Possible Hep A risk?

[Jaydog]

Hi Guys,

This sounds awful but i shook hands with a homeless man, lit him a cigarette then continued to smoke my cigarette and may have touched the cigarette with the shaking hand and may have mistakenly put my hands in or around my mouth without noticing. I think i was vaccinated twice as a baby but don't know how long that lasts for and I'm from the UK so i think the prevalence rate is low.

1) Am i at risk for hepatitis a from this encounter?

2) How exactly does hep a infect somebody through faeces etc without access to the blood stream?

Thank you guys in advance

[Lynn K]

https://www.cdc.gov/hepatitis/hav/afaq.htm


Transmission / Exposure

How is hepatitis A spread?

Hepatitis A usually spreads 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 sex or caring for someone who is ill.

Contamination of food (this can include frozen and undercooked food) by hepatitis A can happen at any point: growing, harvesting, processing, handling, and even after cooking. Contamination of food or water is more likely to occur in countries where hepatitis A is common and in areas where there are poor sanitary conditions or poor personal hygiene. In the United States, chlorination of water kills hepatitis A virus that enters the water supply. The Food and Drug Administration (FDA) routinely monitors natural bodies of water used for recreation for fecal contamination so there is no need for monitoring for hepatitis A virus specifically.

Who is at risk for hepatitis A?

Although anyone can get hepatitis A, in the United States, certain groups of people are at higher risk, such as:

People with direct contact with someone who has hepatitis A
Travelers to countries where hepatitis A is common
Men who have sexual contact with men
People who use drugs, both injection and non-injection drugs
Household members or caregivers of a recent adoptee from countries where hepatitis A is common
People with clotting factor disorders, such as hemophilia
People working with nonhuman primates

I think I have been exposed to hepatitis A. What should I do?

If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department. If you were recently exposed to hepatitis A virus and have not been vaccinated against hepatitis A, you might benefit from an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.

[Lynn K]

2) How exactly does hep a infect somebody through faeces etc without access to the blood stream?

Infection is caused by ingesting small amount of fecal material most often through contaminated food or water.

[Jaydog]

Cheers for the reply Lynn

Would you say from your own personal opinion that i was at risk from shaking this mans hand then maybe touching my lip with my hand  afterwards while smoking my own cigarette? even without physically swallowing any food etc?

[Lynn K]

If he has hep a and has unclean hands contaminated with feces and if you ingested this fecal material then you may have a risk. You should discuss your risk and how to proceed from here with your medical professional.

I am not a medical professional and cannot access your risk.

If you were exposed there is treatment to avoid infection talk to your doctor if you think it possible you may have ingested fecal material through this contact.

[Lynn K]

Found this about hep A in the UK

https://www.gov.uk/government/collections/hepatitis-a-guidance-data-and-analysis

[Jaydog]

There is so little information out there regarding my risk and i feel uncomfortable making an appointment with my doctor to discuss casual contact with another human being. It would be good to know if this was a high or low risk situation but i can't find anything online.

Do you or anybody else have any idea how long i should wait before testing for hep a?

Thanks again

[Lynn K]

You won’t be able to find any data as you are likely the best judge if you are at risk from this contact. If person had hep A they may not initially know they are infected. So the question for you is it possible they had fecal material that was transferred to you and could you have ingested the material. If this did not happen then you are not at risk. If there is a chance you could have ingested any fecal material there is a potential risk. However, there is no way to quantify this risk.

There is no reason to feel uncomfortable discussing this with a medical expert that is what they are there for. Otherwise you are just left guessing, worrying and trying to figure it out on your own without enough knowledge or information to do so.

Here is some more information about the diagnosis, symptoms and treatment from the link I sent earlier.

I think I have been exposed to hepatitis A. What should I do?

If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department. If you were recently exposed to hepatitis A virus and have not been vaccinated against hepatitis A, you might benefit from an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.

What is postexposure prophylaxis (PEP)?

Postexposure prophylaxis (PEP) refers to trying to prevent or treat a disease after an exposure. For hepatitis A, postexposure prophylaxis is an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective in preventing hepatitis A if given within the first 2 weeks after exposure.

What are the symptoms of hepatitis A?

Older children and adults typically have symptoms. If symptoms develop, they can appear abruptly and can include:

Fever
Fatigue
Loss of appetite
Nausea
Vomiting
Abdominal pain
Dark urine
Clay-colored stools
Joint pain
Jaundice (yellowing of the skin and eyes)

How soon after exposure to hepatitis A will symptoms appear?

If symptoms occur, they usually start appearing 4 weeks after exposure, but can occur as early as 2 and as late as 7 weeks after exposure. Symptoms usually develop over a period of several days.

How long do hepatitis A symptoms last?

Symptoms usually last less than 2 months, although some people (10%–15%) with hepatitis A can have symptoms for as long as 6 months.

Can a person spread hepatitis A without having symptoms?

Yes. Many people, especially children, have no symptoms. In addition, a person can transmit the virus to others up to 2 weeks before symptoms appear.

Diagnosis / Treatment

How will I know if I have hepatitis A? How is hepatitis A diagnosed?
A doctor can determine if you have hepatitis A by discussing your symptoms and taking a blood sample.

How is hepatitis A treated?

Unvaccinated people who have been exposed recently (within 2 weeks) to the hepatitis A virus should get the hepatitis A vaccine or a shot of immune globulin to prevent severe illness. To treat the symptoms of hepatitis A, doctors usually recommend rest, adequate nutrition, and fluids. Some people will need medical care in a hospital. It can take a few months before people with hepatitis A begin to feel better.

So anyway based on all that I urge you to speak with a health care professional if you believe you may have been exposed. It is so much better to feel a little silly than suffer a hep A infection.

Ask your doctor about testing and if your old hep A vaccination is still good. The only way you will know for sure is to ask your doctor.

Often in the situation where there is a food worker who is later discovered to be infected with hep A virus a general notice will go out to the public for anyone who ate at that restaurant during the potential timeframe the person could have spread hep A to go have the postexposure prophylaxis an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective in preventing hepatitis A if given within the first 2 weeks after exposure. So better sooner than waiting. If it has been more than two weeks your only other option is to wait for symptoms to develop and avoid the risk of infection others. It is by far better to speak with your doctor if you believe you could have been exposed.

Best of luck and if I didn’t say it enough times talk to your doctor.

[Lynn K]

Found this about hep A testing

https://www.webmd.com/hepatitis/hepa-guide/hepatitis-a-virus-test

Hepatitis A IgM antibodies can be found as early as 2 weeks after you are first infected. They disappear 3 to 12 months after the infection.

However, 2 weeks post possible exposure would be too late for treatment to prevent infection to be effective.

If you think you may have ingested any fecal material from this encounter you should see your doctor to be treated.


https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-a.html

Hepatitis A Vaccine

What You Need to Know

Why get vaccinated?

Hepatitis A is a serious liver disease. It is caused by the hepatitis A virus (HAV). HAV is spread from person to person through contact with the feces (stool) of people who are infected, which can easily happen if someone does not wash his or her hands properly.  You can also get hepatitis A from food, water, or objects contaminated with HAV.

Symptoms of hepatitis A can include:

fever, fatigue, loss of appetite, nausea, vomiting, and/or joint pain
severe stomach pains and diarrhea (mainly in children), or
jaundice (yellow skin or eyes, dark urine, clay-colored bowel movements).
These symptoms usually appear 2 to 6 weeks after exposure and usually last less than 2 months, although some people can be ill for as long as 6 months. If you have hepatitis A you may be too ill to work.

Children often do not have symptoms, but most adults do. You can spread HAV without having symptoms.

Hepatitis A can cause liver failure and death, although this is rare and occurs more commonly in persons 50 years of age or older and persons with other liver diseases, such as hepatitis B or C.

Hepatitis A vaccine can prevent hepatitis A. Hepatitis A vaccines were recommended in the United States beginning in 1996. Since then, the number of cases reported each year in the U.S. has dropped from around 31,000 cases to fewer than 1,500 cases.

Hepatitis A vaccine
Hepatitis A vaccine is an inactivated (killed) vaccine. You will need 2 doses for long-lasting protection. These doses should be given at least 6 months apart.

Children are routinely vaccinated between their first and second birthdays (12 through 23 months of age).  Older children and adolescents can get the vaccine after 23 months. Adults who have not been vaccinated previously and want to be protected against hepatitis A can also get the vaccine.

You should get hepatitis A vaccine if you:

are traveling to countries where hepatitis A is common,
are a man who has sex with other men,
use illegal drugs,
have a chronic liver disease such as hepatitis B or hepatitis C,
are being treated with clotting-factor concentrates,
work with hepatitis A-infected animals or in a hepatitis A research laboratory, or
expect to have close personal contact with an international adoptee from a country where hepatitis A is common
Ask your healthcare provider if you want more information about any of these groups.

There are no known risks to getting hepatitis A vaccine at the same time as other vaccines.

https://www.cdc.gov/hepatitis/hav/havfaq.htm

How long does protection from hepatitis A vaccine last?
The exact duration of protection after vaccination is unknown. Anti-HAV has been shown to persist for at least 20 years in adults administered inactivated vaccine as children with the three-dose schedule (19), and anti-HAV persistence of at least 20 years also was demonstrated among persons vaccinated with a two-dose schedule as adults (20). Detectable antibodies are estimated to persist for 40 years or longer based on mathematical modeling and anti-HAV kinetic studies (20, 21).

[Jaydog]

Hey,

So i decided to get tested for everything and awaiting my results. However i noticed the phlebotomist did not use gloves and i can't say i noticed her washing her hands before sticking.

I understand i sound super ocd right now

Am i at risk here?

[Lynn K]

No you are not at risk.

I have never seen a phlebotomist not wear gloves. I have blood draws done every 6 months for many years. That is not in compliance with standard medical protocols.

You were not at risk your phlebotomist if they did not wear gloves was at risk from you.

From my understanding this lab could be at risk of their license. Was this a licensed laboratory in the US? You may want to report this incident to your doctor.

https://www.ncbi.nlm.nih.gov/books/NBK138655/

Infection control procedures that help to prevent health-care associated infections include:
hand hygiene;
glove use;
skin antisepsis;
sterile, single-use blood-sampling devices;
sharps containers;
disinfection of surfaces and chairs;
cleaning and disinfection of tourniquets;

[Jaydog]

Yes, i think I'm probably going to say something. My worry is that she may have had blood residue on her hand from a previous patient. She never touched my wound directly but there was a little leakage from the puncture site. If she touched my blood (leakage) which had dripped away from the puncture site could a potential hep c/b infection spread back up to the actual puncture wound and infect me (Wow i sound soooooo OCD lol)

Also this was a UK lab

Thanks again

[Lynn K]

Still really surprised in the UK I would think more likely in a third would country.

Ok so you blood was flowing out. Hep c doesn’t swim especially against the tide of blood flowing out of your body. Hep c basically has to be pushed inside your body.

No risk

[Jaydog]

Thank you for your patience and advice Lynn

[Jaydog]

Hello again,

Just looking for clarification on the last answer. I understand Hep c cannot swim but if the blood leakage was connected to my wound could it infect the leakage and spread through the blood back into my wound opening and into my body the same way it would spread inside the body (through blood) if that makes sense?

[Lynn K]

The main issue is it is doubtful the phlebotomist was contaminated with hepatitis C blood but if hepatitis C blood should enter a wound there is a potential for infection.

To describe you potential risk in example if a health care worker should experience an accidental needle stick involving a patient with known hep C their risk of infection would be about 1.8% this is with know infected blood being pushed inside the blood stream of an uninfected person. So given that you can see you are at less risk than that.

You do not know if any blood was present or if this possible blood has hep c. You can’t be infected by what is not there. Even if there was hep c infected blood your risk would be less than the risk from an accidental needle stick scenario.

Wondering and worrying likely needlessly solves nothing. I am just a patient who was once infected with hep c and not a medical professional but I seriously doubt you are at any risk in this situation. My suggestion is either move one with your or if you continue to have concerns get tested then you will know instead of wondering and guessing. Or discuss your concerns with your doctor and consider discussing treatment for anxiety.

Good luck

[Jaydog]

You know what I agree with your comments anxiety. I had an incident before where i snorted cocaine with my own key which hadn't been used by anybody else and went through a period of worrying about that, thinking i could get hep c from the cocaine powder itself because my nose bled after snorting. It seems to come and go these periods of OCD and anxiety. I mean would you even consider something like this a risk or just irrational thoughts that i should consult with a doc?

[Lynn K]

Bearing in mind I am not a doctor as I said previously:

“I seriously doubt you are at any risk in this situation. My suggestion is either move one with your life or if you continue to have concerns get tested then you will know instead of wondering and guessing. Or discuss your concerns with your doctor and consider discussing treatment for anxiety.“

“I mean would you even consider something like this a risk?”

Personally no I would not. The thought would not have even crossed my mind. I am sure my  phlebotomist was wearing gloves on my last blood draw but in all honesty I didn’t even notice one way or the other.


“or just irrational thoughts that i should consult with a doc?”

I can’t speak to rationality of your thoughts we all have concerns from time to time. But I do personally believe your concerns are likely unfounded and speaking with a counselor may help you have a calmer more peaceful life.

Best of luck

[Jaydog]

I completely understand you can't speak for the rationality of my thoughts, i know your not a mental health professional, but would you consider the cocaine incident a legitimate concern? its like when something comes into contact with my blood (key, powder) i automatically think i've caught something even though i used my own equipment lol. Like i said, i tend to go through these phases, i think it wouldn't hurt to talk to somebody... just gotta find time to do it.

[Lynn K]

The cocaine and key no of you were sharing snorting equipment with someone who has hep c that you put inside your nose like straws or bills that is a specific risk listed by the CDC so if shared yes that is a known risk. Your own equipment no.

Isn’t one of the effects of cocaine use paranoia? Maybe if you were to stop using drugs that could help your outlook on life and reduce your risks of many health problems including death by overdose. I would worry more about the risks associated with drug use to your health than touching your own keys or shaking a strangers hand.

[Jaydog]

Well, here we go again....

I seem to have OCD episodes every 3 months or so but this time it seems like a legitimate concern.

So yesterday I was walking to work and noticed what seemed to be a large patch of dried blood on the floor which looked at least 8 hours old. I didn't step on this but later realised I had stepped on the small dried drips that followed. I was wearing shorts and later that day I used the bottom/side of my foot/shoe to scratch my leg when I was walking around not realising I had a small paper cut sized cut on my leg - this occurred about 7 hours after stepping on the dried blood. Do you think I'm at any risk here?. I know hep c positive people account for 0.4 percent of the population in my country.

I also noticed no visible blood on my shoe

Cheers again and sorry to be a pain

[Lynn K]

Could have been soda which is a much more likely possibility vs a random blood spill

Hep c infected blood must enter the blood steam on an uninfected person through an open bleeding wound. Even in the situation where a health care worker should experience an accidental needle stick involving a patient with know hep c the risk of transmission is only about 1.8%

“Do you think I'm at any risk here?”
No

See your doctor for treatment of your OCD. Treat the condition you do have so you can stop worrying needlessly about illness you have no risk of contracting. Illnesses that for example if you should contract hep c, is now very treatable with high rates of cure.

[Jaydog]

I'm pretty sure it was blood as they were putting sand over it when I walked past it later in the day. Would hep c have survived on my shoe for the 7hours leading up to when my shoe came into contact with my leg cut?

[lporterrn]

This is all highly speculative and incredibly unlikely, if not pretty much impossible. Rather than continue with the speculation (and a continuation of anxiety), why don't you just have a test and get the facts.

[Lynn K]

Jay that is not the standard protocol for a blood spill. If there had been ablood spill they call hazmat. Maybe oil would be something they would use sand for clean up.

Highly doubtful to nearly impossible that there would be anyway blood would enter your blood stream from this situation.

If you are worried as Lucinda said wait 12 weeks and get tested. Or see your counselor about your medical anxiety and discuss your concerns.

[Jaydog]

I agree with testing etc but reassurance is good during this 3 month period.

I thought it may be oil or transmission fluid but can't understand why it would be on the pavement (sidewalk)

[Lynn K]

The possibility of it having been transmission fluid or brake fluid or a soda or almost anything else seems much more likely to me then it being blood.

In my entire life I have never encountered a random blood spill. I have see coworkers get badly cut in the job resulting in a blood spill that our work hazmat team responded to. But I have never seen blood out in the world without explanation for it being there.

[Jaydog]

Yeah I understand what you're saying but say it was dried blood would you say my risk was non existent?

[Lynn K]

I suggest you reread the previous posts. Your question has been answered several times.

[Jaydog]

Hi again,

If the symptoms im experiencing at the moment are hcv related, would the virus appear on a blood test?

[Lynn K]

The majority of people either newly or chronically infected with hep c will have no symptoms. The most common symptom is felling tired.

If you had an exposure where blood could have entered your blood stream like sharing IV drug needles or getting a tattoo at an unlicensed shop where they don’t follow standard cleaning and sterilization practices you should wait at least 12 weeks post exposure for sufficient antibodies to form and have the hepatitis c antibody test. However, if your immune system is compromised say if you have HIV or are on chemotherapy it can take up to 6 months for antibodies to rise to detectable levels. But most people with normal immune systems should receive reliable results at the 12 week mark post a possible blood to blood exposure.

[Jaydog]

For argument sake, lets say the virus was enough to cause symptoms. If it was enough to cause symptoms then surely it would appear on bloods at this point?.

I only ask because i was tested before competition and came back negative, but i was feeling very unwell before and during the test (wont go into symptoms). Just looking for peace of mind.

[Lynn K]

Symptoms could be anything or nothing related. The key is waiting for at least 12 weeks and possibly as long as 6 months after a concerning possible blood to blood exposure.

From the Mayo Clinic about possible symptoms of hepatitis c

“ Symptoms

Long-term infection with the hepatitis C virus is known as chronic hepatitis C. Chronic hepatitis C is usually a "silent" infection for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease.

Signs and symptoms include:

Bleeding easily
Bruising easily
Fatigue
Poor appetite
Yellow discoloration of the skin and eyes (jaundice)
Dark-colored urine
Itchy skin
Fluid buildup in your abdomen (ascites)
Swelling in your legs
Weight loss
Confusion, drowsiness and slurred speech (hepatic encephalopathy)
Spiderlike blood vessels on your skin (spider angiomas)

Every chronic hepatitis C infection starts with an acute phase. Acute hepatitis C usually goes undiagnosed because it rarely causes symptoms. When signs and symptoms are present, they may include jaundice, along with fatigue, nausea, fever and muscle aches. Acute symptoms appear one to three months after exposure to the virus and last two weeks to three months.”

[Jaydog]

I know what you're saying. I understand it.

I just want to know whether the virus would show up on a test at a time you were showing symptoms that were a result of hep c/b infection.

I just want to know that my negative result can rule out the the possibility that my symptoms before the test were due to hep.

Common sense tells me that if those symptoms were a result of hep, the virus have shown up on my blood test as the virus would have been abundant enough to cause those symptoms? - is this correct?

Because my test come back negative surely that means those specific symptoms werent related to hep?

[Lynn K]

“ What percentage of persons infected with HCV develop symptoms of acute illness? Approximately 20%–30% of those newly infected with HCV experience fatigue, abdominal pain, poor appetite, or jaundice”

1. It’s more likely you would not experience symptoms and less likely that you would.

2. Hep C is not easily transmitted. In order to contract hep c you would need to have a blood to blood contact i.e. share IV drug needles with someone infected with hepatitis c, experience an accidental needle stick with someone who has known hep c say in a medical setting and in this case the odds of transmission are around 1.8%, having multiple sex partners or engaging in rough sexual practices where exposure to blood is a possibility as in BDSM or blood sports, being born to a mother infected with hep c odds of infection 5%, having a blood transfusion prior to 1990 before antibody testing became available. Lesser risk is sharing personal hygiene items like razors, fingernail clippers or tooth brushes with someone infected with hep c and sharing of drug snorting paraphernalia. If you did not experience a situation similar to what is describe you are at no risk of infection from hep c.

3. “In those people who do develop symptoms, the average period from exposure to symptom onset is 2–12 weeks (range: 2–26 weeks)” We are basically looking at a similar length of time for the antibody testing window as the possibility of symptoms developing.

I tend to doubt your symptoms are related to hepatitis c because of the length of time for symptoms to develop and that most people do not experience any symptoms.

As to your question about the presence of symptoms and if that related to a high enough viral load I’m not an epidemiologist but I strongly doubt this question has benn studied so there isn’t any data to support that position.

“ I just want to know whether the virus would show up on a test at a time you were showing symptoms that were a result of hep c/b infection.”

I doubt this has been studied so one cannot make the assumption that even if someone is actually experiencing symptoms of a hepatitis c infection that the body would have developed sufficient antibodies to rise to detectable levels especially it is more likely (70 to 80%) that even if you were infected any symptoms you may have experienced are not from a hep c infection. Also the symptoms would need to be on the list of common symptoms previously listed.

“I just want to know that my negative result can rule out the the possibility that my symptoms before the test were due to hep.”

I understand you would like to correlate your negative test result to your symptoms but since you do not know your symptoms were from hep c and no one has studied the relationship to symptoms to antibody testing this question cannot be answered. The only way to have confidence in your test results is to wait the prerequisite time and have testing done.

“ Common sense tells me that if those symptoms were a result of hep, the virus have shown up on my blood test as the virus would have been abundant enough to cause those symptoms? - is this correct?”

Scientific investigation often turns up data that contradicts common sense, common knowledge, common opinion. If common lay persons interpretation of a given situation were all that’s needed we would not need scientific investigation. So you ask “is this correct?” There is no data to support that opinion so lacking that data I would say no it is not correct.

“ Because my test come back negative surely that means those specific symptoms werent related to hep?”

Again unknown and unknowable. But if it is determined you in fact do not have hep c then most definitely your symptoms cannot be related to an illness you do not have. Even if it was later determined you do have hep c that is not proof your symptoms were related to hep c. Basically there is no way to know if your symptoms were related to hep c infection.

Things that you do know:

Did you have a risk of a blood to blood contact as described previously? If not you were likely not at risk

If you did experience a risk as described above wait the required time and test for antibodies then you will know. There is nothing to be gained by what saying what if on your symptoms as only a small percentage of people experience symptoms and most of the symptoms are somewhat vague and could be many things or nothing. Hepatitis c cannot be diagnosed by symptoms or the lack there of.

Bottom line get tested at 12 weeks after a blood to blood exposure risk and for additional insurance get retested are 6 months. There is no other way to know unless you want to spend I believe about $400.00 for a viral load test which looks for the presence of the actual hepatitis c virus in your blood. No doctor would recommend this test unless you first had a positive antibody test. If you did not have an exposure that put you at risk of hepatitis c infected blood entering your blood stream I would save my money for other things and just get the antibody testing done.