Chicago Health Alert Network

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• Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. It can range from a mild illness lasting a few weeks to a severe illness lasting several months. Although rare, hepatitis A can cause death in some people. 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.

• Backgound: Since March 2017, the CDC’s Division of Viral Hepatitis (DVH) has been assisting several state and local health departments with hepatitis A outbreaks occurring primarily among persons who use injection and non-injection drugs, and/or persons who are homeless.  While Chicago Department of Public Health (CDPH) managed a small cluster of cases in late 2017 and reported on an increase in activity among Men who have sex with men (MSM) [see health alerts below] like other jurisdictions experiencing outbreaks, activity has decreased in 2018.  CDPH continues to monitor reports of hepatitis A closely given the rapid growth of outbreaks in surrounding states.  Michigan, Kentucky, West Virginia, Indiana, Missouri, Ohio, Tennessee and Arkansas are all experiencing large outbreaks (links to updated case counts).  The 2017-2018 outbreaks continue to have high rates of hospitalizations and death compared to previous hepatitis A outbreaks in the US, especially among individuals with pre-existing chronic liver disease.  Timely reporting and continued vaccination of high risk groups is necessary to prevent a hepatitis A outbreak from spreading to Chicago. . 

  Symptoms: Symptoms of HAV include a viral prodrome of fatigue, malaise, fever, muscle aches, followed by nausea, vomiting, diarrhea (more common in children), abdominal pain and hepatitis (elevated serum aminotransferase levels) which can be associated with darkening of urine, pale-colored stools, and yellowing of the skin (jaundice) and/or eyes (scleral icterus). The most common symptom in adults is jaundice (>70%). Transmission occurs by fecal-oral route. Liver failure and death are more likely to occur in persons over the age of 50 years and those with chronic liver disease.

  Prevention: In order to protect Chicago’s highest risk individuals, Chicago Department of Public Health is asking all adult healthcare providers to vaccinate the following high risk groups with any hepatitis A vaccine currently in stock.
  • Homelessness or transient housing
  • Men who have sex with men
  • Users of injection and non-injection drugs
  • History of incarceration
  • Persons with chronic liver disease
  • Travelers*
  • Persons with clotting-factor disorders
  • Persons who work with non-human primates
  • Persons who anticipate close personal contact with an international adoptee

       PROVIDERS:

• - Have a low threshold to report clinical suspicion for hepatitis A in high risk individuals to Chicago Department of Public Health (CDPH). High risk individuals include those who are homeless or living in transient housing, men who have sex with men, users of injection and non-injection drugs, and/or individuals with a history of incarceration.
• - Use this Hepatitis A ER reporting form if you are in the ER and have clinical suspicion for hepatitis A in a high risk individual.
• - In the setting of national outbreaks, vaccinate high risk patients for hepatitis A now.
• - Consider repeating non-reactive (NR) hepatitis A IgM results in one week for clinically consistent cases.

• LABORATORIES:

• Save all reactive hepatitis A IgM specimens for 30 days.

Notice to Vaccinate High Risk Adults with Hepatitis A Vaccine Amid Ongoing National Hepatitis A Outbreaks  issued October 24, 2017

Call for Suspected Hepatitis A cases Among High Risk Groups in Chicago and Request to Save Laboratory Specimens  issued Nov 3. 2017

Guidance for Emergency Department Physicians to Prevent Further spread of Hepatitis A in Chicago  issued Dec 7, 2017

Increase in Hepatitis A among Men Who Have Sex with Men (MSM) issued Feb 1, 2018

CDC:

Prevention of Hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR 2006;55(No. RR-7):1-23

Hepatitis A Outbreak Information:
San Diego County 
Southeastern Michigan