CDC Health Advisory About Outbreak of Hepatitis A Virus Infections among Persons Who Use Drugs and Persons Experiencing Homelessness

PUBLISHED: Jun 11, 2018
Relevant to: Ambulatory Care, Behavioral Health, Community Mental Health Centers, Critical Access Hospitals, Dialysis Facilities, Home Health, Hospitals, Long Term Care, Medical Office, Rural Health Clinics

The Centers for Disease Control and Prevention (CDC) and state health departments are investigating hepatitis A outbreaks in multiple states among persons reporting drug use and/or homelessness and their contacts. The CDC has issued a Health Alert Network (HAN) Advisory to alert public health departments, healthcare facilities, and programs providing services to affected populations about these outbreaks of hepatitis A infections and provides guidance to assist in identifying and preventing new infections.

From January 2017 to April 2018, the CDC has received more than 2,500 reports of hepatitis A infections associated with person-to-person transmission from multiple states. Of the more than 1,900 reports for which risk factors are known, more than 1,300 (68%) of the infected persons report drug use (injection and non-injection), homelessness, or both. During this time, responses conducted in various states resulted in increased vaccine demand and usage, resulting in constrained supplies of vaccine. As available vaccine supply has increased and progress has been made towards controlling ongoing outbreaks in some jurisdictions, vaccine is more readily available. However, both the CDC and vaccine manufacturers continue to closely monitor ongoing demand for adult hepatitis A vaccine in the United States.

CDC Recommendations for Health Care Providers:

  • Consider hepatitis A as a diagnosis in anyone with jaundice and clinically compatible symptoms.
  • Encourage persons who have been exposed recently to HAV and who have not been vaccinated to be administered one dose of single-antigen hepatitis A vaccine or immune globulin (IG) as soon as possible, within 2 weeks after exposure. Guidelines vary by age and health status (please see for additional information).
  • Consider saving serum samples for additional testing to assist public health officials in the investigation of transmission (i.e., confirmation of antibody test, HAV RNA test, genotyping, and sequencing). Contact the public health department for assistance with submitting specimens for molecular characterization.
  • Ensure all persons diagnosed with hepatitis A are reported to the health department in a timely manner.
  • Encourage hepatitis A vaccination for homeless individuals in areas where hepatitis A outbreaks are occurring.
  • Encourage hepatitis A vaccination for persons who report drug use or other risk factors for hepatitis A.
  • CDC recommends the following groups be vaccinated against hepatitis A:
    • All children at age 1 year
    • Persons who are at increased risk for infection:
    • Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A;
    • Men who have sex with men;
    • Persons who use injection and non-injection drugs;
    • Persons who have occupational risk for infection;
    • Persons who have chronic liver disease;
    • Persons who have clotting-factor disorders;
    • Household members and other close personal contacts or adopted children newly arriving from countries with high or intermediate hepatitis A endemicity; and
    • Persons with direct contact with persons who have hepatitis A.
    • Persons who are at increased risk for complications from hepatitis A, including people with chronic liver diseases, such as hepatitis B or hepatitis C.
    • Any person wishing to obtain immunity.

Follow the link below to access the Health Advisory, to review recommendations for Health Departments and to access links to additional resources.

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