The CDC and state health departments are investigating hepatitis A outbreaks in multiple states among people who are homeless and/or use drugs, the agency announced.
The CDC received more than 2,500 reports of hepatitis A infections associated with person-to-person transmission from multiple states from January 2017 to April 2018. Among more than 1,900 reports for which risk factors are known, more than 1,300 (68%) reported injection and noninjection drug use, homelessness, or both, the agency said in a June 11 health alert.
Recommendations for clinicians from the CDC include the following.
- Consider hepatitis A as a diagnosis in anyone with jaundice and clinically compatible symptoms.
- Encourage patients with recent exposure to hepatitis A who have not been vaccinated to receive one dose of single-antigen hepatitis A vaccine or immune globulin (IG) as soon as possible, within two weeks after exposure. Guidelines vary by age and health status.
- Consider saving serum samples for additional testing to assist public health officials in the investigation of transmission.
- Ensure that all patients who are diagnosed with hepatitis A are reported to the health department in a timely manner.
- Encourage hepatitis A vaccination for homeless individuals in areas where hepatitis A outbreaks are occurring and for persons who report drug use or other risk factors for hepatitis A.
In the U.S., hepatitis A virus is usually transmitted person to person via the fecal-oral route, such as eating something that has been contaminated with the feces of an infected person, the CDC said. It can also be transmitted by contaminated needles and other injection paraphernalia, certain types of sexual contact and practices, or generally poor sanitary conditions.
Symptoms of hepatitis A infection include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice. Atypical and rare extrahepatic manifestations include rash, pancreatitis, renal disease, arthritis, and anemia. Severe infections can cause cholestatic hepatitis, relapsing hepatitis, and fulminant hepatitis leading to death.
Average incubation is 28 days, but illness can occur up to 50 days after exposure. A person infected with hepatitis A can be viremic for up to six weeks through their clinical course and excrete virus in stool for up to two weeks before becoming symptomatic, making identifying exposures particularly difficult. Illness from hepatitis A is typically acute and self-limited; however, when this disease affects populations with already poor health (such as those with hepatitis B and C infections or chronic liver disease), infection can lead to serious outcomes, including death, the CDC said.