Hepatitis A outbreak update

By Kate Cole, Public Health – Seattle & King County

In July 2019, Washington state declared a statewide hepatitis A outbreak among people living homeless.  Since the end of July, Public Health – Seattle & King County has confirmed 6 new cases in King County, bringing the total number of confirmed hepatitis A cases in King County to 24. Health officials will share any further updates to case counts weekly, at kingcounty.gov/HepA .

Many urban areas in the United States have been grappling with hepatitis A outbreaks, especially among people living homeless and people who use drugs (injection and non-injection).

Some states have seen hundreds or even thousands of cases, and a high proportion of these cases have resulted in severe infections. 

How officials are counting cases

Starting this week, in alignment with the Washington State Department of Health, Public Health – Seattle & King County has begun reporting the total number of confirmed hepatitis A cases in the County during 2019 as a single count, rather than separately reporting cases suspected to be linked to this outbreak. 

This change is necessary because it’s difficult to definitively determine whether a case is linked to the statewide outbreak as people may report multiple hepatitis

A risk factors or not always report all risk factors that are present. In addition, genetic testing of the virus strain (another method used to determine if cases are related to one another) can take up to two months, can be difficult to interpret, and is not done on every case. 

Prevention efforts

Given what investigators have witnessed across the country, Public Health – Seattle & King County been working hard to prevent a large-scale outbreak from taking hold in King County.

In this year alone, Public Health staff and Public Health Reserve Corps volunteers have completed over 190 free hepatitis A vaccination clinics for people living homeless. 

Additional vaccination clinics are scheduled for nearly every day through the end of November. This prevention push is in large part possible thanks to King County allocating $375,000 to expand the provision of hepatitis A vaccinations to people living homeless.

“Hepatitis A can be serious and is very contagious from person to person. Vaccination is the best way to protect yourself and prevent the spread of hepatitis A to others,” said Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County. “Providing free vaccines to people living homeless is both an issue of health equity and should help us limit future cases and costs should an outbreak occur by decreasing the number of susceptible people. Other communities have spent millions of dollars responding to large outbreaks and we want to avoid that.”

Public Health vaccination teams have worked in conjunction with the Hepatitis Education Project and other community organizations, shelter operators, and low-income housing providers as well as utilizing public health’s  Healthcare for the Homeless Network’s Mobile Medical Van to offer vaccines to people living in encampments, villages, and on the street. 

More residents at high risk of infection are getting vaccinated every day, but it’s not possible to know with certainty if these efforts will prevent King County from experiencing a large scale outbreak like those seen elsewhere.

Health officials do know that the more people who are vaccinated against hepatitis A, the better off the community will be. People who get infected with hepatitis A can spread the virus to others up to 2 weeks before symptoms appear, and most people don’t develop symptoms until about a month after becoming infected. As a result, it can take a long time to identify new cases and intervene to prevent further spread.

About hepatitis A

Hepatitis A virus infects the liver and can cause illness that range from a mild infection that has no symptoms to a more severe illness that can last for months. Hepatitis A virus spreads easily. It gets into the body through the mouth after someone touches an object, food, or drink that is contaminated with the virus. If an infected person doesn’t wash their hands well, especially after toileting, undetectable amounts of the virus can spread from the hands of that person to other objects, surfaces, and foods.

Symptoms of hepatitis A

Common symptoms include tiredness, nausea, vomiting, abdominal pain, loss of appetite, low-grade fever, clay-colored bowel movements and dark urine, joint pain and yellow discoloration of the whites of the eyes and skin (jaundice). Some people get infected with hepatitis A but do not experience all of these symptoms, or even have no symptoms.

People at highest risk for getting hepatitis A

• People living homeless, especially those living unsheltered without good access to sanitation, hygiene and handwashing facilities
• People who are living with or caring for a person who already has hepatitis A
• People who have sex with people with hepatitis A
• Men who have sex with men
• Illicit drug users (does not have to be injection drugs)
• People with clotting disorders like hemophilia
• International travelers
• People with chronic liver disease, including hepatitis B and hepatitis C are at increased risk for severe infections.

Preventing hepatitis A
Hepatitis A vaccination is the best way to prevent hepatitis A. The shot is safe and effective; anyone who wants to reduce their risk of hepatitis A should get vaccinated. Anyone who is in the higher risk groups should be sure to get the hepatitis A vaccine to protect themselves.

To get a hepatitis A vaccine, visit your doctor, nurse, or clinic. You can also check www.vaccinefinder.org for pharmacies that offer hepatitis A vaccine. For information about where to get free hepatitis A vaccine for people living homeless: www.kingcounty.gov/hch

Practicing good hand hygiene also plays an important role in preventing the spread of hepatitis A, including thoroughly washing hands after using the bathroom, changing diapers, and before preparing or eating food. People in high risk groups should also avoid sharing food, drinks, drug paraphernalia, and other personal items.

For more information on hepatitis A: www.kingcounty.gov/hepA