Dear DWIGHT COLLMAN,
Health Care Provider Advisory
Reemphasis of Hepatitis A Vaccination Recommendations After Substantial Increase in Locally Acquired Infections in Florida and Outbreak Reports Across the Nation
November 14, 2017
Since January 2017, 217 cases of hepatitis A virus (HAV) infection were reported in Florida. This is significantly higher than the previous five-year average of 94 cases during the same timeframe. The increase in HAV cases is predominantly in the southeast Florida region (e.g. Broward and Miami-Dade Counties). Most of the cases do not have international travel exposures. Although infections have occurred across all demographic groups, approximately 69% of the recent cases are among males. The median age of cases is 38 years and the highest rates of disease are among persons 25-44 years. Many male cases have reported male sexual contact.
This year, health departments in Arizona, California, Colorado, Michigan, New York, and Utah, have investigated nearly 1200 outbreak associated cases of HAV infection among persons who are homeless, persons who use drugs, men who have sex with men, and their close direct contacts.
Hepatitis A is transmitted person-to-person through fecal-oral route, which may include some types of sexual contact, or poor hand hygiene after going to the bathroom or changing diapers. HAV can also be spread through food or water contaminated by fecal particles. While most patients with hepatitis A will fully recover, 60% of recent cases in Florida have required hospitalization.
The Advisory Committee on Immunization Practices recommends that the following persons be vaccinated against HAV:
- All children at age 1 year
- Persons who are at increased risk for infection
- Persons who are at increased risk for complications from hepatitis A
- Any person wishing to obtain immunity
The Department recommends that health care providers across the state offer 2-doses of HAV vaccine, 6-12 months apart, to the following persons at increased risk who have not been vaccinated:
- Men who have sex with men
- Users of injection and non-injection drugs
- Persons who have chronic liver disease
- Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A
- Persons who have clotting-factor disorders
- Household members and other close personal contacts of adopted children newly arriving from countries with high or intermediate hepatitis A endemicity
- Persons with direct contact with persons who have hepatitis A
Hepatitis A is a reportable disease and health care providers should immediately report all cases of hepatitis A to your county health department to ensure a prompt public health response to prevent disease among close contacts.
County health department contact information: www.floridahealth.gov/CHDEpiContact
Florida disease reporting information: www.floridahealth.gov/DiseaseReporting