Hepatitis A

The Illinois Department of Public (IDPH) has declared an end to the statewide community hepatitis A person-to-person outbreak that resulted in 276 cases, 182 hospitalizations, and one death. These cases were not associated with international travel and are not foodborne related. Several of the cases were among individuals at high risk for infection, including men who have sex with men (MSM), persons experiencing homelessness, persons who use drugs, and/or persons who are currently or were recently incarcerated.

IDPH officials declared a statewide outbreak in December 2018 and were able to later trace outbreak-related cases back to September 1, 2018. Illinois was one of more than 30 states that experienced an outbreak of hepatitis A associated with person-to-person transmission since 2016.

IDPH and local health departments presented information and distributed resources to organizations and partners who provided services to at-risk populations as part of the statewide response to end the hepatitis A outbreak. Vaccination events started in December 2018 and remain ongoing in order to prevent another outbreak. Although the outbreak is over, IDPH anticipates hepatitis A cases will continue to be reported, albeit at a smaller frequency. Typically, 2-3 cases are reported each month and are largely travel related.

**Men that have sexual contact with other men

In May 2019, the Centers for Disease Control and Prevention (CDC) provided an updated case definition resulting in an increase in the number of outbreak cases in Illinois. IDPH and local health departments continue to investigate reported hepatitis A cases.
The high-risk populations for hepatitis A in this outbreak include:

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

To protect Illinois' residents, IDPH recommends hepatitis A vaccination for those individuals most at risk — including men who have sex with men (MSM), persons experiencing homelessness, persons who use drugs and/or persons who are currently or were recently incarcerated. People who believe that they are at high risk for hepatitis A infection should contact their health care provider or local health department for information about vaccination. People who know that they have been exposed to someone with hepatitis A should contact their health care provider or local health department to discuss post-exposure vaccination options. Individuals who experience symptoms of hepatitis A should contact their health care provider.

What is hepatitis A?
What are the symptoms of hepatitis A?
How is hepatitis A transmitted?
What are the risk factors for hepatitis A?
How can you prevent hepatitis A?
How is hepatitis A treated?
Who should you talk to about a hepatitis A vaccine?
What can health care providers do about hepatitis A?
What has IDPH done about hepatitis A?

Hepatitis A is a vaccine-preventable, infectious liver disease caused by the hepatitis A virus. Itis passed easily from one person to another through food, water, drug use, and sex.It can range from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is a self-limiting disease that does not cause chronic infection.

Symptoms of hepatitis A include:

• Fever

• Fatigue

• Loss of appetite

• Nausea and/or vomiting

• Abdominal pain

• Dark urine

• Clay-colored poop

• Joint pain

• Jaundice (yellowing of the skin or eyes)

Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.

Although anyone can get hepatitis A, certain groups have a higher risk, such as:

• People with direct contact with someone who has hepatitis A

• Men who have sexual contact with men

• People who are homeless

• People who use drugs, both injection and non-injection drugs

• People who are incarcerated

• Travelers to countries where hepatitis A is common

The best way to prevent hepatitis A is through vaccination. The hepatitis A vaccine is a two-dose series, although one dose will still provide a significant amount of protection. Practicing good hand hygiene also prevents the spread of hepatitis A.

Unvaccinated individuals with recent exposure should receive the hepatitis A vaccine or a shot of immune globulin to prevent severe illness. There is no treatment for hepatitis A aside from treating symptoms through rest, fluids and adequate nutrition.

If you are at a higher risk for contracting hepatitis A, talk with your health care provider about vaccination.

Alternatively, IDPH is working with 56 local health departments around the state covering 59 counties to make hepatitis A vaccine more readily available. IDPH has requested a large number of hepatitis A vaccines from the CDC. That vaccine is being delivered to numerous local health departments across Illinois to be available for free or at a reduced cost for people at the greatest risk of becoming infected.

Do you or someone you know fit into one of these groups?

• Use drugs or is a close contact to someone who uses drugs

• Homeless or a close contact to someone who is homeless

• A man who has sex with men or a close contact to a man who has sex with men

• In treatment or counseling for substance abuse

• Receiving drug substitution and/or drug court

• Works or has been detained in a jail or a detention center

If YES to any of the above please ask about being vaccinated against Hepatitis A today. You may be eligible for a free to low cost hepatitis A vaccine.

If health care providers identify any suspected cases of HAV, especially within these high-risk groups, it is important to confirm cases with serologic testing (IgM) and promptly report them to your local health department (LHD).

The HAV vaccine is safe, and highly effective. To prevent hepatitis A, CDC recommends the following groups be vaccinated for HAV:

• All children at age 1 year
• Travelers to countries that have high rates of hepatitis A
• Family members/caregivers of recent adoptees from countries where HAV is common
• Men who have sexual contact with other men
• Users of injection and non-injection illegal drugs
• People with chronic (lifelong) liver diseases, such as hepatitis B or C
• People who are treated with clotting-factor concentrates
• People who work with infected animals or in a HAV research laboratory

Recently, ACIP voted unanimously to add “homelessness” as an additional indication for ACIP-recommended HAV vaccination (1). We recommend all providers screen their patients and provide HAV vaccine when indicated. While two doses are recommended to complete the series, even one dose provides nearly 95% immunity for at least several years

In the fall of 2017, the Illinois Department of Public Health (IDPH) issued a memo regarding multiple outbreaks of hepatitis A in the U.S. So far in 2018, many of these outbreaks are still ongoing and additional outbreaks have been reported in several states such as Indiana, Michigan and Kentucky. These outbreaks are predominantly occurring in the homeless populations and in persons who use injection and non-injection drugs (IDU), along with close contacts of both groups. Additional outbreak clusters have also been identified in men who have sex with other men (MSM) and persons who are or have recently been incarcerated. On June 5, 2018, IDPH sent a memo to local health departments and medical providersencouraging the continuation of testing, reporting and vaccination of populations at risk for Hepatitis A.

• Five Cases of Hepatitis A in Illinois (12/4/18)
• Hepatitis A PSA (9/10/18)
• Hepatitis A Cases are Increasing (7/27/18)

• CDC Nationwide outbreak resource page
• HAV Questions and answers for the public
• Hepatitis A General Information - CDC
• Viral Hepatitis Information for Gay & Bisexual Men - CDC
• Hepatitis A Get Vaccinated - English - IAC
• Hepatitis A Get Vaccinated - Spanish - IAC
• Wash Your Hands - English - CDC
• Wash Your Hands - Spanish - CDC

• CDC HAN
• Interim outbreak vaccine guidance
• FAQ for health care professionals
• FAQ regarding outbreak
• Standing Orders for Administration of Hepatitis A Vaccine for Adults - IAC
• Hepatitis A Vaccine Information Statement - English
• Hepatitis A Vaccine Information Statement - Spanish
• Hepatitis A Vaccine Information Statement - Other Languages

• Hepatitis A Poster
• Hepatitis A Hand Washing Flyer
• Local Health Departments and Clinics Offering Vaccines
• Preventing Hepatitis A Outbreaks In Jails
• January 2019 Memo - Hepatitis A Guidance for Healthcare Providers
• December 2018 Memo - Hepatitis A Outbreak in the United States
• June 2018 Memo - Hepatitis A Outbreak in the United States
• Oct 2017 Memo - Hepatitis A Outbreak in the United States
• Infographic - Hepatitis A Overview
• Infographic - Hepatitis A Prevention and Control
• Infographic - Hepatitis A Guidance for Health Care Providers