What You Should Know About... Hepatitis A in the Child Care Setting Hepatitis A is an infection of the liver caused by the hepatitis A virus (HAV). Young children often have no symptoms or very mild symptoms of disease. Adults and older children are more likely to have typical symptoms, which include fever, loss of appetite, nausea, diarrhea, and generally ill feeling (malaise). The skin and whites of the eyes take on a yellow color (jaundice). A person who has no symptoms is still infectious to others. HAV is spread by the fecal-oral route. This means the disease is spread by putting something in the mouth that has been contaminated with the stool of an infected person. It can also be spread when a person eats food or drinks beverages which have been handled by a person infected with HAV and not subsequently cooked. Outbreaks of hepatitis A among children attending child care centers and persons employed at these centers have been recognized since the 1970s. Because infection among children is usually mild or asymptomatic and people are infectious before they develop symptoms, outbreaks are often only recognized when adult contacts (usually parents) become ill. Poor hygienic practices among staff who change diapers and also prepare food contribute to the spread of hepatitis A. Children in diapers are likely to spread the diseases because of contact with contaminated feces. Outbreaks rarely occur in child care settings serving only toilet-trained children. A new vaccine is available to prevent hepatitis A , but is not currently licensed for children less than 2 years of age. Although hepatitis A outbreaks sometimes occur in child care settings, they do not happen often enough to make it necessary for child care providers or children attending child care to be routinely vaccinated against hepatitis A. When outbreaks occur in child care settings, gamma globulin may be administered to children, providers, and families of child care attendees to to limit transmission of hepatitis A. If a child or adult in your child care facility is diagnosed with hepatitis A: Exclude the child or adult from the child care setting until 1 week after onset of symptoms. Immediately notify your local health department and request advice. Gamma globulin, if administered within the first 2 weeks after exposure, can prevent the infection from spreading to other children and families. Use good handwashing and hygiene practices.