Public Health

30 states have hepatitis A outbreaks: What doctors should know

There have been widespread outbreaks of hepatitis A nationwide. Many people think hepatitis A is spread through contaminated food and water. But in the U.S., it is more commonly spread from person to person, which is what is happening in the current outbreaks. Fortunately, vaccinating people who are at risk can help stop the spread. Find out what physicians can do to prevent or control outbreaks.

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Since 2016, when the outbreaks were first identified, 30 states have publicly reported more than 28,000 cases of hepatitis A, linked to over 17,000 hospitalizations and 285 deaths. When looking at the current hepatitis A outbreak, the states with the highest number of cases are in the states hard hit by the opioid epidemic:

  • Kentucky: 4,966.
  • Ohio: 3,381.
  • Florida: 3,446.
  • Tennessee: 2,704.
  • West Virginia: 2,577.
  • Indiana: 2,219.

In response to the hepatitis A outbreaks across the country, the Centers for Disease Control and Prevention (CDC) provides ongoing epidemiology and lab support, as well as vaccine supply and policy development.

Among adults, the hepatitis A infection results in substantial costs in medical care and work loss, the CDC says. About 60% of people with hepatitis A in these outbreaks are hospitalized as inpatients.

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Know who is at risk

There’s a growing need for all physicians to screen patients to determine who is at the highest risk for acquiring the hepatitis A virus or developing serious complications from the infection. People who fall into the high-risk category for hepatitis A during these outbreaks are ones who:

  • Use illicit drugs—injection or noninjection.
  • Are experiencing unstable housing or homelessness.
  • Are men who have sex with men.
  • Are incarcerated, or who recently were incarcerated.
  • Have hepatitis B or hepatitis C or chronic liver disease, including cirrhosis.

The 2019 recommended immunization schedule from the CDC’s Advisory Committee on Immunization Practices added homelessness as an indication for routine vaccination after a hepatitis A outbreak in San Diego. During that 2017–2018 outbreak, nearly 600 people were infected and 20 died.

San Diego health officials found homelessness was independently associated with two to three times higher odds of hepatitis A infection. This population also had two to four times higher odds of severe hepatitis A outcomes, specifically hospitalization and death.

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Vaccination is best protection

Hepatitis A is currently among the most frequently reported vaccine-preventable diseases in the U.S. Although children are now routinely vaccinated against hepatitis A, many adults remain unvaccinated. According to the 2017 National Health Interview Survey, only 10.9% of adults 19 or older have received two or more doses of the hepatitis A vaccine.

Before the introduction of the vaccine in 1996, incidence followed a cyclic pattern with peak incidence occurring every 10–15 years. Since 2006, the vaccine has been recommended for all children at age 1. But that means many adults did not receive the hepatitis A vaccine as a child and are not protected against the disease.

While the full two-dose series is needed for long-term protection, one dose of the hepatitis A vaccine has been shown to control outbreaks. One dose of the vaccine provides up to 95% seroprotection in healthy adults for up to 11 years. Prevaccination serologic testing is not required to administer the hepatitis A vaccine. People who are at risk for hepatitis A should get vaccinated as soon as possible.

Providing a recommendation can play a key role in patients getting the hepatitis A vaccine. For this reason, physicians should recommend the vaccine at every available opportunity.

If the hepatitis A vaccine is not available in your health care organization, the CDC recommends contacting your local health department to find out how and where to refer high-risk patients in need of vaccination in your community.