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Health Advisory: Hepatitis A Outbreak Intensifies in San Diego and Santa Cruz Counties

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September 11, 2017

From:  Edward L. Moreno, MD, MPH                         Kristy Michie, MS             
Health Officer    831-755-4585                                   Epidemiologist  831-755-4503    

 

Hepatitis A Outbreak Intensifies in San Diego and Santa Cruz Counties 

Medical providers are urged to vaccinate susceptible individuals who may be homeless, incarcerated, or use drugs illegally, as well as others at risk for infection.

Current Situation

The San Diego County Health and Human Services Agency reports an ongoing outbreak of hepatitis A virus (HAV) infections.  As of last week, 398 cases have been reported to San Diego County Health Officials.  Fifteen deaths have been attributed to the outbreak, and approximately 70% of cases required hospitalization.  Many cases, but not all, have been associated with homelessness, incarceration, or illicit drug use.  To date, no common food, drink, or drug source has been identified.  Santa Cruz County is also experiencing an outbreak of HAV.  Since April, the Santa Cruz County Health Services Agency reports that 67 individuals have confirmed HAV infections.  These cases share one or more of the following characteristics: illicit drug use (injection and non-injection), homelessness, and/or dense living conditions.  To date, there have been three reported cases of HAV infection among Monterey County residents, which is slightly more than expected compared to prior years’ morbidity patterns.   

Recommendations

  •  Order an IgM antibody test for HAV (IgM anti-HAV) for individuals who present with clinically compatible illness.
    • Total anti-HAV alone cannot distinguish between current disease, past disease, and vaccination-induced immunity.
    • IgM anti-HAV testing should be limited to individuals with evidence of clinical hepatitis.  Due to a high rate of false positives, it should not be used as a screening tool for asymptomatic patients or for patients without clinically compatible illness.
  • Report suspected cases promptly to the Health Department (phone: 831‑755‑4521; fax: 831-754-6682; after hours call 831-755-5100 and ask for the Hazardous Materials Team, who will link you with the on-call Health Officer).  Early reporting leads to prompt preventative interventions among close contacts and limits the spread of disease.  
  • Promote vaccination among your patients.  Vaccination now can prevent an outbreak in Monterey County.  People who should be routinely immunized with HAV vaccine include: 
    • All children between their first and second birthdays (12 through 23 months of age).
    • Anyone 1 year of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A, such as those located in Central or South America, Mexico, Asia (except Japan), Africa, and eastern Europe.
    • Men who have sex with men.
    • People who use drugs illegally.
    • People with chronic liver disease.
    • People who are treated with clotting factor concentrates.
    • Members of households planning to adopt a child, or care for a newly arriving adopted child, from a country where hepatitis A is common.

In addition, due to the ongoing outbreak in Santa Cruz County, Monterey County Health Officials recommend vaccination of the following groups to help prevent a local outbreak:

    • Homeless individuals or individuals in transitional housing.
    • Individuals who work closely with homeless people and illicit drug users on a frequent and ongoing basis, such as those who work or volunteer at homeless services agencies and syringe exchange programs. o   Incarcerated individuals.
    • Clients of substance abuse treatment programs.
    • Health care workers who provide ongoing direct medical care to homeless individuals and/or illicit drug users. 

If you have additional questions or concerns, please call the Monterey County Health Department’s Communicable Disease Unit at 831-755-4521, visit our website at http://www.co.monterey.ca.us/government/departments-a-h/health/diseases/hepatitis-a, or refer to the Centers for Disease Control and Prevention’s (CDC’s) hepatitis A website: https://www.cdc.gov/hepatitis/hav/index.htm.


 Health Alert:  Warrants immediate action or attention.   Health Advisory:  Provides information for a specific incident or situation; may not require immediate action. Health Update:  Provides updated information regarding an incident or situation; unlikely to require immediate action 

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