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Hepatitis A cases on the rise

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The Tennessee Department of Health has identified an increase in Hepatitis A cases across the state, many of which are tied to a large multi-state outbreak that began in early 2017.

TDH is working with local health officials and other partners to respond to this outbreak.

Those considered at high risk for hepatitis A infection in this outbreak include people who abuse drugs, people experiencing homelessness and men who have sex with men. Notably, this outbreak has had a high hospitalization rate among those infected with hepatitis A.

Hepatitis A can be prevented by a safe and effective vaccine. People who believe they have been exposed to hepatitis A or are experiencing homelessness, use injection or non-injection drugs, are men who have sex with men or had contact with someone who has hepatitis A should contact a health care provider about hepatitis A vaccine.

To reduce the risk of hepatitis A transmission, people who have not received two doses of hepatitis A vaccine may ask their health care provider for protection. Additionally, always wash your hands with soap and water after going to the bathroom, after changing diapers and before preparing meals for yourself and others.

Hepatitis A is a contagious, vaccine-preventable liver infection that is spread in the feces of infected people. People most at risk for hepatitis A infection in this current outbreak include those experiencing homelessness, people who use drugs recreationally and close contacts of these groups. Men who have sex with men are also at risk. Individuals with hepatitis A infection can be contagious for two weeks before and one week after they show symptoms.

Most people become sick about a month after being infected. The illness can range from mild to serious illness and in some situations, result in death. Over the last five years, Tennessee has seen an average of 13 cases per year, often associated with travel to countries where hepatitis A is common.

Tennessee cases sharing the risk factors seen in the multi-state outbreak began to be detected at the end of December 2017. Transmission is presumed to occur person-to-person and through recreational (injection and non-injection) drug use.

According to the TDH, the Hepatitis A vaccine is extremely effective. The first dose of the two-dose series will protect most people for several years. The two-dose series is all that is needed for a lifetime; it does not require booster doses. Hepatitis A vaccine is routinely recommended for certain groups even in the absence of an outbreak including the following:

• All children at age 1 year

• Travelers to countries that have high rates of hepatitis A

• Family members and caregivers of recent adoptees from countries where hepatitis A is common

• Men who have sexual contact with other men

• People who use recreational drugs, whether injected or not

• People with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C

• People who are treated with clotting-factor concentrates

• People who work with hepatitis A infected animals or in a hepatitis A research laboratory

The TDH reported the Hepatitis A vaccine is covered by most insurance plans; people who wish to be vaccinated should check with their healthcare provider or pharmacist. Vaccine is also available through local public health departments, especially for adults at risk.

Individuals travelling to countries where hepatitis A is common are also recommended to receive vaccine from their health care provider or travel clinic.

Pediatric hepatitis A vaccine is recommended for all children and has been required for kindergarten entry in Tennessee since 2011. According to TDH, Hepatitis A vaccine should be considered for any child who has not been vaccinated.