Avian Flu Diary: CDC HAN Update: Vaccination Recommendations For Widespread Hepatitis A Outbreaks Across Multiple States

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For more than a year we've been following the rising number of Hepatitis A infections across the nation, often (but not exclusively) reported among those who use injectable or non-injectable drugs, the homeless, and their close direct contacts. A couple of recent blogs include:

More Outbreaks Of Hepatitis A & Upcoming CDC COCA Call - November 2018

CDC HAN Advisory On Outbreak of Hepatitis A Virus (HAV) Infections among Drug Users & The Homeless - June 2018

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.

Yesterday afternoon the CDC released an updated HAN (Health Alert Network) Advisory which recommends the vaccination of at-risk groups against hepatitis A, applying the updated recommendations of the Advisory Committee on Immunization Practices (ACIP).

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

Distributed via the CDC Health Alert Network
March 25, 2019 1330 ET (1:30 PM ET)
CDCHAN-00418

Summary

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.

This Health Alert Network (HAN) update 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).

This is an update to the Health Alert Network (HAN) advisory released on June 11, 2018 titled Outbreak of Hepatitis A Virus (HAV) Infections among Persons Who Use Drugs and Persons Experiencing Homelessness (https://emergency.cdc.gov/han/han00412.asp).

Background

Multiple states across the country have reported outbreaks of hepatitis A, primarily among people who use drugs and people experiencing homelessness. Since these outbreaks were first identified in 2016, more than 15,000 cases and 8,500 (57%) hospitalizations have been reported. Hospitalization rates have been higher than typically associated with HAV infection.^{1, 2} Severe complications have also been reported, sometimes leading to liver transplantation or death; at least 140 deaths have occurred nationwide.

HAV is highly transmissible from person-to-person. States experiencing large-scale outbreaks have reported widespread transmission soon after their jurisdictions first recognized hepatitis A cases among populations being affected by these outbreaks. For many states, this has resulted in an unprecedented number of hepatitis A cases among unvaccinated adults since hepatitis A vaccine became available in 1996, and has led to prolonged community outbreaks that have been challenging and costly to control.

CDC recommends that public health departments, healthcare providers, and other partners serving affected populations launch a rapid and effective public health response with the following strategies.

Recommendations

Offer Vaccination to the Following Groups to Prevent or Control an Outbreak

The best way to prevent HAV infection is through vaccination with the hepatitis A vaccine. The following groups are at highest risk for acquiring HAV infection or developing serious complications from HAV infection in these outbreaks and should be offered the hepatitis A vaccine:

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.^{3, 4}

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.

New ACIP Recommendations since the June 2018 HAN00412 (https://emergency.cdc.gov/han/han00412.asp)

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.⁵

As of February 15, 2019, ACIP recommends hepatitis A vaccination for people experiencing homelessness.⁶

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