Frequently Asked Questions: Hepatitis A outbreaks

What are the signs and symptoms of hepatitis A virus (HAV) infection?

Older children and adults typically have symptoms. If symptoms develop, they can appear abruptly and can include:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine (Brown in color)
• Diarrhea
• Light-colored stools
• Joint pain
• Jaundice (yellowing of the skin and eyes)

Does CDC recommend that anyone traveling to states with a hepatitis A outbreak be vaccinated against hepatitis A?

No. CDC does not recommend vaccinating people who do not have known risk factors for hepatitis A infection when they are traveling to U.S. states experiencing hepatitis A outbreaks. In accordance with the Advisory Committee on Immunization Practices for hepatitis A, adults at increased risk of hepatitis A infection (e.g., people who use drugs, people experiencing homelessness, or men who have sex with men), or people who are at increased risk of complications from hepatitis A (e.g., people with chronic liver disease) should be vaccinated, regardless of travel plans.

Who should get vaccinated against hepatitis A in states experiencing outbreaks?

The following groups are at highest risk for acquiring HAV infection or developing serious complications from HAV infection and should be offered the hepatitis A vaccine to prevent or control an outbreak:

• • People who use drugs (injection or non-injection)
  • People experiencing unstable housing or homelessness
  • Men who have sex with men (MSM)
  • People who are, or were recently, incarcerated
  • People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C

Who should be vaccinated against hepatitis A in places where there is no ongoing HAV outbreak?

The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis A vaccination for the following people:

Children

• All children aged 12–23 months
• Unvaccinated children and adolescents aged 2–18 years

Persons at increased risk for HAV infection

• International travelers
• Men who have sex with men
• Persons who use injection or noninjection drugs (i.e., all those who use illegal drugs)
• Persons with occupational risk for exposure
• Persons who anticipate close personal contact with an international adoptee
• Persons experiencing homelessness

Persons at increased risk for severe disease from HAV infection

• Persons with chronic liver disease
• Persons with human immunodeficiency virus infection

Other persons recommended for vaccination

• Pregnant women at risk for HAV infection or severe outcome from HAV infection
• Any person who requests vaccination

Implementation strategies for settings providing services to adults
Persons in settings that provide services to adults in which a high proportion of those persons have risk factors for HAV infection

Hepatitis A vaccination is no longer recommended by ACIP for persons who receive blood products for clotting disorders (e.g., hemophilia).

Are the number of hospitalizations and deaths associated with the outbreaks among people who use drugs and people who are homeless higher than usual? Why?

The numbers of hospitalizations and deaths during these person-to-person hepatitis A outbreaks have been higher than what is normally reported through national surveillance of hepatitis A. While routine childhood hepatitis A vaccination practices since 1996 have provided higher immunity protections in younger populations, many adults remain susceptible. Hepatitis A often results in severe disease among older people who are not immune from previous vaccination or community-acquired infection. Higher than expected hospitalization rates have been noted in the past among people with pre-existing chronic illnesses (i.e., diabetes, chronic liver disease, cirrhosis). Fulminant liver failure and death from hepatitis A infection are both rare, but are more common in older people when infected.

Are the outbreaks among people who use drugs and/or people who are experiencing homelessness spreading because of contaminated foods, drinks, or infected food handlers?

No. In these outbreaks, the virus is being spread from person-to-person primarily among people who use injection and non-injection drugs, people who are experiencing homelessness, and their close direct contacts. Although cases in food handlers occur, common sources of food or drinks have not been identified as potential sources of infection in the jurisdictions experiencing hepatitis A outbreaks.

Why does CDC not recommend all food handlers be vaccinated if an infected food handler can spread disease during outbreaks?

CDC does not recommend vaccinating all food handlers because doing so would not prevent or stop the ongoing outbreaks primarily affecting individuals who report using or injecting drugs and people experiencing homelessness. Food handlers are not at increased risk for hepatitis A because of their occupation. During ongoing outbreaks, transmission from food handlers to restaurant patrons has been extremely rare because standard sanitation practices of food handlers help prevent the spread of the virus. Individuals who live in a household with an infected person or who participate in risk behaviors previously described are at greater risk for HAV infection.

What should I do if I have eaten at a restaurant that has reportedly had a hepatitis A-infected food handler?

If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department who can help you to learn if you were recently exposed to hepatitis A virus at that restaurant, have not been vaccinated against hepatitis A, and might benefit from either hepatitis A vaccine or an injection of immune globulin. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.