Background: 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.

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: