Hepatitis A Outbreak: What Clinicians Can Do 

The Centers for Disease Control and Prevention is requesting assistance from health care providers in responding to outbreaks of hepatitis A nationwide. The outbreaks are occurring primarily among people who use drugs, people experiencing homelessness, and men who have sex with men. Visits to a health care clinic represent an ideal opportunity to provide hepatitis A vaccination to people at highest risk of infection.  

Since August 2016, CDC has received reports of more than 31,093 hepatitis A cases, 18,989 (61%) hospitalizations, and 314 deaths associated with person-to-person transmission as of February 7, 2019. While hepatitis A infection is typically self-limited, morbidity and mortality in the current outbreaks are higher than what is normally reported. 

CDC is requesting your assistance to help control these hepatitis A outbreaks by vaccinating populations at risk: 

• People who use drugs (injection or non-injection) 
• People experiencing unstable housing or homelessness 
• Men who have sex with men (MSM) 
• People who are, or were recently, incarcerated 
• People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C 

One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years. 

• Pre-vaccination serologic testing is not required to administer hepatitis A vaccine. 
• Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable. 

CDC is also requesting health care providers to:  

• Consider hepatitis A as a diagnosis in anyone with jaundice and clinically compatible symptoms. If no alternative diagnoses are likely, serologic testing for acute viral hepatitis (including anti-HAV IgM) and liver function tests should be ordered 
• Do not test people without signs of acute hepatitis for hepatitis A; 
• Ensure all people diagnosed with hepatitis A are reported to the local health department in a timely manner. Screen patients for key risk factors (e.g., drug use, homelessness, men who have sex with me, and incarceration) and document their presence or absence in the medical record. 

For resources and more information about the widespread outbreaks of hepatitis A, please visit: www.cdc.gov/hepatitis/hepAoutbreak