What You Should Be Reading: : Hepatitis

Hepatitis A Alert!

Sunday, December 17, 2017   (0 Comments)
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Since March of 2017, there has been an ongoing outbreak of Hepatitis A seen predominantly in the homeless population and among drug users.  State emergencies related to the outbreaks have been declared in California, Kentucky, Michigan, and Utah where the largest number of cases have been found in the urban areas of San Diego, Detroit, and Salt Lake City and the surrounding counties.  Some representative case totals from several states, which demonstrate the increase as reported to the CDC -

 

 

Cumulative number of cases for 2017

Cumulative number of cases for 2016

Total USA

2,503

1,795

California

741

203

Kentucky

31

20

Michigan

451

96

Utah

88

19

Florida

213

95

New York

181

90

 

Source: MMWR weekly report, Vol. 66, Nov 21 2017, Notifiable disease and mortality tables, #II             

 

The CDC has suggested that clinicians have a heightened awareness of Hepatitis A in the relevant populations, and significant efforts are being made to vaccinate large numbers of homeless individuals in some locations.  California has administered over 80,000 doses of the vaccine in the last 6 months.  The CDC is also recommending that samples from cases of confirmed Hepatitis A be submitted to the CDC Division of Viral Hepatitis Laboratory for outbreak monitoring.  It has been demonstrated that some patients in Utah and Kentucky match the Hepatitis A genotype 1B strain seen predominantly in San Diego.  It appears this strain may be more severe, as there is an approximate 70% hospitalization rate for these cases, compared to a 40% rate in seen in other previous outbreaks.  Whether this increased disease severity is due to the viral strain or alternatively due to lower resistance in the patient population or linked to higher rates of co-infection with other hepatitis viruses in the cases is yet to be determined. 

 

Check out the document available on the CDC website – Prevention of Hepatitis A through active or passive immunizations in MMWR 55(RR07); 1-23, May 19, 2006 for more information about vaccination.  Other information can be found at the cdc.gov/hepatitis/outbreaks web page and at multiple state and local public health department web sites.   Many departments are creating information flyers to be distributed to the at-risk population (click here to check out the one from Seattle-King County as an example). 

 

Simone Lanini, et al recently published in PLOS One (10 Nov 2017) data on a 2016 outbreak of Hepatitis A in 513 cases in the MSM community in Lazio, Italy (including metropolitan and the surrounding areas near Rome).  Molecular epidemiology studies demonstrated 5 distinct clusters of HAV subtype 1A strains, four of which had not been found in Lazio before.  Two of the clusters were similar to those obtained in other ongoing 2016 outbreaks, one in an MSM community in the United Kingdom and one in Romania.   Further studies may yield new information about transmission and the possible causes of localized Hepatitis A outbreaks.


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