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Since March 2017 a number of states have been reporting community outbreaks of Hepatitis A - primarily among those who use injectable or non-injectable drugs, the homeless, and their close direct contacts.
Five months ago, in CDC HAN Advisory On Outbreak of Hepatitis A Virus (HAV) Infections among Drug Users & The Homeless, the CDC reported:
From January 2017 to April 2018, 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.8-11Since then, reports of community-wide outbreaks have continued, and on November 29th the CDC will hold a COCA Call for healthcare providers (Hepatitis A Outbreaks in Multiple States: CDC Recommendations and Guidance).
Overview
Hepatitis A is a highly contagious, vaccine-preventable, viral disease spread via a fecal-oral route or by exposure to contaminated food or water. Hepatitis A rates have declined substantially in the United States since the introduction of the hepatitis A vaccine in 1996.
However, since early 2017, the Centers for Disease Control and Prevention (CDC) has observed an increase in the number of community-wide hepatitis A outbreaks in multiple states. For these outbreaks, CDC recommends vaccination for persons who report drug use (injection and non-injection), persons at high risk for drug use (e.g., participating in drug substitution programs, receiving substance abuse counseling or treatment, recently or currently incarcerated), men who have sex with men, and persons experiencing homelessness.While Hepatitis A infection in a healthy adult usually results in a mild illness of a few week's duration - for some - particularly for those with compromised immune systems, it can be far more serious.
CDC also encourages vaccination in certain settings such as emergency departments and corrections facilities in outbreak-affected areas when feasible. During this COCA call, subject matter experts from CDC will discuss vaccination to stop these outbreaks and current CDC recommendations for the hepatitis A vaccine.
The CDC describes the way the virus spreads as:
Transmission / ExposureWhile relatively rare, food handlers who are infected with the virus can sometimes pass on the infection to their customers. This past week Mecklenburg County Public Health (North Carolina) issued the following alert after an employee from a local restaurant tested positive.
How is hepatitis A spread?
Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.
Contamination of food (this can include frozen and undercooked food) by hepatitis A can happen at any point: growing, harvesting, processing, handling, and even after cooking. Contamination of food or water is more likely to occur in countries where hepatitis A is common and in areas where there are poor sanitary conditions or poor personal hygiene. In the United States, chlorination of water kills hepatitis A virus that enters the water supply. The Food and Drug Administration (FDA) routinely monitors natural bodies of water used for recreation for fecal contamination so there is no need for monitoring for hepatitis A virus specifically.
Possible Public Hepatitis A Exposure at Village Tavern on Congress Street; Vaccination Clinics Scheduled
11/8/2018
Patrons who ate at Village Tavern in Charlotte on Oct. 30 should receive a hepatitis A vaccination as soon as possible.
Public Health Director Gibbie Harris announced today that the outbreak identified by the State and Centers for Disease Control earlier this year in Mecklenburg County has led 24 cases since Jan. 1, including a Village Tavern employee diagnosed Wednesday.
“After consulting with the State today, we are recommending a vaccination for all employees and exposed patrons who ate at Village Tavern located at 4201 Congress Street on Tuesday, Oct. 30,” Harris said. “According to the Centers for Disease Control (CDC), the vaccine must be given within 14 days of exposure for it to be effective.”
Public Health vaccination clinics for customers who might have been exposed and for residents who meet the high-risk factors for hepatitis A will be held at Mecklenburg County Health Department, 249 Billingsley Road:
Thursday, Nov. 8, 8 a.m. – 5 p.m.
Friday, Nov. 9, 8 a.m. – 5 p.m.
Saturday, Nov. 10, 9 a.m. – Noon
Sunday, Nov. 11, 9 a.m. – Noon
Monday, Nov. 12, 9 a.m. – Noon
Tuesday, Nov. 13, 8 a.m. – 5 p.m.
People who dined at Village Tavern on Oct. 30 are strongly urged to get a vaccination in the next six days.Yesterday the Tennessee Department of Health issued a statement on the recent (rare) death due to Hepatitis A, and warned that additional deaths were possible.
Public Health announced on June 6 that North Carolina Public Health officials and the CDC declared an outbreak of the liver disease in Mecklenburg County. Those who have had a hepatitis A infection, or one hepatitis A vaccination, are protected from the virus and do not need to take action.
The high-risk factors include:
The best ways to prevent hepatitis A include:
- Those who are household members, caregivers, or have sexual contact with someone who is infected with hepatitis A
- Men who have sexual encounters with other men
- Those who use recreational drugs, whether injected or not
- Recent travel from countries where hepatitis A is common
- Homeless individuals who do not have easy access to handwashing facilities
- Get the hepatitis A vaccine,
- Practice safe handwashing procedures – wash your hands under warm, soapy water for at least 20 seconds after using the bathroom or changing diapers and before you prepare food, and
- Wear a condom during sexual activity.
TDH Continues Response to Hepatitis A Outbreak
Wednesday, November 14, 2018 | 10:11am
NASHVILLE – The Tennessee Department of Health continues to investigate and respond to a hepatitis A outbreak impacting the state with more than 400 cases of illness to date. One death associated with this hepatitis A outbreak has been reported. The outbreak in Tennessee most heavily affects Nashville and Chattanooga.
“We are very saddened by the recent death associated with hepatitis A and realize unfortunately, we could see more deaths, as this continues to be a very serious outbreak with more than half of the people identified with the illness needing hospitalization,” said TDH Commissioner John Dreyzehner, MD, MPH. “We will continue to respond aggressively, vaccinating high risk populations, educating and working with partners in and out of Tennessee to seek additional ways to stem this outbreak.”
Tennessee’s hepatitis A outbreak is linked to a large, multi-state outbreak that began in 2017. This outbreak is primarily affecting recreational drug users and people experiencing homelessness.
Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus. It is usually transmitted from one person to another through contact with contaminated feces or consumption of contaminated food or water. The most at-risk groups for hepatitis A include recreational drug users, men who have sex with men and people experiencing homelessness. Many of the hepatitis A cases in the current outbreak are associated with recreational drug use.
“More than 36,000 doses of hepatitis A vaccine have been provided to those most at risk in our state and I believe this massive effort has made a huge difference in reducing the number of hepatitis A cases,” said TDH Assistant Commissioner for Communicable and Environmental Diseases and Emergency Preparedness Tim Jones, MD.
“We urge anyone in the high risk groups to get vaccinated as soon as possible, and will continue to work with state and local partners to provide hepatitis A vaccine to people at high risk for infection and educate people on how to prevent the spread of this disease.”For more on Hepatitis A, the CDC has a webpage:
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Hepatitis A Questions and Answers for the Public
