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Alert: Spike in acute hepatitis and what to do about it

The Tennessee Department of Health (TDH) has received reports of 9 cases of acute hepatitis A since January 1st: 8 of 9 are in middle Tennessee. Although a small number, this is higher than usual, and some cases have risk factors seen in large outbreaks currently going on in Kentucky (400 cases in 30 counties) and other states, including men who have sex with men and recreational drug users. The other common risk factor seen in other states is homelessness.  TDH anticipates additional cases in coming weeks and months, given the long (1 month) average period between exposure and illness.

Based upon the experience of Kentucky and other states, Tennessee is at risk of a significant hepatitis A outbreak in the coming months. Clinicians can take the following important steps now to protect high risk patients and mitigate the spread of illness:

  1. Hepatitis A vaccine is already recommended for adults at high risk of exposure or severe illness, but most adults who need vaccine have not received it. A single dose of the 2-dose series can provide protection for more than a decade.

Offer vaccine or refer your patients who need hepatitis A vaccine now that include:

  • Persons who use recreational drugs (injection or non-injection)
  • Men who have sex with men
  • Homeless persons
  • Persons with chronic liver disease, including chronic hepatitis B or C

TDH is able to make some vaccine available through local public health departments to adults with these risk factors: local supplies vary. International travelers going to countries where hepatitis A is endemic are also recommended to receive vaccine from their healthcare provider or travel clinic.

  1. Consider hepatitis A vaccine for any child through 18 years who has not had it. Tennessee began requiring this vaccine for kindergarten in 2011. It is routinely given at age 1, but the CDC advises it may be given to any older child through age 18 years who has not had it. Federal Vaccines for Children (VFC) Program vaccine may be used for any eligible child, including children without health insurance coverage and those on TennCare.
  2. Recognize and report cases to public health. Persons with the acute onset of symptoms of hepatitis (yellowing of eyes or skin, fever, nausea/vomiting, dark urine, pale stool, abdominal pain, fatigue and loss of appetite) should have a serologic test  for acute hepatitis A IgM. Do not test persons without signs of acute hepatitis: false positive IgM results can occur in persons without clinical illness, especially in the elderly. Acute hepatitis A is reportable to your local health department to initiate a time-sensitive contact investigation and provide post-exposure prophylaxis to at-risk contacts within 2 weeks of exposure.