Florida is the latest state to declare a public health emergency due to a spike in confirmed cases of hepatitis A. The state surgeon general announced there have been more than 2,000 so far this year—vs 548 in 2018 entirely. State and local health officials are investigating the sources, and urging residents to get vaccinated against hep A. Incidence has jumped in other parts of the country, as well. According to the Centers for Disease Control and Prevention, Kentucky has had 4,793 cases since 2017; Ohio has reported 3,220 since last year, and in the same period West Virginia has confirmed 2,528 cases. With Mississippi also reporting an outbreak recently, nearly 30 states have had hep A activity—over 22,500 cases, all told, with 221 deaths. The CDC notes that intravenous drug users, men who have sex with men, and the homeless are at highest risk. As such, areas with high numbers of those groups are likeliest to see the most cases. The CDC has issued an advisory for patients, public health departments, healthcare facilities, and community centers concerned with increasing risk of hep A. Key instructions include the following steps:
- Screen patients for risk factors (eg, drug use, homelessness, incarceration, men who have sex with men, and chronic liver disease).
- Recommend and administer hepatitis A vaccine to at-risk patients, regardless of the original presenting complaint or the type of clinical facility. The CDC notes that “the emergency department may be an individual’s only interaction with the healthcare system and is an important opportunity for prevention,” but clearly the same holds true for urgent care.
- Record immunizations in the state immunization information system (registry).
- Consider hep A in anyone with jaundice or clinically compatible symptoms.
- Report all persons diagnosed with hepatitis A to the health department immediately to ensure timely case investigation and follow-up of contacts.