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Updated Hepatitis A Outbreak Guidance

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Published on December 26, 2017. Last modified on May 14, 2020

Health Update

December 26, 2017

 

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

 

Updated Hepatitis A Outbreak Guidance

 

Current Situation

There is an ongoing outbreak of hepatitis A virus (HAV) disease in California primarily among persons experiencing homelessness or using illicit drugs in settings of limited sanitation.  The outbreak is being spread person-to-person and through contact with fecally-contaminated environments. In San Diego County, at least 571 HAV cases and 20 deaths have been reported since November 2016.  In Santa Cruz County, at least 76 cases have been reported since April 2017, with 1 death. 

In Monterey County, 10 individuals have been diagnosed with hepatitis A this year.  Eight are believed to be linked to the outbreaks in San Diego and Santa Cruz Counties.  Of these individuals, 5 have strains of HAV that are the same as the outbreak strains in San Diego and Santa Cruz Counties.  Six of the individuals did not travel and so are assumed to have become ill due to transmission within Monterey County.  Monterey County Health Department is working with medical providers, businesses, and homeless service providers to educate individuals about HAV and how to prevent transmission, vaccinate homeless individuals and illicit drug users, and promote disinfection of areas frequented by these populations. 

Recommendations

  • Immediately report suspected cases to the Monterey County Health Department. Prompt reporting limits the spread of disease. Please notify the Health Department while the patient is still at the health care facility, as this may be the Health Department’s only opportunity to interview the patient.
    • Monday thru Friday, 8 am – 5 pm, call 831‑755‑4521 or 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. 

     

  • 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. 
    • Save the patient blood specimen for submittal to the Monterey County Public Health Laboratory for additional testing.
  • Vaccinate individuals at risk for HAV. Due to local transmission of HAV in our county, the Monterey County Public Health Officer recommends the following groups be vaccinated with the hepatitis A vaccine:
    • People who are homeless.
    • Users of illegal drugs.
    • Men who have sex with men.
    • People with chronic liver disease, such as cirrhosis, hepatitis B, or hepatitis C. They may not be at increased risk of getting hepatitis A but are at increased risk of poor outcomes if infected.
    • People with ongoing, close contact with the homeless and/or illegal drug users (e.g., work in homeless shelters, provide medical services to homeless individuals).

     

  •  Continue to offer routine vaccination to the following groups.
    • Travelers to countries where hepatitis A is common.
    • People with clotting factor disorders.
    • People who conduct laboratory research with the virus.
    • People in close personal contact with adopted children from countries where hepatitis A is common.

If adult single antigen hepatitis A vaccine is not immediately available, providers may consider using the combined hepatitis A and hepatitis B vaccine (Twinrix®) for pre-exposure prophylaxis or deferring immunization until additional vaccine becomes available. Vaccine may also be available in pharmacies and is covered as a pharmacy benefit for several insurance sources, including Medi-Cal fee for service and managed care, as well as several qualified health plans through Covered California. (See http://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_26320.asp)

  • Continue to offer routine vaccination to children against HAV.At this time, pediatric vaccine supplies are ample and recommendations for routine childhood immunizations are unchanged.

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 www.mtyhd.org/hepA, or refer to the California Department of Public Health’s hepatitis A website: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Hepatitis-A.aspx.


 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