Hepatitis A Outbreaks Are Cropping Up Again Nationwide

After a lull during the months long shutdown due to COVID-19, cases of hepatitis A virus are rising again in several states.

Hepatitis A is commonly transmitted through contaminated food and water—unlike hepatitis B and C, which are primarily transmitted through blood—but it can also spread from person to person through close contact and can be transmitted via shared drug injection equipment.

Hep A incidence (new cases) declined by more than 95% from 1995 through 2011 but then began to rise, according to the Centers for Disease Control and Prevention. Large person-to-person outbreaks began to occur in 2016.

While hep A outbreaks have often been linked to grocery stores and restaurants, in recent years clusters have increasingly been seen among people experiencing homelessness and people who inject drugs.

Since March 1, three counties in Maine have reported sharp rises in new cases, including six cases in York County, seven in Somerset County and 13 in Penobscot County. Injection drug use or insecure housing were identified as risk factors in all but five cases, according to the Maine CDC. At this rate, the state could equal or exceed the 45 cases reported in 2019, after a decade in which 10 or fewer cases were reported in a typical year. Other New England states are also experiencing outbreaks.

In Illinois, the Jefferson County Health Department received nine reports of hepatitis A in recent weeks. These people went to a hospital because of symptoms, but others may have had milder illness for which they did not seek care and therefore remain uncounted.

Florida reported 56 cases of hepatitis A during the first three weeks of June, bringing its total to over 660 for the year, according to the Florida Department of Health. At this rate, the state total is unlikely to reach the more than 3,000 cases reported in 2019, but it could exceed prior years, which had case numbers in the triple digits.

Louisiana has reported nearly 1,000 hep A cases in an ongoing outbreak that started in 2018. Clusters of three to five cases have occurred in dozens of parishes (the equivalent of counties), with larger clusters in Livingston, East Baton Rouge and Ouachita parishes. So far, the outbreak has led to three deaths.

Hep A resolves on its own and does not led to chronic infection, but in some cases it can cause serious illness. Symptoms may include fatigue, fever, loss of appetite, nausea and vomiting, abdominal pain, dark-colored urine, pale-colored stools and jaundice (yellowing of the skin and eyes).

Fortunately, hepatitis A can be prevented with a vaccine. The CDC recommends hep A vaccination for the following groups:

All children at age 1 to 2 years (or as young as 6 months if traveling to a country where vaccination is recommended)
Previously unvaccinated children and adolescents ages 2 to 18 years
People experiencing homelessness
People who use injected or noninjected recreational or street drugs
Men who have sex with men
People with chronic liver disease, including hepatitis B or C
People living with HIV
People who have an occupational risk for hepatitis A
Travelers up to age 40 visiting countries with medium or high rates of hepatitis A
People who have close contact with adopted children from such countries
People in direct contact with individuals known to have hep A
Anyone else who wishes to obtain immunity.