Aug. 8, 2019
Health officials declare hepatitis A outbreak among people with high-risk factors
Cases in multiple counties among people with history of homelessness, drug use, incarceration
The Minnesota Department of Health (MDH) has declared an outbreak of hepatitis A in multiple counties among people who use street drugs (injection or non-injection), are experiencing homelessness or unstable housing, or have been recently incarcerated.
The outbreak includes 23 cases in nine counties: Pine (5), Hennepin (3), Kanabec (3), Mille Lacs (3), St. Louis (3), Washington (3), Chisago (1), Dakota (1) and Kandiyohi (1). Thirteen cases have been hospitalized and all have been discharged.
While initial cases were clustered in east-central Minnesota and had links to each other, more recent cases occurred in counties in other parts of the state. The infection source is not known for some cases, suggesting some community transmission among those in high-risk groups.
In May 2019, Minnesota began seeing an increase in hepatitis A cases. These cases had similar risk factors to national outbreaks of hepatitis A that have been occurring since 2016. Nationally, there have been more than 23,600 cases in 29 states. MDH has been monitoring the national outbreaks and conducting enhanced surveillance of hepatitis A since mid-2018 to help quickly identify cases.
“We have been working with our public health partners to respond to individual cases and prevent future cases,” said Kris Ehresmann, infectious disease director for MDH. “Declaring an outbreak is a significant step because it allows us to access additional resources to fight the outbreak.”
While anyone who is not vaccinated can get hepatitis A, people who are homeless or who use drugs are at higher risk, particularly if they don’t have access to sanitation, restroom facilities and handwashing stations. People who are currently or were recently incarcerated are also at higher risk.
Hepatitis A is a contagious liver infection caused by a virus. It can range from a mild infection with no symptoms lasting a few weeks to a severe illness lasting several months that can result in liver failure and death. Early diagnosis and medical care are key to preventing more serious health outcomes. Hepatitis A is usually spread person-to-person when someone unknowingly eats food, drinks a beverage or places an object in their mouth that has been contaminated with microscopic, trace amounts of stool from someone who has the virus.
The most effective way to prevent hepatitis A is vaccination. Vaccination is recommended for all children starting at 1 year, for travelers to certain countries and for people at high risk for infection. While hepatitis A vaccination has been recommended for children since 2006, many adults have not been vaccinated for hepatitis A.
Since the increase in hepatitis A cases in this risk group first surfaced, MDH has been working with partners who can help reach people who are at highest risk. The goal is to promote vaccination and in some cases provide vaccine directly so it is convenient and accessible. Partners include local public health departments, syringe exchange services, homeless shelters, jails and more.
MDH also has been notifying health care providers so they can be alert to test for hepatitis A if a patient has symptoms and so they can provide vaccine, if an opportunity occurs, to those at risk of infection.
More information about hepatitis A symptoms and prevention can be found on the MDH website.