2017 – Multi-jurisdiction outbreak of hepatitis A among people who are homeless and people who use drugs

Since March 2017, CDCs Division of Viral Hepatitis (DVH) has been assisting several state and local health departments with hepatitis A outbreaks, spread through person to person contact, that have occurred primarily among persons who are homeless, persons who use illicit drugs, and their close direct contacts. Information on local hepatitis A case counts and outbreak response is available on web pages for the locations affected by the outbreak (San Diego County, Santa Cruz County, Los Angeles County, Michigan, Utah).

For the current U.S. outbreaks among homeless and/or persons who use illicit drugs, CDC has encouraged state and local health departments to:

• Work with community partners to provide hepatitis A vaccine to homeless individuals, persons who use illicit drugs, and others with established risk factors who are not yet immunized
• Consider hepatitis A vaccination for persons with ongoing, close contact with homeless persons or persons who use illicit drugs

In response to these hepatitis A outbreaks, CDC has provided ongoing epidemiology and laboratory support as well as support on vaccine supply and vaccine policy development. On August 25, 2017, CDC notified all state and local health departments about the investigation of a cluster of hepatitis A, genotype IB infections in persons who are homeless and/or use illicit drugs. All U.S. jurisdictions were encouraged to be watchful for increases in hepatitis A cases and consider submitting recently confirmed hepatitis A virus (HAV) specimens meeting specific criteria to the CDC Division of Viral Hepatitis Laboratory.

More information on hepatitis A is available on the DVH website.

Symptoms:

• If you think you are infected with hepatitis A, contact your health-care provider.
  • Some symptoms of hepatitis A virus infection include:
    • Yellow eyes or skin
    • Abdominal pain
    • Pale stools
    • Dark urine

Advice to Public Health Officials

• Post exposure prophylaxis (PEP) is recommended for unvaccinated people who have been exposed to HAV in the last 2 weeks; those with evidence of previous vaccination do not require PEP. PEP consists of:
  • Hepatitis A vaccine for people aged 1-40 years
  • Hepatitis A virus-specific immunoglobulin (IG) for people outside of this age range. If immunoglobulin is not available, hepatitis A vaccine can be substituted

NOTE: CDC recommends that all children be vaccinated against hepatitis A at age 1 year.  Parents or caregivers who are unsure if a child has been vaccinated should consult the child’s health-care provider to confirm vaccination status.

General Hepatitis A Prevention

• CDC recommends the following groups be vaccinated for hepatitis A:
  • All children at age 1 year
  • Travelers to countries that have high rates of hepatitis A
  • Family members and caregivers of recent adoptees from countries where hepatitis A is common
  • Men who have sexual contact with other men
  • Users of injection and non-injection illegal drugs
  • People with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C
  • People who are treated with clotting-factor concentrates
  • People who work with hepatitis A infected animals or in a hepatitis A research laboratory

Guidance on administration of pre- and post-exposure hepatitis A virus prophylaxis

The dose of GamaSTAN™ S/D has recently been changed

Information on Vaccines Purchased with 317 Funds

Information on Vaccine Supply