Hepatitis A Virus Outbreaks Surge in Various Cities, and the EU

The outbreak of hepatitis A, already the nation’s largest in many years, could continue for months, even years.

Hepatitis A cases have erupted across the country this year, sending the number of U.S. cases soaring 28 percent from 2016. 

Dr. Monique Foster, a medical epidemiologist with the Division of Viral Hepatitis at the U.S. Centers for Disease Control and Prevention (CDC), said this hepatitis outbreak could continue to linger even with enhanced education, and adequate vaccine supplies.

This forecast has worried many health officials across the USA, and into Europe.

On August 25, 2017, the CDC’s Division of Viral Hepatitis (DVH) notified all state and local health departments about the investigation of a cluster of hepatitis A, genotype IB infections. 

When requested, the CDC sends “disease detectives” to assist health departments develop and implement vaccination plans..

As of early November 2017, Hepatitis A cases have been reported in states, including: California, Michigan, Utah, Florida and 11 European countries. 

Hepatitis A virus is spread through person to person contact and have occurred primarily among persons who are homeless, persons who use drugs, men who have sex with men (MSM) and their close direct contacts, according to the CDC.

Hepatitis A is a virus spread by fecal contamination that can lead to a potentially deadly liver infection.

But, hepatitis A is considered preventable.

The unexpected surge in 2017 has lead to a “constrained supply” of the vaccine needed to stop it, according to the CDC.

The demand for adult Hepatitis A vaccine has increased substantially over the past 6 months and vaccine supply to meet this unexpected demand in the US has become constrained.

US-licensed manufacturers of Hepatitis A vaccine for adults (GlaxoSmithKline and Merck Vaccines) report that unexpected demand globally has also constrained supplies for this vaccine outside the US.

In addition, Merck reported that its adult Hepatitis A vaccine is temporarily unavailable.

But, these constraints do not apply to the pediatric Hepatitis A vaccine supply in the US. Children are routinely vaccinated between their first and second birthdays.

In general, the hepatitis A vaccine is recommended to:

• adult travelers to countries that have high rates of hepatitis A;
• users of illegal drugs;
• people with chronic liver diseases, such as hepatitis C;
• men who have sexual contact with other men; and
• people who work with animals infected with hepatitis A

CDC has provided interim outbreak-specific guidance on hepatitis A vaccine administration. According to the CDC, second-dose efforts can be delayed in times of vaccine shortages.

A first vaccine dose is 90-percent to 95-percent effective, and a second dose practically guarantees immunity.

Post exposure prophylaxis (PEP) is recommended for unvaccinated people who have been exposed to hepatitis A virus in the last 2 weeks; those with evidence of previous vaccination do not require PEP.

PEP consists of:

• Hepatitis A vaccine for people aged 1-40 years
• Hepatitis A virus-specific immunoglobulin (IG) for people outside of this age range. If immunoglobulin is not available, hepatitis A vaccine can be substituted.

Researchers have reported that implementing an extensive ‘catch-up’ vaccination program for hepatitis A patients may not be cost effective.

The Hepatitis A vaccine is an inactivated (killed) vaccine, according to the CDC. There are three FDA approved monovalent hepatitis A vaccines:

• Vaqta (Merck) and Havrix (GlaxoSmithKline), are approved for people ≥12 months of age in a 2-dose series
• A combined hepatitis A and hepatitis B Twinrix, (GlaxoSmithKline) vaccine is approved for people ≥18 years of age in the United States. 

Individuals can obtain hepatitis A immunizations through primary care physicians and most pharmacies. Pharmacies, such as CVS, have increased their focus on hepatitis vaccinations.

The CDC Vaccine Price List provides current vaccine information.

Vaccine discounts can be found here.