The Centers for Disease Control and Prevention issued a Health Alert Network Advisory this week regarding Hepatitis A infections amidst a multi-state outbreak. The CDC is monitoring vaccine supplies, which some state and local health officials say have been constrained.

Outbreaks have been reported in California, Indiana, Kentucky, Michigan, Utah and West Virginia. The majority of the 2,500 cases are considered to be from the outbreak strain first identified in California. More than 40 people have died.

Of the infections and deaths reported between January 2017 and April this year, 68 percent were among those who reported drug use, homelessness or both. Thus, almost a third of the victims are outside of those high-risk groups

In response to the ongoing outbreaks, the CDC has issued guidelines to help clinicians identify and prevent new infections. These include the following.

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

An infected individual can be viremic, or have the virus present in his or her bloodstream, for as long a six weeks through their clinical course and excrete virus in stool for as long as two 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.

Vaccination against Hepatitis A is recommended for all children at age 1 and for people at increased risk for infection.

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