Widespread Outbreaks of Hepatitis A among People Who Use Drugs and People Experiencing Homelessness across the United States

PUBLISHED: Mar 26, 2019
Relevant to: All Healthcare Organizations

According to the US Centers for Disease Control and Prevention (CDC), multiple states across the country have reported outbreaks of hepatitis A, primarily among people who use drugs and people experiencing homelessness. Since the hepatitis A outbreaks were first identified in 2016, more than 15,000 cases, 8,500 (57%) hospitalizations, and 140 deaths as a result of hepatitis A virus (HAV) infection have been reported.

The CDC has issued an updated Health Alert Network (HAN) notice that recommends that public health departments, healthcare facilities, and partners and programs providing services to affected populations vaccinate at-risk groups against hepatitis A, applying the updated recommendations of the Advisory Committee on Immunization Practices (ACIP).

General Recommendations:

  • Offer Vaccination to the Following Groups to Prevent or Control an Outbreak:
    • People who use drugs (injection or non-injection)
    • People experiencing homelessness
    • Men who have sex with men (MSM)
    • People who are, or were recently, incarcerated
    • People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C
  • One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years.
  • Pre-vaccination serologic testing is not required to administer hepatitis A vaccine. Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable.
  • Be aware of new ACIP Recommendations:
  • As of November 2, 2018, ACIP recommends hepatitis A vaccine for post-exposure prophylaxis (PEP) for people 12 months of age and older. Providers may also administer immunoglobulin to adults older than 40 years of age, if indicated, and persons who are immunocompromised or have chronic liver disease.
  • As of February 15, 2019, ACIP recommends hepatitis A vaccination for people experiencing homelessness.

Recommendations for Healthcare Providers:

  • Screen patients for risk factors (e.g., drug use, homelessness, incarceration, MSM, and chronic liver disease).
  • Recommend and administer hepatitis A vaccine to at-risk patients, regardless of the original presenting complaint or the type of clinical facility. In particular, the emergency department may be an individual’s only interaction with the healthcare system and is an important opportunity for prevention.
  • Record immunizations in the state immunization information system (registry).
  • Consider hepatitis A as a diagnosis in anyone with jaundice or clinically compatible symptoms.
  • Rapidly report all persons diagnosed with hepatitis A to the health department to ensure timely case investigation and follow-up of contacts.

The CDC’s Health Advisory also includes recommendations for health departments and information on case investigation, contact tracing, and outbreak response monitoring. Follow the link below for additional information.

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