By Lindsay Bosslet
Public Health – Seattle & King County

You have probably heard about the hepatitis A outbreaks occurring around the country. These outbreaks primarily have affected people living homeless or unsheltered, or people who inject drugs. Although conditions that would facilitate a large hepatitis A outbreak exist locally, we have not had an outbreak among persons experiencing homelessness or who use injection drugs in King County, and we are taking steps to promote vaccination of people at risk for hepatitis A in area healthcare facilities and by our Public Health team.

Hepatitis A is often reported among international travelers and people with no readily identifiable risk factor. So far in 2018, 11 cases of hepatitis A have been reported to Public Health, four of which do not report activities that could put them at increased risk of disease, such as international travel or travel to areas where hepatitis A outbreaks are occurring, experiencing homelessness, injecting drugs or having close contact with anyone who has injected drugs during their exposure period, or men who have sex with men.

Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. Because these four people did not report high-risk activities, we suspect they acquired hepatitis A locally, through unrecognized or unreported contact with someone at high risk for hepatitis A, or through a contaminated food product.  Someone can spread hepatitis A beginning about two weeks before they develop symptoms to 7-10 days after jaundice develops.

People who have never been infected with hepatitis A virus or received the vaccine are potentially at risk of disease. So, if you want to avoid infection, we recommend the following steps:

1. Get vaccinated. The most effective way to protect yourself against hepatitis A infection is to get vaccinated. Hepatitis A vaccine has been part of the routine childhood vaccination schedule in the United States since 2006. Most adults were not vaccinated as children, so everyone should check with their doctor to find out whether they have received the vaccine, and if not, get vaccinated to prevent infection. You can also sign up to access you or your child’s vaccination records in the Washington State Immunization Registry. Vaccination is especially important fro international travelers, men who have sex with men, people who use injection drugs or are experiencing or at risk for homelessness, and people with chronic liver disease and with clotting factor disorders.
2. Practice good food safety. Foods can become contaminated at many points along the supply chain, so make sure you thoroughly rinse fresh fruits and vegetables before eating, cook seafood, poultry, and meat thoroughly, and avoid opportunities for cross contamination.
3. Wash your hands! It’s a public health blog, so we have to say it! Wash, wash, wash – with warm water and soap, for at least 20 seconds – after using the restroom or changing a diaper and
   before preparing food for yourself and others.
4. Look for symptoms. Fever, tiredness, loss of appetite, nausea and vomiting, abdominal pain, or clay-colored bowel movements are signs that you should see a healthcare provider. Most older children and adults with hepatitis A also will develop jaundice (yellowing of the skin and eyes). Symptoms develop 2–7 weeks after exposure and may be mild and subside in a few weeks, but sometimes hepatitis A infection results in severe illness that lasts several months.

More about hepatitis A vaccine
The hepatitis A vaccine is safe and effective; it is given as 2 shots, 6 months apart. Both shots are needed for long-term protection. The hepatitis A vaccine is inactivated (not “live”), so it can be given to people with compromised immune systems. The hepatitis A vaccine also comes in a combination form (given in 3 shots over 6 months), containing both hepatitis A and B vaccines. The combination vaccine can be given to anyone 18 years of age and older. Hepatitis A vaccine is recommended for:

• All children at age 1 year
• Travelers to countries where hepatitis A is common
• Family and caregivers of adoptees from countries where hepatitis A is common
• Men who have sexual encounters with other men
• Users of recreational drugs, whether injected or not
• People with chronic or long-term liver disease, including hepatitis B or hepatitis C
• People with clotting-factor disorders
• People with direct contact with others who have hepatitis A
• Any person wishing to obtain immunity (protection)

Visit our website for more detail. Search for local clinics and pharmacies that offer hepatitis A vaccine at HealthMap Vaccine Finder.

Originally posted on September 12, 2018.