Hepatitis A is a now vaccine-preventable disease thanks to the hepatitis A vaccine that was first licensed in 1995.
Despite being added to the childhood immunization schedule in 1996 (kids living in high risk areas at first and gradually expanded to all kids in 2006), we do continue to see outbreaks of hepatitis A.
Hepatitis A
Although they are all viruses that can cause hepatitis, hepatitis A doesn’t share too much in common with hepatitis B and C.
Unlike hepatitis B and C, hepatitis A:
- often doesn’t cause any symptoms at all in very young children
- is spread by fecal-oral transmission (not blood and body fluids), typically from one person to another or after eating or drinking contaminated food or water
- is much less likely to cause complications, but still did cause over 100 deaths from fulminant hepatitis A each year
In older children and adults, they symptoms of hepatitis A can include jaundice, fever, malaise, anorexia, nausea, abdominal discomfort, and dark urine, all of which can linger for up to two to six months.
Hepatitis A Epidemics and Outbreaks
In the prevaccine era, before the mid-1990s, hepatitis A outbreaks were common and “hepatitis A occurred in large nationwide epidemics”
After it became a nationally reportable disease in 1966, we saw peaks of hepatitis A disease in the early 1970s and again in the early 1990s and an estimated 180,000 infections per year in the United States.
Not surprisingly, those large nationwide epidemics soon disappeared as hepatitis A vaccination rates rose.
“Vaccination of high risk groups and public health measures have significantly reduced the number of overall hepatitis A cases and fulminant HAV cases. Nonetheless, hepatitis A results in substantial morbidity, with associated costs caused by medical care and work loss.”
CDC on the Epidemiology and Prevention of Vaccine-Preventable Diseases
We do still see some hepatitis A outbreaks though, including:
- a multistate outbreak in 2013 linked to pomegranate seeds from Turkey (162 cases and 71 hospitalizations)
- a multistate outbreak in 2016 linked to frozen strawberries (143 cases and 56 hospitalizations)
- an outbreak in Hawaii in 2016 linked to raw scallops (292 cases and 74 hospitalizations)
Since 2017, there have been clusters of hepatitis A outbreaks in at least 15 states, including California, Utah, New Mexico, Missouri, Arkansas, Louisiana, Michigan, Indiana, Ohio, Kentucky, West Virginia, Tennessee, North Carolina, Massachusetts, and Florida.
The Arkansas outbreak, which includes at least 247 cases and 2 deaths since February 2018, includes exposures at a Taco Bell, a Subway restaurant, a gas station, a catfish restaurant, a BBQ restaurant, On the Border Mexican Grill & Cantina, Little Caesar’s Pizza, Red Lobster, and a Steak ‘n’ Shake.
In Kentucky, of 3,122 cases and 19 deaths, although most of the cases are related to illicit drug use, many have no outbreak related risk factors and there have been exposures from workers in restaurants and grocery stores, including an Applebee’s, Kroger, Denny’s, White Castle, Taco Bell, and an Arby’s.
Many of recent outbreaks are among men having sex with men, among IV drug users, and the homeless, but they can lead to exposures in people with no risk factors.
These have included fatal outbreaks in Arkansas, Ohio, West Virginia, Kentucky, Utah, Michigan, California, Indiana, and Colorado.
From historic lows, we were up to at least 11,166 hepatitis A cases in the United States in 2018.
Getting Hepatitis A
You can get hepatitis A if you are not immune and you are exposed in one of these outbreaks. Still, hepatitis A cases are at historic lows, with about 1,390 cases being reported in 2015.
Even more commonly, you might get hepatitis A if you are not immune and travel to a part of the world where hepatitis A either has high or intermediate endemicity (many people are infected), including many parts of Africa, Mexico, Central and South America, Eastern Europe, and Asia.
Or you could just be exposed to someone who traveled to or from one of these areas, became infected, and is still contagious.
Avoiding Hepatitis A
How can you avoid getting caught up in one of these hepatitis A outbreaks?
Can’t you just wash your hands or avoid eating contaminated food? Since you can get hepatitis A by simply eating food that has been prepared by someone who has hepatitis A and is still contagious, washing your own hands won’t be enough. Even drinking bottled water when traveling might not protect you from contaminated water if you use ice cubes or wash fruits and vegetables in water that might be contaminated.
Remember, if your child did not get a routine 2-dose series of the hepatitis A vaccine when they were between 12 to 23 months old, they can still get one at any time to get immunity against hepatitis A infections.
“On February 25, 2009, the Advisory Committee on Immunization Practices (ACIP) recommended routine hepatitis A vaccination for household members and other close personal contacts (e.g., regular babysitters) of adopted children newly arriving from countries with high or intermediate hepatitis A endemicity.”
ACIP on the Latest Hepatitis A Vaccine Recommendations
Adults can get the vaccine too.
It is an especially good idea if you are not immune and will be traveling out of the United States or are in another risk group, including food handlers, daycare workers, health care workers, and people who consume high risk foods, especially raw shellfish.
“Simultaneous administration of MMR and HepA vaccines is recommended for infants aged 6–11 months traveling internationally.”
Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel
In fact, infants should get an early dose if they are at least six months old and will be traveling out of the United States.
What to Know About Hepatitis A Outbreaks
With all of the recent outbreaks of hepatitis A, it is an especially good idea to make sure that your family is vaccinated and protected.
More Information on Hepatitis A Outbreaks:
- CDC – Hepatitis A Outbreaks in the United States
- CDC – Hepatitis A Outbreak Health Advisory (2018)
- Prevent Hepatitis A: Get Vaccinated Before You Travel
- Ask the Experts about Hepatitis A Vaccines
- Hepatitis A Vaccine Questions and Answers
- Hepatitis A ACIP Vaccine Recommendations
- Pinkbook – Hepatitis A
- Yellowbook – Hepatitis A
- Hepatitis A Prevention Mandates for Daycare and K-12
- MMWR – Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel
- WHO – Hepatitis A Fact Sheet
- CDC WONDER On-line Database. Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1979-1998 and 1999-2015.
- Study – Incidence of Hepatitis A in the United States in the Era of Vaccination
- CDC – 2017 – Outbreaks of hepatitis A in multiple states among people who are homeless and people who use drugs
- MMWR – Hepatitis A Virus Outbreaks Associated with Drug Use and Homelessness — California, Kentucky, Michigan, and Utah, 2017
- Kentucky Is Urging People to Get Hepatitis A Vaccines in the Midst of an Outbreak
Updated on January 9, 2019