BY DEBBIE EDELEN, APRN

It seems much too soon to be thinking about the next school year when we are deep into the current school year  — and often deep in snow. But there is one time-sensitive task that parents need to be taking care of now to prepare for that first day of school in August.

A recent amendment to Kentucky law added the hepatitis A vaccine to the list of required vaccinations for all children attending public school. Beginning July 1, 2018, all students in kindergarten through 12th grade must show proof of having received two doses of the Hepatitis A vaccine before starting the new school year in August.

The term hepatitis refers to inflammation of the liver. When the liver is inflamed or damaged by heavy alcohol use, certain medications or medical conditions, or viruses, its function may be negatively affected. Because the liver performs multiple tasks including metabolizing proteins, carbohydrates and fats, storing vitamins and minerals, metabolizing medications and cleaning the blood, any alteration in its ability to perform these functions can lead to significant health problems.

Hepatitis A is a highly contagious liver infection causing symptoms that range from a mild illness lasting a few weeks to a severe illness lasting several months. Older children and adults typically have symptoms that develop abruptly and may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored stools, joint pain and jaundice (yellow discoloration of the skin and eyes). Most children younger than age 6 do not have symptoms. If symptoms are present in this age group, jaundice rarely occurs. Fortunately, most people who get hepatitis A recover completely and do not have lasting liver damage.

Hepatitis A is usually transmitted when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. Hepatitis A can also spread from close personal contact with an infected person such as through sexual activity or by caring for someone who is ill with the disease. Unfortunately, a person can transmit the virus to others up to two weeks before their symptoms appear.

Contamination of food (including frozen and undercooked food) by hepatitis A can happen at any point, during growing, harvesting, processing, handling and even after cooking. As with any potential bacterial or viral contamination (and we never know when something is contaminated), it is important to cook food properly to kill the virus.

In contaminated food, the hepatitis A virus can be destroyed when exposed to temperatures above 185 degrees Fahrenheit for at least a minute. However, the food can still become contaminated after cooking if it is not handled correctly. Freezing food does not inactivate the virus.

Hepatitis A can also live on surfaces outside the body for months depending on the environmental conditions. It can be destroyed by cleaning surfaces with a freshly prepared solution of 1:100 dilution of household chlorine bleach to water. Our drinking water is kept safe through chlorination in our municipal water treatment systems.

Prevention of transmission starts with good hand washing which should always occur after using the restroom, after changing diapers, and after assisting others with toileting. Hand washing is also important before and during food preparation, before eating, and during clean-up and storage of left-overs.

Like many other contagious illnesses, hepatitis A can be prevented through vaccination. The hepatitis A vaccine, available in the United States since 1995, is approved by the Food and Drug Administration for use in persons 1 year of age and older. While Kentucky law now requires all students in kindergarten through 12th grade to receive two doses of the hepatitis A vaccine, the Advisory Committee on Immunization Practices (ACIP) in the U.S. recommends that many people receive the vaccine including:

• all children at age 1 year;

• persons who are at increased risk for infection (such as those traveling to or working in countries that have elevated rates of hepatitis A, and persons who have direct contact with others who have hepatitis A);

• persons who are at increased risk for complications from hepatitis A (such as those with other liver disease such as hepatitis B or C or other chronic illnesses); and

• any person wishing to obtain immunity.

The vaccine, given as two injections six months apart, is safe and effective in creating immunity to hepatitis A. Both shots are needed for long-term protection. No serious side effects have been reported from the vaccine. However, as with other vaccines, redness and soreness at the injection site may occur.

Because the two-dose vaccine series should be completed by the start of the 2018-2019 school year, the first vaccine should be given in January or February in order to be compliant by the first day of school in August. The vaccine should be available from your health care provider’s office and the local health department.

Parents of students who receive the vaccine should request a new immunization certificate from their health care provider’s office or health department showing the dates the vaccines were given. If you are unsure if your child received this vaccine in the past, you should contact their healthcare provider and ask if your child has received the Hepatitis A vaccine. 

Each child in Kentucky will need to have an immunization certificate on file with the school indicating completion of the two-dose hepatitis A vaccine by the first day of school in August.

In addition to the Hepatitis A vaccine, Kentucky law is now also requiring students age 16 and older to provide proof of having received two doses of the Meningococcal (meningitis) vaccine. The first dose of this vaccine is generally given during the sixth grade physical visit along with the Tetanus booster. 

If the first dose of this vaccine was received at age 16 or older, the second dose will not be required for school entry.

Online information about the hepatitis A and the Meningococcal vaccines is available from the Centers for Disease Control and Prevention at https://www.cdc.gov/vaccines.

Debbie Edelen, APRN is an advanced practice provider at North Garrard Family Medical Center, a service of Ephraim McDowell Health.