Deadly Hepatitis A Outbreaks Across Multiple States

Recently, a number of jurisdictions in California, Kentucky, Michigan, and Utah have experienced unusually large and prolonged hepatitis A outbreaks that have resulted in dozens of deaths. Partnerships between public health departments, health centers, homeless assistance providers, and substance abuse prevention and treatment services including syringe services programs can all play vital roles in a community’s efforts to prevent or respond to an outbreak of hepatitis A.

The outbreaks have spread through person-to-person contact primarily among persons who are homeless and/or who inject drugs. As of December 13, 2017 more than 1,400 cases have been reported, resulting in almost 1,000 hospitalizations, and 41 fatalities. In fact, California is currently experiencing the largest person-to-person (not related to a common source or contaminated food product) hepatitis A outbreak in the United States since the hepatitis A vaccine became available in 1996. The number of new cases in each state continues to rise. Visit the CDC Updated Hepatitis A Outbreak page for more information.

Hepatitis A is transmitted through contact with feces from an infected person. In close, unsanitary conditions, the highly contagious virus can spread explosively. The California Department of Public Health has concluded that poor access to restrooms and sinks in homeless encampments is largely to blame for the outbreak in San Diego County.

Public health officials are concerned about the potential for similar outbreaks in other places, especially given high rates of mobility and transience among homeless populations and as winter’s colder weather approaches.

CDC recommends the following actions that can help prevent outbreaks of hepatitis A:

• Vaccinate vulnerable populations, especially homeless individuals and persons who inject drugs. CDC has issued Interim outbreak-specific guidance on hepatitis A vaccine administration)
• Educate people – vulnerable populations as well as service providers and others who interact with them – about hepatitis A, the recent outbreaks, and prevention opportunities. CDC has available:
  • Hepatitis A Information for the Public
  • Hepatitis A Information for Health Professionals
• Provide access to clean restrooms and hand-washing facilities for homeless individuals

In California, collaborative efforts have engaged homeless services providers familiar with the individuals living in encampments and public health staff knowledgeable about hepatitis A in coordinated street outreach to stop the spread of infections, and get homeless individuals vaccinated as well as off the street and into permanent housing. To connect with homeless services providers in your community, the U.S. Department of Housing and Urban Development [HUD] lists Continuum of Care planning bodies in local communities that develop and execute strategies to end homelessness. Click here to find the CoC in your area.