Acute hepatitis A in an elderly patient after care worker travel to high endemicity country

Hepatitis a virus (HaV) is considered one of the most important vaccine-preventable diseases in travelers. HaV spreads from person to person via the fecal-oral route and gives rise to an estimated 1.4 million cases worldwide each year. In developing countries with poor sanitary conditions people tend to be infected during childhood and have few symptoms, whereas in developed countries with good sanitary conditions fewer people develop immunity during childhood. this leads to susceptible populations of adults, who are also more prone to severe complications. Here we describe two confirmed cases of hepatitis a associated with a nursing home. The index case was a care worker who had recently traveled to a high-endemicity country, and the second case was a resident at the nursing home where the index case worked. Both cases had an identical genotype IIIa strain, consistent with a transmission event. Current policy does not include a requirement for hepatitis a vaccine in care workers who travel to high endemicity countries despite the fact that infected care workers can potentially spread the disease to elderly patients and other groups at risk of severe complications from HaV infection. We suggest that employers should consider hepatitis a vaccine upon employment; particularly in care workers who plan to visit areas where HaV is known to be endemic.