Hepatitis A in Louisiana
The Louisiana Office of Public Health (OPH) is investigating an outbreak of hepatitis A virus (HAV) infections in Louisiana. This increase in cases mirrors the hepatitis A outbreaks occurring in other states, which are affecting certain risk groups:
- People reporting drug use (injection and non-injection),
- People experiencing homelessness,
- Men who have sex with men,
- Incarcerated or recently incarcerated individuals, and
- People who have been in close contact of someone infected with Hepatitis A.
While HAV infections usually resolve without treatment, illnesses and deaths in the current national outbreaks have been higher than usual due to older age and underlying health conditions, especially chronic liver disease, of people affected.
The public health response has included notifications to healthcare providers, offering vaccinations to people who are at high risk for HAV, and public education campaigns.
Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. It is a vaccine-preventable illness that is easily spread through close contact, as well as from sharing injection and non-injection drugs.
Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food or drinks contaminated by small, undetected amounts of stool (feces) from an infected person. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.
An infected person can transmit the virus to others up to two weeks before symptoms appear, and even those who do not experience symptoms can transmit the virus to others.
Symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain and jaundice (yellowing of the skin and eyes).
Most children younger than age 6 do not have symptoms when they have hepatitis A. If symptoms occur, they usually appear four weeks after exposure, but can occur as early as two weeks and as late as seven weeks after exposure.
Symptoms usually develop over a period of several days and last less than two months, although a small percentage of people (10-15 percent) can have symptoms for as long as six months.
Sometimes hepatitis A can cause liver failure and death, although this is rare and occurs more commonly in people older than 50 and people with other liver diseases.
The best way to prevent hepatitis A is through vaccination with the hepatitis A vaccine (see below for Advisory Committee on Immunization Practices (ACIP) recommendations). Unvaccinated people who have been exposed recently (within two weeks) to the hepatitis A virus should get the hepatitis A vaccine or a shot of immune globulin to prevent severe illness.
Practicing good hand hygiene – including thoroughly washing hands after using the bathroom, changing diapers, and before preparing or eating food – plays an important role in preventing the spread of hepatitis A.
Where can I get vaccinated? Click here for vaccinate locations in Louisiana.
The Advisory Committee on Immunization Practices (ACIP) recommends routine hepatitis A vaccination for the following people:
- 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)
Since 1999, when routine HAV immunization of children was recommended by the ACIP of the CDC, the number of yearly reported cases of hepatitis A fell dramatically from over 200 cases in 1999 to only eight cases reported in 2017 in Louisiana. Over the past ten years, an average of nine cases are reported each year (Figure 1).
As of January 24, 2020, Louisiana has 754 reported cases of HAV infection, 5 of which are not linked to the current outbreak. These are cumulative counts since January 1, 2018.
|Outbreak Cases||% Hospitalized||Deaths||Age Range||Median Age|
|749||57%||2||5-81 years||37 years|
Outbreak cases by week of onset are shown below (Figure 2). Please note, all data are preliminary and may change as more reports are received. Case counts shown for recent weeks may increase due to what is known as a reporting lag – the time between a patient’s onset, diagnosis, and reporting of laboratory results.
Outbreak cases by parish are shown below.
- Counseling Guide for Vaccine Hesitancy Among At Risk Adults during Hepatitis A Outbreak
- CDC Hepatitis A Questions and Answers for the Public
- LA OPH Hepatitis A 2017 Annual Infectious Disease Surveillance Report
- CDC Hepatitis A General Fact Sheet
- CDC Outbreaks of Hepatitis A in Multiple States Among People Who Use Drugs and/or People Who Are Homeless
- Protect Yourself From Hepatitis A
Health care providers should consider hepatitis A diagnosis in anyone with clinically compatible symptoms, including jaundice, and particularly in at-risk patients. Please report any suspect case of Hepatitis A within one business day to the Louisiana Office of Public Health Infectious Disease Epidemiology Hotline at 1-800-256-2748.
A single dose of hepatitis A vaccine in previously unvaccinated persons is 95% seroprotective and has been demonstrated to help curb outbreaks. Providers are encouraged to vaccinate individuals who are:
- men who have sex with men,
- reporting drug use,
- experiencing homelessness,
- incarcerated or recently incarcerated, or
- close contacts of identified cases.
- LA HAN: Widespread Outbreaks of Hepatitis A among People Who Use Drugs and People Experiencing Homelessness across the United States: Louisiana Update
- CDC Hepatitis A Questions and Answers for Health Professionals
- CDC Interim Outbreak-Specific Guidance on Hepatitis A Vaccine Administration
- ACIP Recommendations for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for international Travel 11.2.18