SUMMARY POINTS
- Hepatitis A is increasing in Philadelphia especially among persons who use drugs, those living homeless, and MSM.
- Take every opportunity to vaccinate high risk persons.
- Consider acute HAV infection among patients presenting with compatible symptoms.
- Promptly report acute cases to PDPH.
On May 20, 2019, Pennsylvania declared a statewide outbreak of Hepatitis A Virus (HAV) and joined a growing list of states experiencing widespread transmission since March 2017. In Philadelphia, there have been 63 confirmed HAV cases since 2017. The 2019 HAV case count through May (n=23) has surpassed previous annual case totals since 2005. Among cases from 2019, median age was 28 years (range: 17–50 years) and 70% were male. Of 20 HAV cases from 2019 that were acquired locally, 30% reported current drug use, 10% reported past drug use only, 10% were experiencing homelessness, and 15% identified as men who have sex with men (MSM). During May, nearly all cases (5/6) reported current opioid use including persons who also use other drugs (methamphetamine, cocaine) and/or are experiencing homelessness. HAV vaccination is the most important strategy to prevent further increases in HAV.
HAV Prevention and Control:
Providers should use all opportunities to routinely give HAV vaccine to all children at age 12-23 months and to any person wishing to obtain immunity, as well as the following persons at high risk for exposure to HAV:
- Persons who use injection and non-injection drugs
- Men who have sex with men
- Persons experiencing homelessness or unstable housing
- Persons who are or were recently incarcerated
One dose of single-antigen HAV vaccine leads to a protective response in 95% of healthy individuals for up to 11 years. Two doses given at least 6 months apart provide life-long immunity. Providers may also use TWINRIX for adults ≥18 years old. TWINRIX combination vaccine requires 3 doses (0,1 and 6 months) for full protection. Vaccines for Children (VFC) and Vaccines for Adults at Risk (VFAAR) providers should continue to order HAV vaccine through the PhilaVax inventory module. If you have any questions about accessing vaccine as a VFC/VFAAR provider, contact Jillian Brown: [email protected].
Case ascertainment: Prompt recognition of HAV is also important to control transmission and allow time-sensitive administration of post-exposure prophylaxis (PEP) to exposed contacts. One dose of single antigen HAV vaccine given within 2 weeks of last exposure can prevent infection in healthy contacts aged ≥12 months who lack HAV immunity and have no HAV vaccine contraindications.
ALL confirmed and suspected Hepatitis A cases should be promptly reported to PDPH at 215-685-6740 during regular business hours or 215-686-4514 after-hours. PDPH can provide details on local risk factors, diagnostic testing, and disease control recommendations. For further information about the current outbreak, HAV vaccine recommendations and post-exposure prophylaxis guidance, please also see: https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm.
Originally released by the Philadelphia Department of Public Health Division of Disease Control on May 31, 2019.
