CDC issues advisory on Hep A outbreaks in multiple states

The Centers for Disease Control and Prevention sent an advisory Monday alerting local public health agencies to a multiple-state Hepatitis A outbreak that has hit homeless populations and those who use drugs particularly hard.

Hepatitis A is a type of viral liver infection that causes inflammation and can range in effect from making someone feel ill for several weeks to death in some individuals, though it does not usually lead to lasting liver damage, according to the CDC. Between January 2017 and April 2018, the CDC received more than 2,500 reports of Hepatitis A infections associated with person-to-person transmission, according to Monday’s advisory. Of the 1,900 cases where the CDC was able to determine risk factors for infection, 1,300 — or 68 percent — were experiencing homelessness or were drug users.

Homeless populations and those who use drugs can be particularly vulnerable to contracting Hepatitis A for a number of reasons, including economic instability, limited access to health care, lack of sterile injection equipment and distrust of public officials. Outbreaks of Hepatitis A infections among homeless populations have occurred in other countries, but large outbreaks among the homeless have not been reported previously in the U.S., according to the advisory.

The Kenai Department of Public Health distributed the alert to doctors offices and other health care providers, Leslie Felts, nurse manager with the Alaska Division of Public Health in Kenai, said.

Health care providers who see symptoms of Hepatitis A — jaundice, fatigue, loss of appetite, vomiting, joint pain or dark urine — should perform a blood test to confirm a Hepatitis A infection, Felts said.

Hepatitis A is contracted through the ingestion of fecal matter from an infected person, and transmitted by hand-to-mouth contact. The best way to prevent infection is to wash hands thoroughly after using the bathroom, changing diapers or coming into contact with any kind of fecal material.

“It’s a very simple prevention, but very effective,” Felts said.

Alaska, which has not yet experienced an outbreak, has seen reports of Hepatitis A cases decrease significantly in the last four decades, as new vaccine recommendations and requirements have gone into effect.

Between 1973 and 2016, the Alaska Section of Epidemiology received 6,488 Hepatitis A case reports, according to a June 1, 2017 State of Alaska Epidemiology Bulletin. The majority of those cases took place before 1996, however, at an average rate of 74.7 cases per 100,000 people.

Between 1996 and 2001 — when Hepatitis A vaccine became part of the recommended childhood vaccination schedule — 4.4 cases per 100,000 people were reported. Hepatitis A rates per 100,000 people dropped to 0.6 cases per year for the period between 2002 and 2016, when the vaccine became a requirement of school and daycare enrollment.

Erin Thompson can be reached at

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