Hepatitis A Outbreaks in the United States
Multiple states across the country have reported outbreaks of hepatitis A, primarily among people who use drugs and people experiencing homelessness. Since the hepatitis A outbreaks were first identified in 2016, 30 states have publicly reported the following as of January 10, 2020: 30,003 cases, 18,271 (61%) hospitalizations, and 304 deaths. CDC provides updates on state-reported outbreaks here.
The Health Department is taking preventive steps in response to neighboring states Massachusetts and New Hampshire experiencing hepatitis A outbreaks by offering immunization clinics at shelters and syringe services programs.
Requested actions of health care professionals:
- Hospital emergency departments and urgent care centers should offer hepatitis A vaccine to susceptible individuals.
- Clinical and community-based agencies providing services to people experiencing homelessness and those with substance use disorder, especially those injecting drugs, should work with Health Department local health offices to increase hepatitis A vaccination among at-risk individuals. Public health nurses from District Offices can provide on-site clinics for susceptible individuals at homeless shelters, syringe services programs and other locations.
- Check patients’ vaccination status in the Vermont Immunization Registry. Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable. Enter vaccine doses administered into the Vermont Immunization Registry.
- Primary care providers should continue their efforts to vaccinate all children and teens with two doses of hepatitis A vaccine. Data from the Vermont Immunization Registry indicates that statewide, only 56% of children aged 13-17 years are fully vaccinated against hepatitis A and less than 15% of adults aged 19-64 years old have received a dose of hepatitis A vaccine.
- Refer uninsured individuals to local health offices for free vaccination.
- Report suspected cases of hepatitis A infection and hepatitis A IgM positive laboratory findings to the Epidemiology Program 24/7 at 802-863-7240.
Hepatitis A Vaccine
Hepatitis A vaccine is highly safe and effective. A complete hepatitis A vaccine series provides long-term protection against hepatitis A infection. One dose of single-antigen hepatitis A vaccine provides up to 95% seroprotection in immunocompetent individuals. Pre-vaccination serologic testing is not required to administer hepatitis A vaccine.
Hepatitis A vaccination is recommended routinely for children at age 12-23 months. It's also recommended for people who are at increased risk for hepatitis A infection and for anyone wishing to obtain immunity. People at increased risk for hepatitis A infection include:
- International travelers to areas with high or intermediate hepatitis A endemicity.
- Men who have sex with men.
- People experiencing homelessness.
- People who use injection and noninjection drugs.
- People who are currently or were recently incarcerated.
- People with chronic liver disease.
- People with a clotting factor disorder.
- People who work with hepatitis A-infected primates or with hepatitis A in a research laboratory setting.
Tools, fact sheets and guidelines
- Hepatitis A Vaccination: Information for Health Care Providers (CDC)
- Hepatitis A Vaccination Coverage Data (Vermont Immunization Registry)
Outbreak updates and advisories
- Health Advisory (January 15, 2020)
- Health Advisory (July 30, 2019)
- Increase in hepatitis A virus infections (MMWR, CDC)
- Massachusetts Hepatitis A Outbreak
- New Hampshire Hepatitis A Outbreak
- Widespread outbreaks of hepatitis A among people who use drugs and people experiencing homelessness across the United States (CDC, HAN)
- Map of reported outbreaks across the United States (CDC)