When can a hepatitis A–infected employee be cleared to return to work, considering timing after jaundice or symptom onset, symptom resolution, hand‑hygiene requirements, and need for stool PCR in food‑service or high‑risk settings?

Return to Work Clearance After Hepatitis A Infection

A hepatitis A–infected employee can return to work 7 days after the onset of jaundice (or 7 days after symptom onset if anicteric), provided they practice strict hand hygiene; stool PCR testing is not required for clearance in any setting, including food service. 1

Timing of Return to Work

The critical clearance window is based on the infectious period of hepatitis A:

• Peak infectivity occurs 14 days before jaundice onset, with viral shedding continuing through approximately 7 days after jaundice appears 1, 2
• Most adults can return to work 7 days after jaundice onset, as this marks the end of the highly infectious period 1
• For anicteric cases (no jaundice), return to work is appropriate 7 days after initial symptom onset (fever, malaise, dark urine) 2
• The 2-week period before jaundice represents the highest transmission risk, meaning most infected employees have already passed peak infectiousness by the time they are diagnosed 3

Hand Hygiene Requirements

Strict hand hygiene is the cornerstone of preventing transmission upon return:

• Wash hands with soap and water for at least 20 seconds after using the bathroom, before food preparation, and before eating 4
• Hand hygiene must be emphasized as the primary control measure, as hepatitis A is transmitted via the fecal-oral route 1, 5
• Standard precautions should always be observed in healthcare settings 6

Stool PCR Testing: Not Required

Stool PCR or viral testing is NOT necessary for return-to-work clearance, even in high-risk settings:

• The 7-day post-jaundice timeline is the established clearance criterion, not laboratory confirmation of viral clearance 1
• Viral shedding in stool can persist for weeks, but infectivity drops dramatically after the 7-day window 2
• Children may shed virus for up to 10 weeks, but this does not change adult return-to-work criteria 3

Special Considerations for Food Service Workers

Food handlers require the same clearance timeline but warrant additional scrutiny:

• Food handlers should be excluded from work until 7 days after jaundice onset 6
• If a food handler is diagnosed with hepatitis A, other food handlers at the same establishment should receive post-exposure prophylaxis (hepatitis A vaccine or immune globulin within 2 weeks) 6
• Patrons typically do not require prophylaxis unless the food handler both directly handled uncooked/cooked foods AND had diarrhea or poor hygiene during the infectious period, and patrons can be identified within 2 weeks of exposure 6
• In institutional cafeterias with repeated exposures, stronger consideration for patron prophylaxis may be warranted 6

Healthcare and High-Risk Settings

Healthcare workers and those in contact with vulnerable populations follow the same 7-day rule:

• No additional restrictions beyond the 7-day post-jaundice period are required for healthcare personnel 6
• Careful hygienic practices should be emphasized rather than routine prophylaxis for hospital staff when a patient with hepatitis A is admitted 6
• Post-exposure prophylaxis should be given to staff only if epidemiologic investigation indicates actual HAV transmission occurred 6

Symptom Resolution: Not the Primary Criterion

While symptom improvement is expected, it is not the defining factor for clearance:

• Most patients recover within 3-4 weeks with complete resolution of elevated liver enzymes 3
• 10-15% experience relapsing disease lasting up to 6 months, but this does not extend work exclusion beyond the initial 7-day period 3
• Jaundice typically resolves within 2 weeks in 85% of cases, but prolonged jaundice alone does not require continued work exclusion if the 7-day post-onset period has passed 2

Common Pitfalls to Avoid

• Do not require negative stool tests for clearance—this is unnecessary and will inappropriately delay return to work 1
• Do not extend exclusion based on persistent fatigue or mild symptoms beyond 7 days post-jaundice if hand hygiene can be maintained 2
• Do not assume all food service exposures require patron prophylaxis—this is indicated only when specific high-risk conditions are met (direct food handling + diarrhea/poor hygiene + identifiable patrons within 2 weeks) 6
• Do not provide prophylaxis to exposed persons after cases have begun to occur in a common-source outbreak, as the 2-week effective window for vaccine/IG has passed 6

Documentation for Clearance

Employers may require:

• Confirmation of jaundice onset date (or symptom onset date if anicteric) to calculate the 7-day exclusion period 1
• Physician assessment documenting that the employee understands and will comply with strict hand hygiene requirements 6
• For food handlers, documentation that co-workers have received post-exposure prophylaxis if indicated 6