{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T06:21:56Z","timestamp":1783059716646,"version":"3.54.6"},"reference-count":12,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T00:00:00Z","timestamp":1599091200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2021,2]]},"abstract":"Abstract<\/jats:title>Objective:<\/jats:title>The Tennessee Department of Health (TDH) investigated a hepatitis A virus (HAV) outbreak to identify risk factors for infection and make prevention recommendations.<\/jats:p><\/jats:sec>Design:<\/jats:title>Case series.<\/jats:p><\/jats:sec>Setting:<\/jats:title>Community hospital.<\/jats:p><\/jats:sec>Participants:<\/jats:title>Healthcare workers (HCWs) or patients with laboratory-confirmed acute HAV infection during October 1, 2018\u2013January 10, 2019.<\/jats:p><\/jats:sec>Methods:<\/jats:title>HCWs with suspected or confirmed hepatitis A infections were interviewed to assess their exposures and activities. Patient medical records and hospital administrative records were reviewed to identify common exposures. We conducted a site investigation to assess knowledge of infection control practices among HCWs. Serum specimens from ill persons were tested for HAV RNA by polymerase chain reaction (PCR) and genotyped.<\/jats:p><\/jats:sec>Results:<\/jats:title>We identified 6 HCWs and 2 patients with laboratory-confirmed HAV infection. All cases likely resulted from exposure to a homeless patient with a history of recreational substance use and undiagnosed HAV infection. Breaches in hand hygiene and use of standard precautions were identified. HAV RNA was detected in 7 serum specimens and all belonged to an identical strain of HAV genotype 1b.<\/jats:p><\/jats:sec>Conclusions:<\/jats:title>A hepatitis A outbreak among hospital patients and HCWs resulted from exposure to a single patient with undiagnosed HAV infection. Breakdowns in infection control practices contributed to the outbreak. The likelihood of nosocomial transmission can be reduced with proper hand hygiene, standard precautions, and routine disinfection. During community outbreaks, medical providers can better prevent ongoing transmission by including hepatitis A in the differential diagnosis among patients with a history of recreational substance use and homelessness.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2020.403","type":"journal-article","created":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T09:25:57Z","timestamp":1599125157000},"page":"139-141","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":7,"title":["Nosocomial hepatitis A outbreak among healthcare workers and patients in a community hospital during an ongoing statewide outbreak"],"prefix":"10.1017","volume":"42","author":[{"given":"Julia","family":"Brennan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Mullins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelley","family":"Tobey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion A.","family":"Kainer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Fiscus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"May","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Dunn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1375-8078","authenticated-orcid":false,"given":"William","family":"Schaffner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy F.","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,9,3]]},"reference":[{"key":"S0899823X20004031_ref8","unstructured":"8. Council of State and Territorial Epidemiologists. Hepatitis A, acute 2012 case defintion. Centers for Disease Control and Prevention website. https:\/\/wwwn.cdc.gov\/nndss\/conditions\/hepatitis-a-acute\/case-definition\/2012\/. Published 2012. Accessed December 18, 2019."},{"key":"S0899823X20004031_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(82)90182-6"},{"key":"S0899823X20004031_ref11","doi-asserted-by":"publisher","DOI":"10.2307\/30142429"},{"key":"S0899823X20004031_ref6","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6516a5"},{"key":"S0899823X20004031_ref10","first-page":"1","article-title":"Division of Viral Hepatitis NC for ID. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"55","author":"Fiore","year":"2006","journal-title":"Morb Mortal Wkly Rep"},{"key":"S0899823X20004031_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2005.07.018"},{"key":"S0899823X20004031_ref2","unstructured":"2. Health Alert Network. Outbreak of hepatitis A virus (HAV) infections among persons who use drugs and personsexperiencing homelessness. Centers for Disease Control and Prevention website. https:\/\/emergency.cdc.gov\/han\/han00412.asp. Published 2019. Accessed March 28, 2019."},{"key":"S0899823X20004031_ref9","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6806a6"},{"key":"S0899823X20004031_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2007.07.020"},{"key":"S0899823X20004031_ref1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6743a3"},{"key":"S0899823X20004031_ref12","unstructured":"12. Seigel, JD , Rhinehart, E , Jackson, M , Chiarello, L , for the Healthcare Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention website. http:\/\/www.cdc.gov\/ncidod\/dhqp\/pdf\/isolation2007.pdf. Published 2007. Accessed August 8, 2020."},{"key":"S0899823X20004031_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2010.11.010"}],"container-title":["Infection Control & Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X20004031","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T09:29:58Z","timestamp":1613640598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X20004031\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,3]]},"references-count":12,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,2]]}},"alternative-id":["S0899823X20004031"],"URL":"https:\/\/doi.org\/10.1017\/ice.2020.403","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,3]]},"assertion":[{"value":"\u00a9 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}