County of Erie

MARK POLONCARZ
County Executive
GALE R. BURSTEIN, MD, MPH, FAAP DEPARTMENT OF HEALTH
COMMISSIONER OF HEALTH

HEALTH ADVISORY # 348 October 2, 2018

INCREASE IN HEPATITIS A INFECTIONS IN ERIE COUNTY

Please distribute to All Clinical Staff, Internal Medicine, Pulmonary and Intensive Care Medicine,
Geriatrics, Primary Care, Infectious Diseases, Emergency Medicine, Family Medicine, Laboratory
Medicine, and Infection Control

SUMMARY

 The Erie County Department of Health (ECDOH) is investigating an increased number of

hepatitis A cases. Twenty-one hepatitis A cases have been reported to date in 2018 in Erie
County compared to an average of 3 cases in the previous 3 years.
 The ECDOH is asking providers to consider hepatitis A as a diagnosis in persons with jaundice
and clinically compatible symptoms.
 Health care providers are required to report suspect and confirmed hepatitis A cases to the local
health department where the patient resides. Suspected cases occurring in a food handler or an
individual associated with other sensitive settings (e.g. child care, certain health care settings)
should be reported immediately to the ECDOH Office of Epidemiology and Disease Surveillance
at (716) 858-7697.
 Post-exposure prophylaxis with either hepatitis A vaccine or Immunoglobulin (IG) should be
offered to all previously unvaccinated persons who are or have been in close contact with a
person who has hepatitis A infection, including household members, sex partners, and persons
who have shared injection or non-injection illicit drugs with an infected patient. The IG and
hepatitis A vaccine is shown to be effective if administered within 2 weeks after exposure.
 The best way to prevent hepatitis A infection is through vaccination with the hepatitis A vaccine.
The number and timing of the doses depends on the type of vaccine administered. Vaccines
containing hepatitis A antigen that are currently licensed in the United States are the single-
antigen vaccines HAVRIX® (manufactured by GlaxoSmithKline, Rixensart, Belgium) and
VAQTA® (manufactured by Merck & Co., Inc., Whitehouse Station, New Jersey) and the
combination vaccine TWINRIX® (containing both hepatitis A virus and hepatitis B virus
antigens; manufactured by GlaxoSmithKline). All are inactivated vaccines.
 For questions, please contact the ECDOH Office of Epidemiology and Disease Surveillance at
(716) 858-7697 between 8:00am and 4:00pm, Monday through Friday.

DISEASE BACKGROUND
Hepatitis A infection is a vaccine-preventable illness. In the United States, hepatitis A virus is primarily a
person-to-person fecal-oral transmission (i.e., ingestion of something that has been contaminated with the
feces of an infected person). Symptoms include fever, fatigue, loss of appetite, nausea, vomiting,
abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice. Although rare,
atypical extra hepatic manifestations include rash, pancreatitis, renal disease, arthritis, and anemia.
Severe infections can result in cholestatic hepatitis, relapsing hepatitis, and fulminant hepatitis leading to
death. The incubation of hepatitis A is 15 to 50 days after exposure with an average of 28 days. A
hepatitis A virus infected person can excrete virus in stool for two weeks prior to becoming symptomatic
and up to 7 days after symptoms appear making identifying exposures particularly difficult. Hepatitis A
virus illness is typically acute and self-limited; however, when this disease affects populations with
already poor health (e.g., hepatitis B and C infections, chronic liver disease), infection can lead to serious
outcomes.

RECOMMENDATIONS FOR HEALTH CARE PROVIDERS

 Consider hepatitis A as a diagnosis in anyone with jaundice and clinically compatible symptoms.
 Encourage persons who have been recently exposed to hepatitis A virus and who have not been
vaccinated to be administered one dose of single-antigen hepatitis A vaccine or immune globulin
(IG) as soon as possible, within 2 weeks after exposure.
 Ensure all persons diagnosed with hepatitis A are reported to the health department in a timely
manner.
 Encourage hepatitis A vaccination for homeless individuals.
 Encourage hepatitis A vaccination for persons who report drug use or other risk factors for
hepatitis A.
 CDC recommends the following groups be vaccinated against hepatitis A:
o All children at age 1 year
o Persons traveling to or working in countries that have high or intermediate endemicity of
hepatitis A;
o Men who have sex with men;
o Persons who use injection and non-injection drugs;
o Persons who have occupational risk for infection;
o Persons who have chronic liver disease;
o Persons who have clotting-factor disorders;
o Household members and other close personal contacts or adopted children newly arriving
from countries with high or intermediate hepatitis A endemicity;
o Persons with direct contact with persons who have hepatitis A;
o Persons who are at increased risk for complications from hepatitis A, including people
with chronic liver diseases, such as hepatitis B or hepatitis C;
o Any person wishing to obtain immunity.

ADDITIONAL INFORMATION

For questions or to report a case of hepatitis A, please contact the ECDOH Office of Epidemiology and
Disease Surveillance at (716) 858-7697 between 8:00am and 4:00pm, Monday through Friday.

General Hepatitis A Information:

https://www.cdc.gov/hepatitis/hav/index.htm

Hepatitis A Vaccine:
https://www.cdc.gov/hepatitis/hav/havfaq.htm#vaccine
Hepatitis A Prophylaxis:
https://www.cdc.gov/hepatitis/hav/havfaq.htm#protection

Health Category Definitions:

Health Alert FLASH: conveys the highest level of importance due to a large-scale, catastrophic public health
emergency; warrants immediate action or attention
Health Alert Priority: conveys the highest level of importance; warrants immediate action or attention to a health
problem or situation
Health Advisory: provides important information for a specific incident or situation; may not require immediate
action
Health Update: provides updated information regarding an incident or situation; no immediate action necessary
The Erie County Department of Health does not provide medical advice. The information provided on the Erie County Department of
Health website is not an attempt to practice medicine and is not intended as a substitute for professional medical advice, diagnosis,
or treatment. It is for informational purposes only. Always seek the advice of your personal physician or other qualified health
provider with any questions you may have regarding a medical condition or issue. Never disregard professional medical advice or
delay in seeking it because of the content found on the Erie County Department of Health website or this correspondence.

The ECDOH Health Alert & Advisory System is an e-mail notification system designed to alert community partners about important
health related information. You can sign up to receive alerts & advisories at http://www2.erie.gov/health/index.php?q=node/59.