Hepatitis A Outbreak Situation Update
Homelessness has been added as an indication for Hepatitis A vaccine. The 2019 Immunization Schedule published by the Advisory Committee on Immunization Practices includes this new risk factor.
California was part of a multi-state hepatitis A outbreak that began as early as March 2017 and occurred primarily among persons who use injection and non-injection drugs, and/or persons experiencing homelessness. While there has been a significant slowdown in reported hepatitis cases across California, Los Angeles County experienced three cases in late 2018. Alameda County does not have reported outbreak associated cases at this time. The vigilance and actions of providers and partners is critical to prevent a hepatitis A outbreak in our jurisdiction. We encourage all medical providers to please continue to:
- BE AWARE of hepatitis A symptoms
- ASK about hepatitis A risk factors
- VACCINATE all individuals in risk groups for hepatitis A disease
- REPORT all suspected and confirmed hepatitis A cases immediately to the Public Health Department
What is Hepatitis A?
Hepatitis A is a vaccine-preventable contagious disease caused by the Hepatitis A virus. It causes acute inflammation of the liver (hepatitis means inflamed liver) and does not become a chronic condition unlike other Hepatitis infections such as B, C or D. After an individual is infected with Hepatitis A they cannot catch it again as the body develops antibodies to protect against future exposures.
Signs and symptoms may include:
- Loss of appetite
- Abdominal pain
- Dark urine
- Clay-colored bowel movements
- Joint pain
- Jaundice (yellowing of skin or eyes)
How is Hepatitis A spread?
The hepatitis A virus is usually spread by putting something in your mouth that is contaminated by the stool (poop) of another person who is infected with hepatitis A.
Hepatitis A is contracted through:
- household contact with an infected person
- sexual contact with an infected person
- eating or drinking contaminated food or water
- sharing eating utensils that are contaminated
- touching contaminated surfaces and then placing your hands near or in the mouth
Who is at risk for Hepatitis A infection: 2-dose vaccine series
Administer hepatitis A vaccine to any person exposed to a case of hepatitis A (household/sexual contact) and continue to vaccinate all persons in the following risk groups:
- Persons with chronic liver disease
- Men who have sex with men
- Injection or non-injection drug use
- Persons currently experiencing homelessness
- Persons traveling to or working in countries where hepatitis A is common
What can I do to protect myself?
Immunization is the best protection
It is recommended that children 12 months through 18 years of age be given the two dose vaccine series. A single dose vaccine is effective protection for most healthy adults and is especially recommended for those travelling to an area where Hepatitis A is endemic.
Practice good hand hygiene
Because so many cases of hepatitis A are due to close contact with an infected person, you should always practice good personal hygiene. The simple act of washing your hands can protect you against Hepatitis A and other diseases.
What should I do if I think I have been exposed to Hepatitis A?
If you believe you were exposed to Hepatitis A contact your health care provider or local health department. If you were recently exposed to Hepatitis A virus and have not been vaccinated against it, an injection of Hepatitis A vaccine may be recommended and needs to be given within first two weeks after exposure to be effective. Consult with your health care provider to collaborate on making the best decision for you and your family.
- Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness
- ACPHD & BPH Joint Health Advisory: Discharge Guidelines for Patients Experiencing Homelessness (1/31/2019)
- CDC educational materials to support the outbreak at the state and local levels
- Los Angeles County Hepatitis A Information
- Environmental Health General Disinfection Guidelines for Hepatitis A for Food Facility and Non Food Facility
- Full ACPHD & BPH Joint Update: Hepatitis A Outbreak and Vaccine Update
- CDPH All Facilities Summary Letter (10/17/17)
- CDPH Postexposure Prophylaxis guidance
- CDPH Preventing Hepatitis A In Non-Medical Facilities (1/16/2019)
- CDPH - Hepatitis A Environmental Sanitation Resources
- CDPH Hepatitis A Web Page
- Hepatitis A Fact Sheet