Hepatitis A Outbreak Accelerating Update #1

On April 16, 2019, NH DHHS issued a health alert regarding acceleration of a Hepatitis A outbreak.

KNH Division of Public Health Services Health Alert Networkey Points and Recommendations:

  1. The hepatitis A virus (HAV) outbreak in New Hampshire is worsening. There have been 79 new acute hepatitis A virus (HAV) infections diagnosed since the outbreak began in November 2018, with increasing numbers every month (historically, NH has 6-7 cases per year, or <1 case per month).
  2. Most people infected with hepatitis A in this outbreak have been hospitalized (63%), and one person has died. This individual had a co-infection with hepatitis C and died from fulminant liver failure after developing an acute HAV infection.
  3. Vaccinate the following groups as soon as possible because they are currently at highest risk for acquiring HAV infection or developing serious complications from HAV infection:
    • People who use drugs (injection or non-injection)
    • People experiencing homelessness
    • Gay and bisexual men (i.e., men who have sex with men)
    • People who are, or were recently, incarcerated
    • People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C
  4. All healthcare providers at all levels of patient care (including outpatient offices, emergency departments, urgent care facilities, inpatient wards, jails/prisons, etc.) should screen patients for and vaccinate those with these risk factors. Checking bloodwork for immunity (either from prior infection or prior vaccination) is not recommended as this will delay vaccination.
  5. The following individuals should also be vaccinated:
    • All children beginning at age 1 year should be vaccinated as part of the routine childhood immunization recommendations.
    • Any person wishing to obtain immunity can/should be vaccinated.
  6. Healthcare workers and first responders are not at increased risk for HAV infection, so do not prioritize them for vaccination as part of control of this outbreak. However, encourage anybody who wants to be protected to talk to their primary care providers or seek vaccination at a commercial pharmacy; vaccination is covered by insurance.
  7. Test all patients who inject drugs for HIV, hepatitis C, and hepatitis B infection.
  8. If you need assistance obtaining and administering vaccines, contact the New Hampshire Immunization Program within the NH Division of Public Health Services (DPHS) at (603) 271-4482. Community-based organizations that serve individuals at highest risk should reach out to their Regional Public Health Network representatives listed here to coordinate vaccination opportunities for clients: https://www.dhhs.nh.gov/dphs/rphn/documents/rphncontactlist.pdf.
  9. Report any suspect or confirmed case of hepatitis A promptly to the NH DPHS (within 24 hours) by calling 603-271-4496 (after hours 603-271-5300).
  10. Please also review the following information:
    • The attached CDC HAN (page 4)
    • Prior NH DHHS HAN (February 2019)
    NH DHHS Healthcare provider FAQs (February 2019)

    Full DHHS Alert