Overview

More than half of states across the country have reported outbreaks of hepatitis A. Since first identified in 2016, more than 27,000 cases with over 60% hospitalizations and at least 270 deaths have been reported. Transmission of Hepatitis A occurs by fecal-oral route.


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 February 1, 2018 health alert) and continues to monitor reports of hepatitis A closely given the rapid growth of outbreaks across the country (updated case counts per CDC).

Symptoms: Symptoms 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, CDPH is asking all adult healthcare providers to vaccinate the following high risk groups:

  • Homelessness or transient housing
  • Men who have sex with men (MSM)
  • Persons who use drugs (injection or non-injection)
  • Persons with a history of incarceration
  • Persons with chronic liver disease
  • Persons living with HIV
  • Travelers
  • Persons with clotting-factor disorders
  • Persons who work with non-human primates
  • Persons who anticipate close personal contact with an international adoptee
Pre-vaccination serologic testing is not required to administer vaccine. Vaccination should not be postponed if patient history or records cannot be obtained or are unavailable.

Information for Providers

CDC Acute Hepatitis A Case Definition, 2019

Have a low threshold to report clinical suspicion for Hepatitis A in high-risk individuals.

If you are in the Emergency Department (ED) and have clinical suspicion for hepatitis A in a high-risk individual, use the Hepatitis A ED reporting form.

Given national outbreaks, vaccinate all high-risk patients for Hepatitis A now. Consider repeating non-reactive (NR) IgM results in one week for clinically consistent cases.

For clinical questions, please call the CDPH Provider Reportable Disease Hotline: 312-743-9000.

Information For Vaccinators

Resources for Vaccinators

Hepatitis A Patient Evaluation and Management for ED and Outpatient Providers

Hepatitis A Vaccination - Information for Providers

Emergency Department Hepatitis A Vaccination Program FAQ

Standing Orders for Administering Hepatitis A Vaccine to Adults

Hepatitis A Vaccine Information Statement (VIS)

Manufacturer’s Vaccine Assistance Program

Merck Vaccine Patient Assistance Program provides vaccine for uninsured adults (19 years or older). Call 1-800-293-3881 from 7:00 a.m. to 7:00 p.m. CST, Monday through Friday or click here.

 

Hepatitis A Vaccine Locations in Chicago

Hepatitis A vaccine is available and provided by Howard Brown Health Center and CDPH Immunization Clinics.

 

Hepatitis A Across the State of Illinois (IDPH)

 

Hepatitis A Case Counts in the United States (CDC)

As of February 22, 2020:

Hepatitis A Update

Chicago Hepatitis A Case Data

(September 2018 - December 2019)

Outbreak-Related Cases

54

Hospitalizations

41 (75.9%)

Deaths

0

Last Updated: February 14, 2020

Chicago Hepatitis A Task Force (CHART) Newsletters

 

Information For Providers And Patients

Educational Materials

Fact Sheets

CDC General Hepatitis A (English)

CDPH General Hepatitis A (English) (Spanish)

CDC Viral Hepatitis Information for Gay and Bisexual Men (English)

Hepatitis A for Volunteers with Direct Contact with High-Risk Groups (English)

Hepatitis A for Food Handlers (English)

Hepatitis A Disinfection Tip Sheet (English)

Posters

Why Should You Care About Hepatitis A? - English
Porque Debe Importarle La Hepatitis A? - Spanish

TouchCards

TouchCard – English and Spanish (Side A) (Side B)

CDPH Hepatitis A Health Alerts

Related Links

Hepatitis-A Reporting

For Clinical Questions or to Report Suspect Cases, Contact:

The CDPH Disease Reporting Hotline at
312-743-9000

*After hours, weekends, and holidays, call 311 and ask for the communicable disease physician on-call (or 312-744-5000 if outside the City of Chicago)

Per the Control of the Communicable Disease Code of Illinois, Hepatitis A cases must be reported to CDPH within 24 hours.

CDPH Case Report Form (preferred)

Communicable Disease Hepatitis Surveillance

312-746-6388 (Fax)

If your organization would like to:

Laboratory Testing

Please save all reactive Hepatitis A IgM specimens for 30 days. View CDC’s Letter Re: Submission of Patient Specimens to CDC for Hepatitis A Testing (April 26, 2019) for further guidance.

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Hepatis-A Contacts

CDPH Provider Disease Reporting Hotline

312-743-9000

Communicable Disease Hepatitis Surveillance

312-743-9000 (Phone), 312-746-6388 (Fax)