The Centers for Disease Control and Prevention (CDC) has issued a Health Alert Network Advisory regarding outbreaks of hepatitis A infection among individuals reporting drug use and/or homelessness. 

Of the 2500 cases of hepatitis A infection reported between January 2017 and April 2018, 68% were among persons who reported drug use (injection and non-injection), homelessness, or both. In response to these outbreaks, the CDC has issued guidelines to assist clinicians in identifying and preventing new infections. These include: 

  • Consider hepatitis A as a diagnosis in anyone with jaundice and clinically compatible symptoms. 
  • Encourage persons who have been exposed recently to hepatitis A virus and who have not been vaccinated to be administered 1 dose of single-antigen hepatitis A vaccine or immune globulin (IG) as soon as possible, within 2 weeks after exposure. 
  • Consider saving serum samples for additional testing to assist in the investigation of transmission.
  • Ensure all persons diagnosed with hepatitis A are reported to the health department in a timely manner.
  • Encourage hepatitis A vaccination for homeless persons in areas where hepatitis A outbreaks are occurring.
  • Encourage hepatitis A vaccination for persons who report drug use or other risk factors for hepatitis A.

An infected individual can be viremic up to 6 weeks through their clinical course and excrete virus in stool for up to 2 weeks prior to becoming symptomatic. Symptoms may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice.

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Vaccination against hepatitis A is recommended for all children at age 1 and for individuals at increased risk for infection. Vaccines currently licensed in the US are the single-antigen vaccines Havrix (GlaxoSmithKline) and Vaqta (Merck) and the combination vaccine Twinrix (GlaxoSmithKline); GamaSTAN S/D (Grifols Therapeutics) IG is approved for hepatitis A virus prophylaxis.  

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This article originally appeared on MPR