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Message from the Interim Health Officer for Los Angeles County
Jeffrey Gunzenhauser, MD, MPH


October 3, 2017

Hepatitis A

On September 19, 2017, the Los Angeles County Department of Public Health declared a local outbreak of hepatitis A occurring among persons who are homeless or actively use drugs. The declaration was based on the discovery of cases among individuals who appear to have acquired the infection within Los Angeles County. As of late September, Public Health has identified a total of 12 cases in Los Angeles County associated with this outbreak. Many of these cases had direct links with outbreaks in other counties. The most recent cases had no known links with other cases, suggesting that transmission may be occurring within our County.

The outbreak in Los Angeles County follows on the heels of much larger outbreaks that have been on-going in San Diego and Santa Cruz counties and are largely restricted to persons who are homeless or use drugs. Prior to the declaration of the outbreak in Los Angeles County, the Department of Public Health had been preparing for this possibility, given our proximity to San Diego and Santa Cruz counties. As cases have been identified, Public Health has worked with a variety of health care providers and community partners to conduct rapid investigations and ensure that all contacts receive appropriate treatment and follow-up. Now that a local outbreak has been declared, efforts to protect all persons who might be at-risk have become an even greater priority. Public Health is conducting active outreach to shelters, feeding centers, and other locations and working with a wide range of service providers to vaccinate persons who are homeless or use drugs, as well as other persons who might be at risk.

What is Hepatitis A and How is it Spread?

Hepatitis A is a highly contagious liver infection that is caused by a virus. Symptoms may include fever, fatigue, nausea, loss of appetite, stomach pain, vomiting, dark urine, pale stools, diarrhea, and yellowing of the skin or eyes (jaundice). Some people may not have any of these symptoms even though they are infected with hepatitis A. In some persons the illness can last for weeks or even months. Among individuals with pre-existing liver disease or other serious health problems, the illness can be severe, possibly leading to death.

Hepatitis A is spread from person-to-person through what is called the “fecal-oral” route. Persons who are infected excrete the virus in their stool. Other persons become infected by ingesting food or other material that has been contaminated with fecal material from an infected person. This is why hand-washing after using the bathroom or before eating food is so important. The ways in which hepatitis A is spread from one person to another include:

  • Not washing your hands after using the bathroom or changing diapers
  • Consuming food or drinks contaminated with the virus
  • Having sexual or other close contact with infected persons
  • Sharing needles, pipes or other items related to the use of drugs

Hepatitis A-infected individuals can spread the infection for two weeks before they exhibit symptoms. Once they have symptoms, they may spread the virus for another week. Some people will not have symptoms but can still pass the virus to someone else. Once someone fully recovers, they are immune and protected against ever getting the infection again.

Who is Most at Risk for Acquiring Hepatitis A?

Anyone can get infected with hepatitis A. However, in the current situation, those who are at-risk are limited to specific groups. These include persons who:

  • Are homeless
  • Use recreational drugs
  • Have close contact with someone who has hepatitis A
  • Have sexual contact with someone who has hepatitis A
  • Are men who have sex with men
  • Travel to or live in countries where hepatitis A is common
  • Have chronic hepatitis or blood-clotting disorders
  • Provide services that involve direct contact with persons who are homeless or use drugs
  • Are involved in the environmental clean-up of areas that may be contaminated with feces
  • Are food service workers who serve persons who are homeless

Hepatitis A Treatment

There is no specific treatment for hepatitis A infection. Most people will recover completely and, while they are ill, should rest, stay hydrated, eat nutritious foods, and be under the care of a doctor. However, those who become very ill may need to be hospitalized. Patients who are over 50 years of age, have underlying medical conditions or weakened immune systems are at greatest risk for severe illness. This is why it is very important to seek medical care if you experience the symptoms of hepatitis A.

Hepatitis A Prevention

The hepatitis A vaccine is the best way to prevent hepatitis A infection. This vaccine has been licensed for use in the United States since 1995. Most persons in Los Angeles County who were born in 1998 or later received the vaccine as children and are protected against this infection. The vaccine series consists of two shots, given six months apart. A single dose is highly effective in providing protection in adults, and there is no harm in getting the vaccine if you may have received it before.

Persons who are at-risk for infection as a result of the work they do can often receive the vaccine from their employer. Vaccine can also be obtained from a person’s primary care provider. Some pharmacies may also offer the vaccine. Persons who are at-risk for hepatitis A infection and who are not able to receive the vaccine from other sources, may get the vaccine at the Department of Public Health’s clinics. Extended hours are offered at some of these clinics. For more information on where to get the vaccine, call Los Angeles County’s 2-1-1 phone line.

Additional important steps to prevent hepatitis A infection include the following:

  • Wash hands with soap and water after using the bathroom, changing diapers, and before preparing, serving or eating food and drinks
  • Use your own towels, toothbrush and utensils
  • Avoid sharing food and drinks with others
  • Avoid sharing needles or pipes with others
  • Clean any areas that may be contaminated with feces. Specific infection prevention and control measures can be found here.

Additional Hepatitis A Resources

The Department of Public Health’s hepatitis A web page has extensive information for the public including health education materials in multiple languages. Information specific to clinicians, such as how to report suspect cases of hepatitis A, is available on the Department’s Acute Communicable Disease Control hepatitis A web page.



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