- Department of Public Health
Since April 2018, 65 cases of acute hepatitis A virus (HAV) infection have been reported to the Massachusetts Department of Public Health (MDPH). These cases are all individuals who have recent experience of homelessness, unstable housing, and/or substance use disorder.
MDPH strongly encourages local health departments to work with clinical and community-based agencies providing services to people experiencing homelessness and those with substance use disorder, especially those injecting drugs, in their jurisdictions.
For outbreak control, MDPH is recommending education of at-risk individuals and that all members of these populations be offered a single dose of monovalent hepatitis A vaccine. Arranging for follow-up doses to complete the vaccine series may be conducted, but is not necessary to interrupt transmission. MDPH has an HAV fact sheet and poster available in multiple languages that can be used for education and outreach, and further materials are in development. Hepatitis A vaccine is available through MDPH to community partners for provision to members of the target populations.
We will be holding a call with local health departments on Wednesday, September 26, 10-11 AM to review this outbreak in more detail and to answer questions.
If you would like to discuss this outbreak with MDPH staff, please contact:
For questions about HAV cases, transmission, prevention, and HAV educational materials:
MDPH Epidemiology Staff (617) 983-6800
For calls about ordering HAV vaccine for target populations:
MDPH Vaccine Unit (617) 983-6828
For questions about use of contract resources or additional resource needs:
MDPH Office of HIV/AIDS, Linda Goldman (617) 624-5347
BACKGROUND:
MDPH and the Boston Public Health Commission released a clinical advisory regarding this situation in early August when it first became evident that there was ongoing transmission occurring in these populations: https://www.mass.gov/files/documents/2018/08/02/hepaadvisory08-02-18.pdf
An update was published several weeks later: https://www.mass.gov/clinical-advisory/ongoing-hepatitis-a-outbreak-among-persons-experiencing-homelessness-and.
Both of these advisories urged clinicians to be alert for signs and symptoms of acute HAV infection, recommended enhanced vaccination efforts targeting high-risk individuals, and reminded that effective sanitation plays an important role in preventing new cases.
The Centers for Disease Control and Prevention has been tracking multiple large outbreaks of HAV infection in other states in these populations since 2017, raising concern that the current outbreak in Massachusetts could continue (https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm).Reinforcing that concern, identification of cases of hepatitis A among at-risk persons has accelerated in recent weeks and it is clear that prevention efforts must be expanded and intensified. Administration of hepatitis A vaccine to at-risk persons is the cornerstone of these efforts.
Of the 65 HAV cases that have been reported to date, 45% have been located in the City of Boston. An increasing number of cases are being reported as residents of other cities and towns in other regions of the Commonwealth, including the Southeast and metro-Boston areas. Many of the cases have complex medical issues, including co-infection with confirmed hepatitis C virus (68%) and HIV (8%). There has been high morbidity reported with 93% of cases requiring hospitalization. There has been one death due to HAV infection during this time. The graph at the end of this document details the number of outbreak cases by week as of September 24, 2018.
