Wisconsin DHS Health Alert #63: Potential Hepatitis A Exposure in Wisconsin
Bureau of Communicable Diseases
November 22, 2024
Key points
- The Wisconsin Department of Health Services (DHS), Division of Public Health (DPH) is working with the City of Milwaukee Health Department (MHD) to monitor for hepatitis A cases throughout the state following a potential exposure at Beans & Barley Café.
- Hepatitis A is a liver infection that is caused by the hepatitis A virus and is spread through person-to-person contact, or by eating or drinking food or water with the hepatitis A virus in it.
- People who ate at Beans & Barley between October 31–November 13, 2024, may be at a slight risk of disease.
- Providers should vaccinate exposed patients who have not previously been vaccinated for hepatitis A and be alert for infection in exposed, unvaccinated people who are experiencing symptoms of acute hepatitis.
Background
MHD has identified a confirmed case of hepatitis A in a food worker. The individual is an employee at Beans & Barley, a food establishment located on Milwaukee’s East Side. The individual took necessary precautions after developing symptoms and is fully cooperating with public health officials to minimize the risk of further transmission. Although the overall risk of contracting hepatitis A is low, a common way for hepatitis A to be spread is through contaminated food and water. Identification of the employee’s responsibilities and schedule have determined that people who consumed food or drink from the restaurant during the “infectious period” of October 31 through November 13, 2024, may be at a slight risk. There is no risk of exposure outside of these dates.
What is hepatitis A?
Hepatitis A is a liver infection caused by the hepatitis A virus. Symptoms often develop 2–7 weeks after exposure and may include:
- Fever
- Tiredness
- Loss of appetite
- Nausea or vomiting
- Stomach cramps or pain
- Dark urine or pale stool
- Joint or muscle pain
- Jaundice (yellowing of the skin or eyes)
Most people recover fully within two months, but severe cases can result in prolonged illness or complications, particularly for individuals with underlying liver conditions. Hospitalization is common.
Transmission
People with hepatitis A are most contagious and able to spread the virus to others for one to two weeks before symptoms begin but could still spread the virus after symptom onset. It is typically spread through:
- Person-to-person contact, especially when proper handwashing is not practiced.
- Consuming food or water contaminated with the virus.
- Certain high-risk behaviors, such as drug use or close contact with an infected individual.
Transmission can be prevented by washing hands thoroughly with soap and water after using the bathroom, changing diapers, or before preparing food. Avoid close personal contact with infected individuals if unvaccinated. If exposed, do not handle or prepare food or drinks if you feel unwell or are experiencing symptoms.
Public health response
MHD is already working closely with the restaurant to identify and notify individuals who may have been exposed. Beans & Barley remains open to the public as a safe dining establishment. There is currently no known ongoing risk to patrons who did not consume food or drinks from the restaurant outside of the specified timeframe. Out of an abundance of caution, MHD is offering vaccinations to potentially exposed individuals to prevent further spread of the virus.
Individuals can also receive the hepatitis A vaccine through their local pharmacy, primary care provider, or at any MHD walk-in immunization clinic.
Who should get vaccinated?
Vaccination is the best way to prevent hepatitis A. If administered within two weeks of exposure to hepatitis A, the vaccine can prevent illness. Because the incubation is so long (up to 50 days) it is still beneficial to get vaccinated more than two weeks after exposure. Vaccination between 15 and 50 days after exposure may still decrease the severity of disease and prevent or shorten hospitalization. Vaccination will also provide future protection. Two doses are recommended for long-term protection.
Vaccination is recommended for individuals who may have been exposed, including:
- Employees of Beans & Barley who worked between October 31 and November 13, 2024.
- Anyone who consumed food or drinks from Beans & Barley during this period and has not received two doses of the hepatitis A vaccine.
Information for clinicians
Clinicians should be aware of early signs of hepatitis A in patients presenting for care. Wisconsin law requires clinicians to report suspected cases of hepatitis A to their local health department within 24 hours by telephone. Questions and consultations can be directed to MHD or DPH:
-
Report suspected cases of hepatitis A within 24 hours by telephone to your local or state public health authority.
- Contact MHD at 414-286-6800 or
- Contact DPH at 608-267-9003, or after hours at 800-943-0003.
Testing
To avoid cross-reactive or false-positive IgM results, do not test asymptomatic or vaccinated people. Only test for hepatitis A in people with signs of acute hepatitis, such as: fever, fatigue, loss of appetite, nausea, vomiting, stomach pain, dark urine, pale stool, joint pain, or jaundice (yellowing of the skin or eyes).
It is important to perform an IgM-specific test and not only a total antibody (IgG and IgM) test to identify acute hepatitis A infection. If a total anti-hepatitis A virus (HAV) test is ordered, an IgM anti-HAV test also needs to be ordered—either separately or reflexed from the total anti-HAV test. If hepatitis A is suspected in a patient and the IgM anti-HAV result is positive or reactive, collect an extra red top tube of blood and submit it to the Wisconsin State Laboratory of Hygiene (WSLH) for confirmation.
If your facility does not have the capacity to test for IgM, specimens can be tested, fee-exempt, at WSLH. Possible genotype testing at CDC may also be performed. Please notify DPH at 608-267-9003, or after hours at 800-943-0003, of specimens that meet these criteria, and they can assist you in submitting them to WSLH.
Resources
Questions
Questions regarding this health alert may be directed to the Bureau of Communicable Disease at dhsdphbcd@dhs.wisconsin.gov.
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