves to the liver.
Hepatitis A infections result in fatigue, low appetite, stomach pain, nausea, and jaundice. These usually resolve within two months. Children younger than age six may show no symptoms or may have an unrecognized infection.
Prior to recent outbreaks among the homeless, the most commonly reported risk factor for hepatitis A infection in the US was international travel. One way to prevent hepatitis A is to be vaccinated. CDC recommends children be vaccinated against the virus at age one year.

In the waning months of 2017, an American Chemistry Council-organized ad hoc group of outside experts that previously had produced a set of norovirus disinfection posters was alerted to the need for clear instructions on disinfecting surfaces contaminated with the hepatitis A virus. The group realized the norovirus disinfection posters could be appropriately adjusted for disinfecting surfaces against hepatitis A.1

The mission was completed this summer by the collaborative group, informally dubbed the “Hepatitis A Team.” The new posters feature easy-to-understand pictogram directions and contain the bare minimum of English text, enabling their use by speakers of other languages and non-readers. A “snip” of the pictogram directions illustrating the surface disinfecting step is shown below.


A Collaborative Partnership

Three Types of Hepatitis

The three major types of hepatitis are “A,” “B,” and “C.” Each is caused by a separate virus infecting the liver. Hepatitis A is caused by ingestion of even microscopic amounts of fecal matter containing the virus; hepatitis B is caused by contact with infectious body fluids (blood through needle sharing or sexual contact); and hepatitis C is caused by contact with the blood of an infected person. Symptoms of all types of viral hepatitis are similar. Whereas there are vaccines against hepatitis A and B, there is no vaccine against hepatitis C. More information is available from CDC.

The collaborative “Hepatitis A Team” included representatives from CDC, the Somerset County (New Jersey) Department of Health, the National Environmental Health Association, the American Chemistry Council, the Albuquerque (New Mexico) Environmental Health Department, the Lincoln Lancaster County (Nebraska) Health Department, and myself, representing the Water Quality & Health Council. One of the two-poster set instructs on cleaning and disinfecting surfaces following contact with hepatitis A-contaminated bodily fluids, such as vomitus or fecal matter. The other guides the user in disinfecting frequently touched surfaces. The resources reside on the website of the Water Quality & Health Council, and are freely available for download.

Resources to Battle Hepatitis A

Thanks to a vaccine that became available in 1995, hepatitis A is less common today than it was in the past. Nevertheless, many adults remain unvaccinated and susceptible to infection. The primary source of vaccination for most adults should be their primary care provider. However, some health departments, such as the Los Angeles County Department of Public Health provide online information on obtaining free or low cost vaccines for uninsured and underinsured adults.

We of the “Hepatitis A Team” fervently hope these posters will help reduce the spread of the hepatitis A virus.

Linda F. Golodner is President Emeritus of the National Consumers League and Vice Chair of the Water Quality & Health Council.

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1 Although the cleanup and disinfection steps are very similar, a stronger solution of bleach is required to destroy the hepatitis A virus compared to the norovirus.