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  • Writer's pictureIslon Woolf MD

Hepatitis A outbreak in California - Don’t worry

There is currently an outbreak of hepatitis A in California with 600 documented cases and 19 deaths. This started in homeless shelters in San Diego and has spread to homeless shelters in Los Angeles over the last several months. However, due to vaccination, an understanding of transmission, modern methods of infection control, and governmental intervention it should be contained in the near future.

Hepatitis A, unlike hepatitis B and C, is transmitted through oral/fecal route. The virus is found in high concentrations in stool up to 2 weeks prior to symptoms and 1 week after symptoms. Spread occurs from shaking hands or ingesting food touched by someone with hepatitis A.

The disease is manifested by flu-like symptoms followed by jaundice (yellow eyes and Coca-cola urine). It does not lead to chronic hepatitis and is rarely fatal (<1%). Those most likely to experience a more severe course are those with a history of other liver disease - especially hepatitis C.

It is preventable with hand washing and sanitation, as well as a very effective vaccine. Since the addition of the hepatitis A vaccine to the childhood vaccine series (in 1996) the incidence of hepatitis A has declined by 95% in the US. (see map below)

map decline of hepatitis A

Image Source: Uptodate

As humans are the only reservoir of hepatitis A, complete eradication is possible. However, many other countries are endemic with Hepatitis A and outbreaks have occurred sporadically in the US from the importation of contaminated food. In 2003, there were 601 cases, and 3 fatalities in the US from green onions imported form Mexico. I wonder if a wall would be helpful?

Please call the office if you plan to travel to California in the near future. We can look up your immune status from old blood work (if we have it available) or we can check our records to see if you have been given the vaccine in our office. As mentioned, children are given the hepatitis A vaccine as part of their standard series (hopefully). Adults might have received the vaccine as part of travel vaccines. Those from countries with a high prevalence of disease (South or Central America) may have immunity from exposure to the virus. It's even possible that a prior episode of flu or gastroenteritis was actually Hepatitis A in disguise.

The vaccine consists of a series of 2 shots 6 months apart. If you are younger than 40 it will start to take effect within 2 weeks of the first shot. If you are older than 40 years old you must get the second shot to assure immunity. So if you are older than 40 and have to travel to a high risk area immediately, you can get the vaccine and a shot of immune globulin which gives immediate immunity. Immune globulin is only available at travel clinics.

However, I wouldn’t consider California as a ‘high risk’ area even with this current outbreak. Unless you plan on hanging out with Nick Nolte or the unvaccinated children of your affluent friends.


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