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For the better part of two years we've been following the rapidly growing 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 few past blogs include:
CDC HAN Update: Vaccination Recommendations For Widespread Hepatitis A Outbreaks Across Multiple States
COCA Call On Multi-State Hepatitis A Outbreak
CDC HAN Advisory On Outbreak of Hepatitis A Virus (HAV) Infections among Drug Users & The Homeless - June 2018The latest national surveillance numbers (as of July 26th) from the CDC show an increase of more than 2,000 hospitalizations and 27 deaths over the previous month's numbers (see June CDC Update).
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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.
On Thursday (Aug. 1st) , the city of Philadelphia - citing a sudden spike in cases since May - declared a Public Health Emergency. In their announcement (City Declares Public Health Emergency to Address Rise in Hepatitis A), they reported:
- Thus far in 2019, the Philadelphia Department of Public Health (the “Department”), Division of Disease Control, has confirmed 154 reports of acute Hepatitis A disease compared to an expected 3 reports as observed between January and July from 2013 to 2017;
- The vast majority of the 2019 cases of Hepatitis A in Philadelphia have occurred since May (85%), where preliminary investigations indicate high proportions among adults who report using drugs (67%), or report experiencing homelessness (26%), provided that these risk factors are expected to increase as more investigations are completed;
Florida, unfortunately, has - and yesterday afternoon the state's Surgeon General, Dr. Scott Rivkees declared it a public health emergency. The announcement from Florida Health:
Florida Surgeon General Scott A. Rivkees Issues Public Health Emergency in Response to Hepatitis A Outbreak
August 01, 2019
NewsMedia@flhealth.gov(Continue . . . )
(850) 245-4111
Tallahassee, Fla. — Today, Florida Surgeon General Dr. Scott Rivkees declared a Public Health Emergency to address the increase in Hepatitis A cases in Florida due to the current national outbreak. The declaration builds upon the Public Health Advisory that was issued by the Florida Department of Health (FDOH) on November 18, 2018 and reemphasizes the importance of the Hepatitis A vaccination as the best way to prevent Hepatitis A infection.
To provide information to the public, FDOH has launched a dedicated webpage for Hepatitis A: FloridaHealth.gov/hepa. On this page, visitors can find general information, frequently asked questions, and surveillance data from FDOH, as well as fact sheets for the general public, health care providers, and food service workers. For questions about Hepatitis A, the department has also established a dedicated email address:HepA@flhealth.gov, and information line: 1-844-CALL-DOH (1-(844) 225-5364), available Monday – Friday, 8 a.m. – 5 p.m.
"I am declaring this Public Health Emergency as a proactive step to appropriately alert the public to this serious illness and prevent further spread of Hepatitis A in our state,"said Florida Surgeon General Dr. Scott Rivkees. "The best way to prevent hepatitis A is through vaccination. It is important that we vaccinate as many high-risk individuals as possible in order to achieve herd immunity. I will continue to work with Governor DeSantis and Lieutenant Governor Jeanette Nuñez to take proactive steps to protect the health of Florida's residents and visitors.”
Pursuant to the Public Health Emergency, the Florida Department of Health (FDOH) will request assistance from the Centers for Disease Control and Prevention (CDC).
This declaration signals to health care providers the importance of screening and vaccination for all individuals considered at high risk for contracting Hepatitis A. While anyone can contract hepatitis A, individuals who are considered by the CDC and FDOH to be high risk include: those who are experiencing homelessness; intravenous and non-intravenous drug users; men who have sex with other men; individuals in an emergency room or other acute care setting, after being administered an opioid antagonist, such as naloxone; individuals working with homeless persons or intravenous drug users outside of health care settings; and first responders.
The declaration also recommends vaccination for individuals or who are at heightened risk for suffering serious complications from contracting hepatitis A. This includes individuals with chronic liver disease, clotting factor disorders, and individuals over 60 years of age with a serious underlying medical condition, as determined by their health care provider, in critically impacted counties.
In Florida, the critically impacted counties are: Brevard, Citrus, Glades, Hernando, Hillsborough, Lake, Liberty, Manatee, Marion, Martin, Okeechobee, Orange, Pasco, Pinellas, Sumter, Taylor, and Volusia. Hepatitis A case counts for 2019 thus far have already surpassed those in 2018. From January 1, 2019 through July 27, 2019, 2,034 hepatitis A cases were reported.
Through this declaration of a Public Health Emergency, the State Surgeon General reminds all individuals to practice good handwashing procedures to prevent further spread of Hepatitis A. All individuals should wash their hands with soap and water for at least 20 seconds, especially after using bathrooms, changing diapers, and before preparing or eating food. Additionally, the declaration emphasized the importance of consistent sanitation practices for public and private facilities with restrooms and showers. The Department of Health has created detailed infographics for sanitation practices designed to prevent the spread of Hepatitis A. These infographics and additional resources are available at FloridaHealth.gov/hepa.
Admittedly, the recent spike in Hepatitis A across the country is a worrisome trend, but it is important to put it into historical perspective. Prior to the release of the first Hepatitis A vaccine in 1995, we routinely saw numbers far higher than we are seeing today.
From a 2005 JAMA report:
Incidence of Hepatitis A in the United States in the Era of Vaccination
Annemarie Wasley, ScD; Taraz Samandari, MD, PhD; Beth P. Bell, MD, MPH
National Trends in Hepatitis A Incidence
During the 35 years from 1966 through 1995, there were 2 cycles of hepatitis A incidence with peaks occurring in 1971 (59 000 cases; 29/100 000) and 1989 (36 000 cases; 14/100 000), and corresponding nadirs in 1983 (22 000 cases; 9.2/100 000) and 1992 (23 000 cases; 9.1/100 000) (Figure 1).
The CDC has advice for high risk individuals who should consider getting the vaccine at :
Frequently Asked Questions: Hepatitis A outbreaks
For the general public, however, the risks remain pretty low.
Still these outbreaks are another reminder why performing good hand hygiene should be a year-round practice, and that if you are in a high risk group, you should get the vaccine.
