Accommodation and Compliance Series:
Employees with Hepatitis
JAN’s Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.
The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee’s individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.
For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar.
What is hepatitis?
Hepatitis is an inflammation of the liver caused by a hepatitis virus. There are several types of hepatitis infections. The three most common in the U.S. are Hepatitis A, B, and C (Hepatitis Foundation International, n.d.).
Knowing your ABCs – What types of hepatitis are there?
Hepatitis A: Hepatitis A is the most common type of Hepatitis. It occurs when a person is infected by the Hepatitis A Virus (HAV) does not result in chronic infection or chronic liver disease. HAV is transmitted through a fecal-oral route either by person-to-person transmission between household contacts, by sex contact, or by ingesting contaminated food or water. Blood borne transmission is rare. Hepatitis A is highly contagious if you are in close personal contact with an infected individual. The Hepatitis A virus can be transmitted through food; no other type of hepatitis can be transmitted through the food supply. Hepatitis A has an incubation period of approximately 28 days and while most individuals infected begin recovery within three weeks, some may have recurring symptoms for up to six months. Symptoms include fatigue, nausea, jaundice, fever & abdominal pain. There is currently no treatment for HAV, but it can be prevented with the Hepatitis A vaccine. Good proper hygiene and sanitation help prevent Hepatitis A (Center for Disease Control and Prevention, 2011).
Hepatitis B: Hepatitis B is caused by the Hepatitis B virus (HBV) and can be acute or chronic. Acute HBV symptoms can last for several weeks or persist for up to 6 months. The majority of adults infected (95%) will recover completely and not become chronically infected (CDC 2011). Approximately 2%-6% of adults acquire a lifelong infection, which can result in cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. HBV is transmitted by contact with the blood or body fluids of an infected person. It is NOT spread through food, water, or by casual contact. Symptoms include jaundice, fatigue, abdominal pain, loss of appetite, nausea and vomiting. There is no cure for Hepatitis B and that is why prevention is so important. The rates of new HBV infections have declined since routine vaccinations of children have been recommended (CDC, 2011).
Hepatitis C: Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). HCV is transmitted by direct contact with infected blood. Examples of how someone might contract Hepatitis C include the use of injected street drugs; receiving blood, blood products, or solid organs from contaminated blood; long-term kidney dialysis and unknowingly sharing contaminated supplies or equipment; frequent contact with blood on the job (e.g., healthcare workers and accidental needle-sticks); having sex with a person infected with HCV; and sharing items such as razors or toothbrushes with someone infected with HCV. HCV is NOT spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses, or causal contact. Individuals who are newly infected can be asymptomatic or have mild symptoms including fever, fatigue, loss of appetite, headaches, abdominal pain and nausea. Those with chronic HCV infection can have chronic liver disease which in severe cases can include cirrhosis and liver cancer. Of every 100 persons infected with HCV about 85 may develop long-term infection, 70 may develop chronic liver disease, 15 may develop cirrhosis, and 5 may die from the consequences of long term infection (CDC, 2011).
How is Hepatitis treated?
There is no treatment for Hepatitis A (HAV), but it can be prevented with the Hepatitis A vaccine. Once an individual is infected with HAV they build antibodies which prevent the individual from ever becoming infected again. There is no medication available to treat acute Hepatitis B (HBV) infections but treatment for chronic HBV usually consists of several antiviral drugs, such as Alpha interferon and lamivudine. HBV can also be prevented with the Hepatitis B vaccine. For Hepatitis C, interferon and ribavirin are the recommended drugs. Interferon can be taken alone or in combination with ribavirin. Combination therapy is currently the treatment of choice (CDC, 2011).
Is hepatitis a disability under the ADA?
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC Regulations . . ., 2011). Therefore, some people with hepatitis will have a disability under the ADA and some will not.
A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment (EEOC Regulations . . . , 2011). For more information about how to determine whether a person has a disability under the ADA, visit http://AskJAN.org/corner/vol05iss04.htm.
Note: People with hepatitis may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with hepatitis will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee with hepatitis experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Has the employee with hepatitis been consulted regarding possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee with hepatitis to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training regarding hepatitis?
- Flexible leave. Consider time off of work as an accommodation if, for example, an individual is experiencing fatigue or needs to attend doctor appointments. An employer may allow the employee to use existing sick or annual leave. If all other leave has been exhausted, provide further unpaid.
- Modified schedule. Types of accommodations may include adjusting the time of arrival or departure; provide intermittent breaks throughout the day; shorten the workday and extend the workweek; or provide a part-time schedule
- Consider access to the facility (ramps, parking, etc.)
- Frequent rest breaks
- Reduce or eliminate strenuous activity
- Flexibility to sit or stand (adjustable workstation)
- Provide a rest area with cot
- Job sharing
- Cognitive Complications:
- Provide written job instructions and prioritize assignments
- Increase job structure
- Use of day planner or electronic organizer
- Minimize distractions
- Psychological Implications: (Difficulties adjusting to having a disability, stress, etc.)
- Identify stressors and reduce stress
- Educate coworkers, but keep person and his/her condition confidential
- Allow telephone calls to emotional supports
- Open door policy to supervisor
- Time off for counseling or therapy
- Provide praise and positive reinforcement
- Other Considerations:
- Work from home options
- Reassignment. Reassignment is typically considered if the employee can no longer perform the essential functions of their job (either with or without accommodations).
Situations and Solutions:
A factory worker with Hepatitis C, receiving treatment for six months, was experiencing flu like symptoms with extreme fatigue. The employer provided a modified schedule so that the employee could attend doctor's visits and also leave when symptoms were exacerbated.
An account representative was out of leave due to treatment for Hepatitis C. The employee wanted to return to work, but due to side effects of treatment, could not maintain the stamina needed to visit clients. The employer reassigned the employee to another account representative position that did not require travel.
A computer programmer with Hepatitis B was experiencing fatigue and nausea, which resulted in problems commuting. The employer provided a modified schedule and gave the employee an option to work from home.
A food service worker disclosed Hepatitis C to her employer. The employer was concerned that the employee would risk transmission through the food supply. The employee provided a note from her doctor, indicating that Hepatitis C was "NOT transmitted through the food supply," and that the individual was "safe to perform the essential job functions." Note: Hepatitis A is a food borne illness, but Hepatitis C is not.
There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.
Center for Disease Control and Prevention. (2011). Viral hepatitis. Retrieved December 30, 2011, from http://www.cdc.gov/hepatitis/index.htm
EEOC Regulations To Implement the Equal Employment Provisions of the Americans With Disabilities Act, as Amended, 29 C.F.R. § 1630 (2011).
Hepatitis Foundation International. (n.d.). Frequently asked questions. Retrieved December 30, 2011, from http://www.hepfi.org/HEPATITIS/Hepatitis-overview.html