In Philadelphia and other surrounding counties in NJ and PA, rapid increases in Hepatitis A virus (HAV) infections are occurring among persons who use drugs especially among those who are living homeless. Many other states have recently experienced similar HAV outbreaks that have lasted several months and were due to local, person-to-person transmission among at-risk groups. In Philadelphia, the HAV case count to date for 2019 has reached 91, with 73 (80%) cases reported since May. The majority (75%) of HAV cases reported since May are adults who reported drug use (injection or non-injection use of heroin, fentanyl, cocaine, and/or methamphetamine) including 26 (47%) persons who were experiencing homelessness. Local emergency departments/hospitals have diagnosed all but 2 recent cases.
With higher levels of HAV activity expected to continue, providers particularly those who serve patients who use drugs or are experiencing homelessness should:
- Vaccinate: Offer HAV vaccine to patients most at-risk for HAV infection or serious complications from HAV due to local transmission including:
- People who use injection or non-injection drugs
- People experiencing homelessness or unstable housing
- People who were recently incarcerated
- Men who have sex with men (MSM)
- People with chronic liver disease (cirrhosis, Hepatitis B, and Hepatitis C)
- People with HIV (New Advisory Committee on Immunization Practices’ Recommendation)
One dose of single-antigen HAV vaccine can be effective for outbreak control and 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.
- Identify and report cases: Consider HAV for any patient, particularly if at-risk, who has symptoms compatible with acute hepatitis even if presenting to care for other reasons. Promptly report acute HAV cases to PDPH by calling 215-685-6740 (after hours: call 215-686-4514).
- Recommend HAV control and prevention measures for cases:
- Offer HAV vaccine to susceptible, close contacts of cases (e.g., household members, sex partners, persons who shared drugs with the case). Guidance for use of post-exposure vaccine is available here.
- Advise HAV cases to take other steps to prevent transmission, such as hand washing, avoiding food preparation for others, condom use, and harm reduction practices while contagious (1 week after jaundice onset or if no jaundice, 2 weeks after illness onset).
- To learn more about the local situation, attend Hot Topics in Public Health: Resurgence of Vaccine Preventable Diseases and the Opioid Epidemic in Philadelphia on July 24, 2019 (click here for details).
Originally released by the Philadelphia Department of Public Health on July 19, 2019.
