Cases/Infectious Disease and Travel Health

Partner Diagnosed with Hepatitis A — Free SCA Practice Case

Woman whose partner has just been diagnosed with hepatitis A

Station Timer

12:00

Golden Minute

Initial Introduction

•Introduce yourself

•Ask an open question — "How can I help you today?"

•Listen — don't interrupt

•Catch early cues

Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

Safety Net

Follow-up & Close

12:00

Golden Minute

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Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Orla Lockhart

Age

29 years

Consultation Type

Telephone

Age

Situation

Telephone Consultation. The patient has phoned the surgery for advice today.

Reason for Encounter

"My partner's been admitted to hospital with hepatitis A. I feel fine, but I need to know if I can go to work tomorrow."

Medical Records

●PMH: Nil significant. Medications: Combined oral contraceptive pill. Allergies: NKDA.
●Immunisations: Childhood schedule complete. No hepatitis A or travel vaccines recorded.
●Social: Nursery assistant. Lives with her partner.
●Reception message, today: Partner (registered elsewhere) admitted 2 days ago with hepatitis A. Ward staff told her to ask her GP about "a jab". No health protection team contact recorded.

Patient Script

For the friend playing the patient role

Character Overview: You are Orla Lockhart, a 29 year old nursery assistant in the toddler room of a small day nursery: twelve children aged two to three and five staff, 7.45 to 4.15, Monday to Friday, paid by the hour. You change nappies, help with toilet training, sit with the children at lunch and cut up fruit and sandwiches at snack time. You live in a rented two bedroom flat with your partner Gethin, an electrician, and his younger brother Seb, who has had the spare room for three weeks since splitting up with his girlfriend. Gethin has been in hospital for two days with hepatitis A after ten days in Egypt with three friends for a thirtieth birthday. You did not go because you could not get the leave. You feel completely well. You are practical, chatty and a bit flustered, and you speak at a normal pace. Your voice goes quiet and wobbly when you talk about the toddlers or Gethin, and brisker and more worried when work or money come up. You have never had a serious illness.

Opening Sentence: "Hello, thanks for fitting me in. My partner Gethin's in hospital with hepatitis A, and the ward said I should ask the doctor about a jab for myself. I feel absolutely fine, but I work in a nursery and I'm on shift tomorrow, so I don't know whether I'm allowed to go in."

History if Asked (Data Gathering Phase)

●How Gethin's illness began (if asked): "He got back from Egypt about six weeks ago. About two and a half weeks ago he started feeling rotten. Exhausted, off his food, achy, hot and cold, and sick a couple of times. He thought it was a bug from the holiday."
●Yellow skin, dark urine or pale stools (if asked): "His wee went dark, like strong tea, about ten days ago, and the day after his eyes and skin went yellow. So that's nine days ago now. His poo's gone really pale too."
●Admission and diagnosis (if asked): "His mum nagged him into going to A and E two nights ago because he couldn't keep anything down and looked so yellow. They kept him in. The ward doctor told us last night his blood test showed hepatitis A. She said his liver tests are high but it should settle by itself, and he's a bit brighter today."
●The trip (if asked): "Ten days at a resort with three of his mates. I didn't go. He says they ate at the buffet and a few local places, with salads and ice in their drinks."
●Public health (if asked whether anyone has been in touch): "No, nobody's rung me. The ward doctor said someone from public health might get in touch, but I haven't heard a thing."
●Living with Gethin (if asked about the bathroom, food, bed or contact): "We share one bathroom, I do most of the cooking and we sleep in the same bed. I looked after him at home when he was ill. I did his meals and washed his bedding. The last time we were intimate was about ten days ago, before he got properly poorly."
●Your own symptoms (if asked how you feel, or about fever, sickness, tummy pain, urine, stools, itching, yellow skin or tiredness): "Nothing at all. I feel completely normal. I'm eating normally, my wee and poo are normal, no temperature, no tummy ache, nobody's said I look yellow, no itching, no more tired than usual, no confusion or bleeding."
●Vaccines and past illness (if asked about hepatitis A jabs, travel jabs, jaundice or hepatitis): "I don't think I've ever had a hepatitis A jab. I've only been to Spain and Portugal on holiday. I've never been yellow and never had hepatitis."
●Seb and the household (if asked who else lives with you or visits): "It's the three of us. Seb's 24 and drives a delivery van. He uses the same bathroom and eats what I cook, and he feels fine. He's registered with his old doctor in Swindon, not here. Gethin's mum lives in Cardiff and hasn't been up for months."
●Your job (if asked about work or duties): "I'm in the toddler room, twelve children aged two to three. I change nappies, help with toilet training, sit with them at lunch and cut up the fruit and sandwiches at snack time. I get paid by the hour, so if I'm off I lose the money."

Ideas, Concerns, Expectations

Gating note: Orla does not raise any of the following herself. Each part comes out only when the doctor asks what she thinks is going on, what is worrying her, or what she was hoping for.

●Ideas: She thinks hepatitis A is caught abroad from dirty food, so she assumes she is safe because she did not go to Egypt and feels well. She thinks the jab is a holiday vaccine. "I wasn't even there, and I feel fine, so I'd have said I'm OK. I thought it was a holiday thing, from dodgy food. And I thought the jab was like a travel jab, for before you go away."
●Concerns: Her main worry is the children, some only just two. Her second is money and her manager Dawn, who is already short of staff. If asked more, she admits she is frightened for Gethin. "If I've got it and I pass it to the little ones, I'd never forgive myself. And Dawn's already short this week and I only get paid for the hours I do. I'm worried about Gethin too, honestly. He's never been ill like this."
●Expectations: "I just want you to tell me whether I can go in tomorrow, and sort out whatever jab the hospital meant." She did not know there might be a time limit.

If Asked: Medical History and Social Detail

Gating note: Orla answers each of these plainly when the doctor asks about it.

●Health: "I'm healthy. No liver problems, no immune problems, no allergies, and I've never had a reaction to a jab. Only the combined pill, nothing else."
●Pregnancy and lifestyle: "My period finished about a week ago, so I'm not pregnant, and we're not trying. A glass of wine at the weekend. I've never smoked."
●Home and work: She rents the flat with Gethin and Seb, with no children. Gethin has not worked since he became ill. Dawn needs the rota tonight. "I've been going to the hospital every evening after work, so I need to know whether I'm in tomorrow."

Responses to Management (The Negotiation Phase)

●
If the doctor says she can go to work tomorrow if she stays well, or that she should stay off until public health have been spoken to:
- ●Reaction: If told she can go in: surprised, then guarded relief. "Really? Even though I live with him? I don't want to be the one who brings it into the room. And do I have to tell Dawn?" If told to stay off: worried about money. "Off for how long? I only get paid for the hours I do. Is that definitely what I have to do?" If it is only until the doctor has rung public health and will ring back today: "Okay, as long as I hear before six tonight, because I've got to give Dawn the rota." Challenged that there is no risk to the children: "But I've been living with him the whole time he's been ill. Can you really promise that?"
●
If the doctor offers the jab, explains the time limit, or mentions blood tests or antibodies:
- ●Reaction: Surprised it is for her. "Today? Is it the same as a holiday jab? Will it make me poorly?" Satisfied once a sore arm and similar effects are explained. Told about the time limit: "Only a few days left? I'd never have known that. Thank goodness I rang." She says the ward nurse mentioned an injection with antibodies in it, and asks "Is that not what I need?" Accepts a clear explanation. Asked if she needs a blood test first: "Will that hold things up?"
●
If the doctor asks when she can come in, or explains a second dose:
- ●Reaction: Practical. "I can come before quarter past seven in the morning or after half past four. Anywhere in between I'm at work." About the second dose: "Another one in six months? Will someone remind me, or do I have to remember?"
●
If the doctor says the health protection team will be told, or asks what she will tell her manager:
- ●Reaction: Anxious about privacy. "Will they ring the nursery? I don't want everyone knowing my business." She calms if told what the team does and that she can choose what to tell Dawn, and is grateful for a short line to use.
●
If the doctor gives hygiene advice, or asks about Seb or visiting Gethin:
- ●Reaction: Given vague advice such as "keep washing your hands": "I do wash my hands. What exactly do I need to do differently? Do I need my own towel, or bleach in the bathroom?" About Seb: "He's at work till six. I'll tell him tonight. He's not registered here, so what does he do about the jab?" She asks whether she can still visit Gethin tonight.
●
If the doctor gives safety netting, discusses Gethin's outlook, or asks her to check herself:
- ●Reaction: Given vague safety netting such as "ring us if you feel unwell": "How long do I need to watch for? What exactly am I looking for?" Quiet about Gethin: "Is he going to be alright? Will it have done any damage to his liver?" She is steadied by an honest, balanced answer. Asked to check her eyes, skin or temperature, she declines politely: "I haven't got a thermometer. I can come in if you want to see me."

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 14 indicators checked+0−0

Positive (0/7)

Negative (0/7)

Domain 2: Clinical Management and Medical Complexity

0 / 20 indicators checked+0−0

Positive (0/10)

Negative (0/10)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

The Core Dilemma and the Model Plan

●Orla is a close contact of a confirmed case through household, shared food and bathroom, and sexual contact. She feels well and asks if she can work tomorrow in a toddler room.
●Two decisions follow: post exposure prophylaxis and how quickly, and whether contact status bars her from work. Current guidance gives hepatitis A vaccine inside a time limit, and no exclusion for a well contact who stays well and keeps strict hygiene. Exclusion applies to the case.
●Model plan: recognise the need for vaccine despite feeling well; book it today or tomorrow; single dose, no immunoglobulin and no blood test; phone the health protection team (HPT) the same day; give a work answer with hygiene and a symptom rule; arrange Seb; safety net; second dose; named callback.
●Also acceptable: holding her off work until you have spoken to the HPT, provided she is told when she will hear before tomorrow's shift. Counting the 14 days from his admission, last contact or first symptoms instead of the onset of jaundice also passes if she is vaccinated urgently.
●The time limit is the pressure point. A candidate who answers only the work question has missed what cannot wait.

Hepatitis A in Brief

●A faecal oral virus, spread person to person, through food and water, and sexually (UKHSA factsheet).
●Incubation is usually 28 to 30 days, with a range of 15 to 50 (Green Book chapter 17, January 2024).
●About 70 to 80% of adults become jaundiced, but young children are often asymptomatic, so toddlers can pass it on unnoticed. There is no specific treatment and liver failure is rare.
●The infectious period runs from 2 weeks before the first symptoms to 1 week after the onset of jaundice (or of dark urine, pale stools or first symptoms if there is no jaundice). Gethin's first symptoms began about 17 days ago and his jaundice 9 days ago, so he was infectious from about a month ago until about 2 days ago. Orla was exposed throughout.

Close Contacts and Immunity

●UKHSA (Hepatitis A public health management guidance, February 2024) defines close contacts as people at household type risk, with a low threshold: the same household or regularly sharing food or toilets, sexual contacts, and those who changed a case's nappies. Orla qualifies three ways and Seb by sharing the bathroom and meals. Nursery colleagues and children are not close contacts of Gethin and matter only if Orla becomes a case. "Were you on the holiday?" is a distraction.
●Immune, needing nothing: a complete vaccine course in the past 10 years, one dose in the past 12 months, or reliable evidence of past infection. Primed: any other vaccine history, who need vaccine but never immunoglobulin. Fully susceptible: no vaccine and no past infection. Orla is fully susceptible.

Post Exposure Prophylaxis

●Inactivated monovalent hepatitis A vaccine, as soon as possible and within 14 days of exposure, where trial efficacy approached that of immunoglobulin. Benefit is good but not absolute, so safety netting still matters.
●For continuous exposure such as a shared household, the 14 days run from the onset of the case's jaundice. For a single exposure they run from that day, and for intermittent exposure from the last day. Gethin's jaundice began 9 days ago, so about 5 days remain.
●A healthy contact aged 12 months to 59 years has a single dose, with a second dose 6 to 12 months later. One dose protects for up to about 12 months, and two doses for at least 25 years (Green Book). Day care staff with children not yet toilet trained may be at increased risk, which supports completing her course.
●Human normal immunoglobulin (HNIG) is added only for fully susceptible contacts aged 60 or over, with chronic liver disease including hepatitis B or C, or with immunosuppression including HIV with a CD4 count below 200, given within 14 days of last exposure and not more than 7 days after the first vaccine dose. Orla is 29 and healthy, so vaccine alone is right.
●No blood test is needed first. Anti HAV IgG is only an option before HNIG, and a test taken at the same visit without waiting for the result is fine. Pregnant and breastfeeding contacts are managed the same way. The only contraindication is confirmed anaphylaxis to a previous dose or component. Common effects are a sore arm, headache and tiredness.
●After 14 days, UKHSA still advises vaccine for all contacts in a household with more than one close contact, if seen within 8 weeks of the onset of jaundice.

Work, Nursery and Exclusion

●The case is excluded from work, school or nursery until 7 days after the onset of jaundice. The UKHSA settings guidance (September 2026) applies exclusion to infected people only.
●The Public Health England 2019 gastrointestinal infections guidance excludes a contact only if they are a food handler not immunised within 14 days of exposure, who cannot avoid unwrapped ready to eat food until 30 days after exposure and cannot achieve scrupulous hand hygiene. No guidance read excludes a well contact who works with young children, so a well nursery assistant is not excluded.
●Orla cuts fruit and makes sandwiches, so she is a possible food handler. Vaccinated within 14 days she has no restriction. Avoiding unwrapped ready to eat food until vaccinated is a sensible extra, not a requirement.
●If she develops symptoms she stops being a well contact: off work, tested, and the HPT assesses the nursery.
●The HPT risk assesses each setting. "I will speak to public health this afternoon and ring you back before your shift" is a reasonable alternative to "you can go in", but leaving her without an answer before the shift is not. A fixed exclusion of a week or more with no HPT instruction is unsupported.

Hygiene Advice

●Wash hands with soap and water after the toilet, after nappy changes or helping with toileting (immediately, for contacts who look after children), and before preparing or eating food. Clean shared bathroom and kitchen surfaces regularly. The same applies to Seb, and to Gethin when he comes home.
●Name the occasions rather than saying "wash your hands", and do not overpromise: hygiene lowers risk but does not remove it.
●She can visit Gethin: his infectious period ended about a week after his jaundice began, and she should follow the ward's hand hygiene.

Notification and the Health Protection Team

●Acute infectious hepatitis is notifiable and urgent: telephone the local UKHSA HPT within 24 hours and notify online within 3 days, without waiting for laboratory confirmation (UKHSA notifiable diseases guidance, May 2026). The hospital will usually have notified, but a GP who is unsure should check, because a call takes minutes and the HPT may not yet have reached Orla.
●The HPT risk assesses contacts and settings and often sends the GP a contact immunisation letter. Do not wait for the letter when time is short. Useful details for the call: the case's name and hospital, the date jaundice began, Orla's occupation and duties, her vaccine history and Seb's details. Tell the patient what is passed on and why, and follow GMC confidentiality guidance beyond the notification.

Safety Netting

●Orla may already be incubating and the vaccine is not a guarantee, so she should watch for up to about 7 weeks (50 days).
●Report fever, tiredness, nausea or vomiting, loss of appetite, tummy pain, dark urine, pale stools, and yellow eyes or skin. If any appear she stays off work, phones the surgery the same day for liver function tests and hepatitis A IgM, and the HPT is told and the nursery risk assessed.
●Acute liver failure is rare but needs 999 or A&E: confusion, drowsiness, vomiting blood, or easy bruising or bleeding. Seb should get the same advice.

Seb and the Second Dose

●Seb is a second close contact. He can be vaccinated by his registered doctor in Swindon, by a practice that registers him as a temporary resident, or by a route the HPT arranges. The HPT usually writes to each contact's registered practice asking for vaccine without delay.
●Record Orla's second dose at 6 to 12 months as a recall, together with her contact status, vaccine batch and date and the HPT conversation.

Common Candidate Mistakes in This Station

●Reassuring her that she is fine because she feels well or was not abroad, with no vaccine.
●Answering the work question and missing that vaccine is time limited, or booking a routine slot weeks away.
●Counting the 14 days from the wrong date, or not asking when the jaundice began.
●Offering immunoglobulin to a healthy 29 year old, sending her for blood tests before vaccinating, or never contacting the HPT.
●Excluding her from work for a week or more with no basis, or sending her in with no hygiene advice or symptom rule.
●Forgetting Seb, vague safety netting such as "ring us if you feel unwell", promising the children are completely safe, or forgetting the second dose.

Mapped to the RCGP curriculum topic: Infectious Disease and Travel Health.

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