Appendix B: Provincial Case Definitions for Reportable Diseases

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1 Infectious Diseases Protocol Appendix B: Provincial Case Definitions for Reportable Diseases Disease: Hepatitis A Revised December 2014

2 Hepatitis A 1.0 Provincial Reporting Confirmed and probable cases of disease 2.0 Type of Surveillance Case-by-case 3.0 Case Classification 3.1 Confirmed Case Laboratory confirmation of infection, in the absence of recent hepatitis A vaccination, with detection of anti-hav IgM AND Acute illness with discrete onset of symptoms and jaundice or elevated serum aminotransferase levels (AST, ALT). OR An epidemiologic link to laboratory-confirmed case 3.2 Probable Case Acute illness in a person with an epidemiologic link to a laboratory-confirmed case 4.0 Laboratory Evidence 4.1 Laboratory Confirmation The following will constitute a confirmed case of acute/recent hepatitis A: Serum/plasma sample positive for HAV IgM antibody 4.2 Approved/Validated Tests Tests for anti-hav IgM and anti-hav Total (IgG and IgM) antibody 4.3 Indications and Limitations Anti-HAV IgM results should be repeated in duplicate to confirm a positive result. Serology tests indicating IgM anti-hav antibodies confirm recent infection. Antibodies are generally detectable in serum 5-10 days after infection and usually decrease to undetectable levels within 6 months after onset of infection. In rare cases, they may persist for longer. Acute/recent infection should be confirmed with clinical history, symptoms, and biochemical tests (e.g. elevated serum transaminases AST, ALT, bilirubin, etc.) 2

3 Reactive anti-hav IgM serological tests have been reported, in the absence of clinically compatible illness, or epidemiologic links to hepatitis A cases / settings with hepatitis A transmission. This may reflect a false-positive anti-hav IgM test, due to non-specific cross reactivity in the lab test, presence of rheumatoid factor in serum, or for other unexplained reasons. It may also be due to remote hepatitis A infection as noted above, with persistent anti-hav IgM, which has been reported. Finally, it may signal detection of inapparent / anicteric hepatitis A infection. Detection of IgG antibodies signals recovery from acute hepatitis A infection. When IgG antibodies are detected alone they indicate some level of immunity either from past infection or previous immunization. Total hepatitis A virus antibody (total IgM and IgG antibody) is not a confirmatory test for acute HAV infection but is used as an initial screening test in some laboratories. Following immunization with the hepatitis A vaccine, both IgG and IgM antibodies will appear in serum within two weeks after immunization. AST and ALT generally return to normal before the anti-hv IgM disappears. 5.0 Clinical Evidence Acute clinical illness is characterized by abrupt fever, malaise, anorexia, nausea and abdominal pain followed by jaundice or elevated aminotransferase levels within a few days. 6.0 ICD Code(s) 6.1 ICD-10 Code(s) B15.0 Hepatitis A with hepatic coma B15.9 Hepatitis A without hepatic coma [Hepatitis A (acute) (viral) NOS] 6.2 ICD-9/ICD-9CM Code(s) Viral hepatitis A with hepatic coma Viral hepatitis A without mention of hepatic coma 7.0 Comments N/A 8.0 Sources Heymann DL, editor. Control of communicable diseases manual. 19 th ed. Washington, DC: American Public Health Association; 2008 Advisory Committee on Epidemiology; Health Canada. Case definitions for diseases under national surveillance. Can Commun Dis Rep. 2000;26 Suppl 3:i-iv, Available from: 3

4 Centers for Disease Control and Prevention [Internet]. Atlanta, GA: CDC; Vaccines and immunizations: hepatitis A vaccination [updated 2013 Feb 7; cited 2014 Feb 16]. Available from: Centers for Disease Control and Prevention. Positive test results for acute hepatitis A virus infection among persons with no recent history of acute hepatitis --- United States, MMWR Morb Mortal Wkly Rep. 2005;54(18): Available from: Kao HW, Ashcavai M, Redeker AG. The persistence of hepatitis A IgM antibody after acute clinical hepatitis A. Hepatology. 1984;4(5): Document History Table 1: History of Revisions Revision Date Document Section Description of Revisions December 2014 General New template. Title of Section 8.0 changed from References to Sources. Section 9.0 Document History added. December Confirmed Case Addition of Hepatitis A. Addition of (AST, ALT) to first bullet. December 2014 December Tests for anti-hav IgM antibody 4.3 Indications and Limitations December Sources Updated. Tests for anti-hav IgM antibody changed to Tests for anti-hav IgM and anti-hav Total (IgG and IgM) antibody. Entire section revised. 4

5 2014 Queen s Printer for Ontario

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